pbp_a_hnumber	pbp_a_plan_identifier	segment_id	pbp_a_ben_cov	pbp_a_plan_type	orgtype	bid_id	version	part_d_model_demo	part_d_enhncd_cvrg_demo	mrx_tier_label_list	mrx_tier_benefit_type	mrx_tier_drug_type	mrx_tier_includes	mrx_tier_cstshr_struct_type	mrx_tier_id	mrx_tier_type_id	mrx_tier_locat_rstd	mrx_tier_locat_rsplt	mrx_tier_locat_oon	mrx_tier_locat_mostd	mrx_tier_locat_mosplt	mrx_tier_locat_ltc	mrx_tier_rstd_1m_num	mrx_tier_rstd_2m_num	mrx_tier_rstd_3m_num	mrx_tier_rsplt_1m_num	mrx_tier_rsplt_2m_num	mrx_tier_rsplt_3m_num	mrx_tier_extd_days_yn	mrx_tier_extd_first_fill	mrx_tier_mostd_1m_num	mrx_tier_mostd_2m_num	mrx_tier_mostd_3m_num	mrx_tier_mosplt_1m_num	mrx_tier_mosplt_2m_num	mrx_tier_mosplt_3m_num	mrx_tier_oonp_1m_num	mrx_tier_oonp_othnumn	mrx_tier_ltcp_1m	mrx_tier_rstd_copay_1m	mrx_tier_rstd_copay_2m	mrx_tier_rstd_copay_3m	mrx_tier_rstd_coins_avg_1m	mrx_tier_rstd_coins_1m	mrx_tier_rstd_coins_2m	mrx_tier_rstd_coins_3m	mrx_tier_rsstd_copay_1m	mrx_tier_rsstd_copay_2m	mrx_tier_rsstd_copay_3m	mrx_tier_rsstd_coins_avg_1m	mrx_tier_rsstd_coins_1m	mrx_tier_rsstd_coins_2m	mrx_tier_rsstd_coins_3m	mrx_tier_rspfd_copay_1m	mrx_tier_rspfd_copay_2m	mrx_tier_rspfd_copay_3m	mrx_tier_rspfd_coins_avg_1m	mrx_tier_rspfd_coins_1m	mrx_tier_rspfd_coins_2m	mrx_tier_rspfd_coins_3m	mrx_tier_mostd_copay_1m	mrx_tier_mostd_copay_2m	mrx_tier_mostd_copay_3m	mrx_tier_mostd_coins_1m	mrx_tier_mostd_coins_2m	mrx_tier_mostd_coins_3m	mrx_tier_mosstd_copay_1m	mrx_tier_mosstd_copay_2m	mrx_tier_mosstd_copay_3m	mrx_tier_mosstd_coins_1m	mrx_tier_mosstd_coins_2m	mrx_tier_mosstd_coins_3m	mrx_tier_mospfd_copay_1m	mrx_tier_mospfd_copay_2m	mrx_tier_mospfd_copay_3m	mrx_tier_mospfd_coins_1m	mrx_tier_mospfd_coins_2m	mrx_tier_mospfd_coins_3m	mrx_tier_oonp_copay_1m	mrx_tier_oonp_copay_othnum	mrx_tier_oonp_coins_1m	mrx_tier_oonp_coins_othnum	mrx_tier_ltcp_copay_1m	mrx_tier_ltcp_coins_1m	mrx_tier_rstd_copay_daily	mrx_tier_rsstd_copay_daily	mrx_tier_rspfd_copay_daily	mrx_tier_mostd_copay_daily	mrx_tier_mosstd_copay_daily	mrx_tier_mospfd_copay_daily	mrx_tier_ltcp_copay_daily	mrx_tier_form_model_desc	mrx_tier_includes_mmp	mrx_tier_copay_amt_rstd_mmpmin	mrx_tier_copay_amt_rstd_mmpmax	mrx_tier_copay_amt_oon_mmpmin	mrx_tier_copay_amt_oon_mmpmax	mrx_tier_copay_amt_mstd_mmpmin	mrx_tier_copay_amt_mstd_mmpmax	mrx_tier_copay_amt_ltc_mmpmin	mrx_tier_copay_amt_ltc_mmpmax	mrx_tier_gap_cost_share	mrx_tier_gap_part_drugs	mrx_tier_gap_part_includes
H0022	001	0	1	48	05	H0022_001_0	3			Generic Drugs	4	01			1	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31																																																					Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	1	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H0022	001	0	1	48	05	H0022_001_0	3			Brand Drugs	4	10			2	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31																																																					Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	1	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H0022	001	0	1	48	05	H0022_001_0	3			Non-Medicare Rx/OTC Drugs	4	11			3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31																																																					Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	2	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H0028	014	0	1	01	01	H0028_014_0	3		Y	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	014	0	1	01	01	H0028_014_0	3		Y	Preferred Generic	4	11	3	2	1	3	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H0028	014	0	1	01	01	H0028_014_0	3		Y	Generic	4	11	3	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	0.00		0.00																									20.00		60.00				0.00		0.00				0.00				0.00		0				0.67	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	014	0	1	01	01	H0028_014_0	3		Y	Generic	4	11	3	2	2	3	110		01		110	1	30		90				2	2				30		90	30		31	0.00		0.00																									20.00		60.00				0.00		0.00				0.00				0.00		0				0.67	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H0028	014	0	1	01	01	H0028_014_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	014	0	1	01	01	H0028_014_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	99.00		297.00																									100.00		300.00				99.00		287.00				99.00				99.00		3.30				3.33	3.30	3.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	014	0	1	01	01	H0028_014_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	016	0	1	02	01	H0028_016_0	3		Y	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	6.00		18.00																									10.00		30.00				6.00		0.00				6.00				6.00		0.20				0.33	0.20	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	016	0	1	02	01	H0028_016_0	3		Y	Generic	4	11	3	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	11.00		33.00																									20.00		60.00				11.00		0.00				11.00				11.00		0.37				0.67	0.37	0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	016	0	1	02	01	H0028_016_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	016	0	1	02	01	H0028_016_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	99.00		297.00																									100.00		300.00				99.00		287.00				99.00				99.00		3.30				3.33	3.30	3.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	016	0	1	02	01	H0028_016_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					30																										30						30					30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	017	0	1	01	01	H0028_017_0	3		Y	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	6.00		18.00																									10.00		30.00				6.00		0.00				6.00				6.00		0.20				0.33	0.20	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	017	0	1	01	01	H0028_017_0	3		Y	Generic	4	11	3	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	11.00		33.00																									20.00		60.00				11.00		0.00				11.00				11.00		0.37				0.67	0.37	0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	017	0	1	01	01	H0028_017_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		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	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	99.00		297.00																									100.00		300.00				99.00		287.00				99.00				99.00		3.30				3.33	3.30	3.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	017	0	1	01	01	H0028_017_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	019	0	1	01	01	H0028_019_0	3		Y	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	019	0	1	01	01	H0028_019_0	3		Y	Preferred Generic	4	11	3	2	1	3	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H0028	019	0	1	01	01	H0028_019_0	3		Y	Generic	4	11	3	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	0.00		0.00																									20.00		60.00				0.00		0.00				0.00				0.00		0				0.67	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	019	0	1	01	01	H0028_019_0	3		Y	Generic	4	11	3	2	2	3	110		01		110	1	30		90				2	2				30		90	30		31	0.00		0.00																									20.00		60.00				0.00		0.00				0.00				0.00		0				0.67	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H0028	019	0	1	01	01	H0028_019_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	45.00		135.00																									47.00		141.00				45.00		90.00				45.00				45.00		1.50				1.57	1.50	1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	019	0	1	01	01	H0028_019_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		200.00				100.00				100.00		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	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	021	0	1	01	01	H0028_021_0	3		Y	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	2.00		6.00																									10.00		30.00				2.00		0.00				2.00				2.00		0.07				0.33	0.07	0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	021	0	1	01	01	H0028_021_0	3		Y	Generic	4	11	3	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	10.00		30.00																									20.00		60.00				10.00		0.00				10.00				10.00		0.33				0.67	0.33	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	021	0	1	01	01	H0028_021_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	42.00		126.00																									47.00		141.00				42.00		84.00				42.00				42.00		1.40				1.57	1.40	1.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	021	0	1	01	01	H0028_021_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	95.00		285.00																									100.00		300.00				95.00		190.00				95.00				95.00		3.17				3.33	3.17	3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	021	0	1	01	01	H0028_021_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	023	0	1	01	01	H0028_023_0	3		Y	Preferred Generic	4	11	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	4.00		12.00																									10.00		30.00				4.00		0.00				4.00				4.00		0.13				0.33	0.13	0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	023	0	1	01	01	H0028_023_0	3		Y	Generic	4	11	1	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	10.00		30.00																									20.00		60.00				10.00		0.00				10.00				10.00		0.33				0.67	0.33	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	023	0	1	01	01	H0028_023_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	45.00		135.00																									47.00		141.00				45.00		90.00				45.00				45.00		1.50				1.57	1.50	1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	023	0	1	01	01	H0028_023_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		200.00				100.00				100.00		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	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					29																										29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	024	0	1	01	01	H0028_024_0	3		Y	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	024	0	1	01	01	H0028_024_0	3		Y	Preferred Generic	4	11	3	2	1	3	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H0028	024	0	1	01	01	H0028_024_0	3		Y	Generic	4	11	3	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	5.00		15.00																									20.00		60.00				5.00		0.00				5.00				5.00		0.17				0.67	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	024	0	1	01	01	H0028_024_0	3		Y	Generic	4	11	3	2	2	3	110		01		110	1	30		90				2	2				30		90	30		31	5.00		15.00																									20.00		60.00				5.00		0.00				5.00				5.00		0.17				0.67	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H0028	024	0	1	01	01	H0028_024_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	45.00		135.00																									47.00		141.00				45.00		90.00				45.00				45.00		1.50				1.57	1.50	1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	024	0	1	01	01	H0028_024_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		200.00				100.00				100.00		3.33				3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	024	0	1	01	01	H0028_024_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	025	1	1	01	01	H0028_025_1	3		Y	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	025	1	1	01	01	H0028_025_1	3		Y	Preferred Generic	4	11	3	2	1	3	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H0028	025	1	1	01	01	H0028_025_1	3		Y	Generic	4	11	3	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	5.00		15.00																									20.00		60.00				5.00		0.00				5.00				5.00		0.17				0.67	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	025	1	1	01	01	H0028_025_1	3		Y	Generic	4	11	3	2	2	3	110		01		110	1	30		90				2	2				30		90	30		31	5.00		15.00																									20.00		60.00				5.00		0.00				5.00				5.00		0.17				0.67	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H0028	025	1	1	01	01	H0028_025_1	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	45.00		135.00																									47.00		141.00				45.00		90.00				45.00				45.00		1.50				1.57	1.50	1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	025	1	1	01	01	H0028_025_1	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	95.00		285.00																									100.00		300.00				95.00		190.00				95.00				95.00		3.17				3.33	3.17	3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	025	1	1	01	01	H0028_025_1	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	025	2	1	01	01	H0028_025_2	3		Y	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	025	2	1	01	01	H0028_025_2	3		Y	Preferred Generic	4	11	3	2	1	3	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H0028	025	2	1	01	01	H0028_025_2	3		Y	Generic	4	11	3	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	5.00		15.00																									20.00		60.00				5.00		0.00				5.00				5.00		0.17				0.67	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	025	2	1	01	01	H0028_025_2	3		Y	Generic	4	11	3	2	2	3	110		01		110	1	30		90				2	2				30		90	30		31	5.00		15.00																									20.00		60.00				5.00		0.00				5.00				5.00		0.17				0.67	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H0028	025	2	1	01	01	H0028_025_2	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	45.00		135.00																									47.00		141.00				45.00		90.00				45.00				45.00		1.50				1.57	1.50	1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	025	2	1	01	01	H0028_025_2	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	95.00		285.00																									100.00		300.00				95.00		190.00				95.00				95.00		3.17				3.33	3.17	3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	025	2	1	01	01	H0028_025_2	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	027	0	1	01	01	H0028_027_0	3		Y	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	2.00		6.00																									10.00		30.00				2.00		0.00				2.00				2.00		0.07				0.33	0.07	0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	027	0	1	01	01	H0028_027_0	3		Y	Generic	4	11	3	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	5.00		15.00																									20.00		60.00				5.00		0.00				5.00				5.00		0.17				0.67	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	027	0	1	01	01	H0028_027_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	45.00		135.00																									47.00		141.00				45.00		90.00				45.00				45.00		1.50				1.57	1.50	1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	027	0	1	01	01	H0028_027_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		200.00				100.00				100.00		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	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	028	0	1	01	01	H0028_028_0	3		Y	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	5.00		15.00																									10.00		30.00				5.00		0.00				5.00				5.00		0.17				0.33	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	028	0	1	01	01	H0028_028_0	3		Y	Generic	4	11	3	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	15.00		45.00																									20.00		60.00				15.00		0.00				15.00				15.00		0.50				0.67	0.50	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	028	0	1	01	01	H0028_028_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	45.00		135.00																									47.00		141.00				45.00		90.00				45.00				45.00		1.50				1.57	1.50	1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	028	0	1	01	01	H0028_028_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		200.00				100.00				100.00		3.33				3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	028	0	1	01	01	H0028_028_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					29																										29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	029	0	1	01	01	H0028_029_0	3		Y	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	029	0	1	01	01	H0028_029_0	3		Y	Preferred Generic	4	11	3	2	1	3	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H0028	029	0	1	01	01	H0028_029_0	3		Y	Generic	4	11	3	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	0.00		0.00																									20.00		60.00				0.00		0.00				0.00				0.00		0				0.67	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	029	0	1	01	01	H0028_029_0	3		Y	Generic	4	11	3	2	2	3	110		01		110	1	30		90				2	2				30		90	30		31	0.00		0.00																									20.00		60.00				0.00		0.00				0.00				0.00		0				0.67	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H0028	029	0	1	01	01	H0028_029_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	45.00		135.00																									47.00		141.00				45.00		125.00				45.00				45.00		1.50				1.57	1.50	1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	029	0	1	01	01	H0028_029_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	99.00		297.00																									100.00		300.00				99.00		287.00				99.00				99.00		3.30				3.33	3.30	3.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	029	0	1	01	01	H0028_029_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	030	0	1	01	01	H0028_030_0	3		Y	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	030	0	1	01	01	H0028_030_0	3		Y	Preferred Generic	4	11	3	2	1	3	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H0028	030	0	1	01	01	H0028_030_0	3		Y	Generic	4	11	3	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	0.00		0.00																									20.00		60.00				0.00		0.00				0.00				0.00		0				0.67	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	030	0	1	01	01	H0028_030_0	3		Y	Generic	4	11	3	2	2	3	110		01		110	1	30		90				2	2				30		90	30		31	0.00		0.00																									20.00		60.00				0.00		0.00				0.00				0.00		0				0.67	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H0028	030	0	1	01	01	H0028_030_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	42.00		126.00																									47.00		141.00				42.00		116.00				42.00				42.00		1.40				1.57	1.40	1.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	030	0	1	01	01	H0028_030_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	99.00		297.00																									100.00		300.00				99.00		287.00				99.00				99.00		3.30				3.33	3.30	3.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	030	0	1	01	01	H0028_030_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	035	0	1	01	01	H0028_035_0	3		Y	Preferred Generic	4	11	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	035	0	1	01	01	H0028_035_0	3		Y	Generic	4	11	1	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	0.00		0.00																									20.00		60.00				0.00		0.00				0.00				0.00		0				0.67	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	035	0	1	01	01	H0028_035_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	45.00		135.00																									47.00		141.00				45.00		90.00				45.00				45.00		1.50				1.57	1.50	1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	035	0	1	01	01	H0028_035_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	99.00		297.00																									100.00		300.00				99.00		198.00				99.00				99.00		3.30				3.33	3.30	3.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	035	0	1	01	01	H0028_035_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	036	0	1	01	01	H0028_036_0	3		N	Preferred Generic	4	11	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	5.00		15.00																									10.00		30.00				5.00		0.00				5.00				5.00		0.17				0.33	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	036	0	1	01	01	H0028_036_0	3		N	Generic	4	11	1	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	13.00		39.00																									20.00		60.00				13.00		0.00				13.00				13.00		0.43				0.67	0.43	0.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	036	0	1	01	01	H0028_036_0	3		N	Preferred Brand	4	11	1	1	3	1	110		01		110	1	30		90				2	2				30		90	30		31				46.00	20		20																								20		20				20		20			20			20								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	036	0	1	01	01	H0028_036_0	3		N	Non-Preferred Drug	4	11	1	1	4	1	110		01		110	1	30		90				2	2				30		90	30		31				69.00	25		25																								25		25				25		25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	036	0	1	01	01	H0028_036_0	3		N	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	037	0	1	01	01	H0028_037_0	3		Y	Preferred Generic	4	11	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	037	0	1	01	01	H0028_037_0	3		Y	Preferred Generic	4	11	1	2	1	3	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H0028	037	0	1	01	01	H0028_037_0	3		Y	Generic	4	11	1	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	0.00		0.00																									20.00		60.00				0.00		0.00				0.00				0.00		0				0.67	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	037	0	1	01	01	H0028_037_0	3		Y	Generic	4	11	1	2	2	3	110		01		110	1	30		90				2	2				30		90	30		31	0.00		0.00																									20.00		60.00				0.00		0.00				0.00				0.00		0				0.67	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H0028	037	0	1	01	01	H0028_037_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		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	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	99.00		297.00																									100.00		300.00				99.00		287.00				99.00				99.00		3.30				3.33	3.30	3.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	037	0	1	01	01	H0028_037_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	039	0	1	01	01	H0028_039_0	4		Y	Preferred Generic	4	11	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	039	0	1	01	01	H0028_039_0	4		Y	Preferred Generic	4	11	1	2	1	3	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H0028	039	0	1	01	01	H0028_039_0	4		Y	Generic	4	11	1	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	0.00		0.00																									20.00		60.00				0.00		0.00				0.00				0.00		0				0.67	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	039	0	1	01	01	H0028_039_0	4		Y	Generic	4	11	1	2	2	3	110		01		110	1	30		90				2	2				30		90	30		31	0.00		0.00																									20.00		60.00				0.00		0.00				0.00				0.00		0				0.67	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H0028	039	0	1	01	01	H0028_039_0	4		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	45.00		135.00																									47.00		141.00				45.00		90.00				45.00				45.00		1.50				1.57	1.50	1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	039	0	1	01	01	H0028_039_0	4		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	99.00		297.00																									100.00		300.00				99.00		198.00				99.00				99.00		3.30				3.33	3.30	3.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	039	0	1	01	01	H0028_039_0	4		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	041	0	1	01	01	H0028_041_0	3		Y	Preferred Generic	4	11	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	041	0	1	01	01	H0028_041_0	3		Y	Preferred Generic	4	11	1	2	1	3	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H0028	041	0	1	01	01	H0028_041_0	3		Y	Generic	4	11	1	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	5.00		15.00																									20.00		60.00				5.00		0.00				5.00				5.00		0.17				0.67	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	041	0	1	01	01	H0028_041_0	3		Y	Generic	4	11	1	2	2	3	110		01		110	1	30		90				2	2				30		90	30		31	5.00		15.00																									20.00		60.00				5.00		0.00				5.00				5.00		0.17				0.67	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H0028	041	0	1	01	01	H0028_041_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	45.00		135.00																									47.00		141.00				45.00		90.00				45.00				45.00		1.50				1.57	1.50	1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	041	0	1	01	01	H0028_041_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	99.00		297.00																									100.00		300.00				99.00		198.00				99.00				99.00		3.30				3.33	3.30	3.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	041	0	1	01	01	H0028_041_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	042	0	1	01	01	H0028_042_0	4		Y	Preferred Generic	4	11	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	042	0	1	01	01	H0028_042_0	4		Y	Preferred Generic	4	11	1	2	1	3	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H0028	042	0	1	01	01	H0028_042_0	4		Y	Generic	4	11	1	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	0.00		0.00																									20.00		60.00				0.00		0.00				0.00				0.00		0				0.67	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	042	0	1	01	01	H0028_042_0	4		Y	Generic	4	11	1	2	2	3	110		01		110	1	30		90				2	2				30		90	30		31	0.00		0.00																									20.00		60.00				0.00		0.00				0.00				0.00		0				0.67	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H0028	042	0	1	01	01	H0028_042_0	4		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	042	0	1	01	01	H0028_042_0	4		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		290.00				100.00				100.00		3.33				3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	042	0	1	01	01	H0028_042_0	4		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					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		Y	Preferred Generic	4	11	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	043	1	1	01	01	H0028_043_1	4		Y	Preferred Generic	4	11	1	2	1	3	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H0028	043	1	1	01	01	H0028_043_1	4		Y	Generic	4	11	1	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	0.00		0.00																									20.00		60.00				0.00		0.00				0.00				0.00		0				0.67	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	043	1	1	01	01	H0028_043_1	4		Y	Generic	4	11	1	2	2	3	110		01		110	1	30		90				2	2				30		90	30		31	0.00		0.00																									20.00		60.00				0.00		0.00				0.00				0.00		0				0.67	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H0028	043	1	1	01	01	H0028_043_1	4		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	45.00		135.00																									47.00		141.00				45.00		90.00				45.00				45.00		1.50				1.57	1.50	1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	043	1	1	01	01	H0028_043_1	4		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	99.00		297.00																									100.00		300.00				99.00		198.00				99.00				99.00		3.30				3.33	3.30	3.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	043	1	1	01	01	H0028_043_1	4		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	043	2	1	01	01	H0028_043_2	4		Y	Preferred Generic	4	11	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	043	2	1	01	01	H0028_043_2	4		Y	Preferred Generic	4	11	1	2	1	3	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H0028	043	2	1	01	01	H0028_043_2	4		Y	Generic	4	11	1	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	0.00		0.00																									20.00		60.00				0.00		0.00				0.00				0.00		0				0.67	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	043	2	1	01	01	H0028_043_2	4		Y	Generic	4	11	1	2	2	3	110		01		110	1	30		90				2	2				30		90	30		31	0.00		0.00																									20.00		60.00				0.00		0.00				0.00				0.00		0				0.67	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H0028	043	2	1	01	01	H0028_043_2	4		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	45.00		135.00																									47.00		141.00				45.00		90.00				45.00				45.00		1.50				1.57	1.50	1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	043	2	1	01	01	H0028_043_2	4		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	99.00		297.00																									100.00		300.00				99.00		198.00				99.00				99.00		3.30				3.33	3.30	3.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	043	2	1	01	01	H0028_043_2	4		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	046	0	1	01	01	H0028_046_0	4		Y	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	046	0	1	01	01	H0028_046_0	4		Y	Preferred Generic	4	11	3	2	1	3	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H0028	046	0	1	01	01	H0028_046_0	4		Y	Generic	4	11	3	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	0.00		0.00																									20.00		60.00				0.00		0.00				0.00				0.00		0				0.67	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	046	0	1	01	01	H0028_046_0	4		Y	Generic	4	11	3	2	2	3	110		01		110	1	30		90				2	2				30		90	30		31	0.00		0.00																									20.00		60.00				0.00		0.00				0.00				0.00		0				0.67	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H0028	046	0	1	01	01	H0028_046_0	4		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	046	0	1	01	01	H0028_046_0	4		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		290.00				100.00				100.00		3.33				3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	046	0	1	01	01	H0028_046_0	4		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	047	0	1	01	01	H0028_047_0	3		Y	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	5.00		15.00																									10.00		30.00				5.00		0.00				5.00				5.00		0.17				0.33	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	047	0	1	01	01	H0028_047_0	3		Y	Generic	4	11	3	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	10.00		30.00																									20.00		60.00				10.00		0.00				10.00				10.00		0.33				0.67	0.33	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	047	0	1	01	01	H0028_047_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	45.00		135.00																									47.00		141.00				45.00		90.00				45.00				45.00		1.50				1.57	1.50	1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	047	0	1	01	01	H0028_047_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		200.00				100.00				100.00		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	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	048	1	1	01	01	H0028_048_1	3		Y	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		100				1	2				30		100	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	048	1	1	01	01	H0028_048_1	3		Y	Preferred Generic	4	11	3	2	1	3	110		01		110	1	30		100				1	2				30		100	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H0028	048	1	1	01	01	H0028_048_1	3		Y	Generic	4	11	3	2	2	1	110		01		110	1	30		100				2	2				30		100	30		31	0.00		0.00																									20.00		60.00				0.00		0.00				0.00				0.00		0				0.67	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	048	1	1	01	01	H0028_048_1	3		Y	Generic	4	11	3	2	2	3	110		01		110	1	30		100				2	2				30		100	30		31	0.00		0.00																									20.00		60.00				0.00		0.00				0.00				0.00		0				0.67	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H0028	048	1	1	01	01	H0028_048_1	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		100				2	2				30		100	30		31	47.00		141.00																									47.00		141.00				47.00		94.00				47.00				47.00		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	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		100				2	2				30		100	30		31	100.00		300.00																									100.00		300.00				100.00		200.00				100.00				100.00		3.33				3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	048	1	1	01	01	H0028_048_1	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	048	2	1	01	01	H0028_048_2	3		Y	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		100				1	2				30		100	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	048	2	1	01	01	H0028_048_2	3		Y	Preferred Generic	4	11	3	2	1	3	110		01		110	1	30		100				1	2				30		100	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H0028	048	2	1	01	01	H0028_048_2	3		Y	Generic	4	11	3	2	2	1	110		01		110	1	30		100				2	2				30		100	30		31	0.00		0.00																									20.00		60.00				0.00		0.00				0.00				0.00		0				0.67	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	048	2	1	01	01	H0028_048_2	3		Y	Generic	4	11	3	2	2	3	110		01		110	1	30		100				2	2				30		100	30		31	0.00		0.00																									20.00		60.00				0.00		0.00				0.00				0.00		0				0.67	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H0028	048	2	1	01	01	H0028_048_2	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		100				2	2				30		100	30		31	47.00		141.00																									47.00		141.00				47.00		94.00				47.00				47.00		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	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		100				2	2				30		100	30		31	100.00		300.00																									100.00		300.00				100.00		200.00				100.00				100.00		3.33				3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	048	2	1	01	01	H0028_048_2	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	050	0	1	01	01	H0028_050_0	4		Y	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0028	050	0	1	01	01	H0028_050_0	4		Y	Preferred Generic	4	11	3	2	1	3	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		3
H0028	050	0	1	01	01	H0028_050_0	4		Y	Generic	4	11	3	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	0.00		0.00																									20.00		60.00				0.00		0.00				0.00				0.00		0				0.67	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0028	050	0	1	01	01	H0028_050_0	4		Y	Generic	4	11	3	2	2	3	110		01		110	1	30		90				2	2				30		90	30		31	0.00		0.00																									20.00		60.00				0.00		0.00				0.00				0.00		0				0.67	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		3
H0028	050	0	1	01	01	H0028_050_0	4		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				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												
H0028	050	0	1	01	01	H0028_050_0	4		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	99.00		297.00																									100.00		300.00				99.00		287.00				99.00				99.00		3.30				3.33	3.30	3.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0028	050	0	1	01	01	H0028_050_0	4		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0028	050	0	1	01	01	H0028_050_0	4		Y	Select Care Drugs	4	11	1	2	6	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0				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	4		Y	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0028	051	0	1	01	01	H0028_051_0	4		Y	Preferred Generic	4	11	3	2	1	3	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		3
H0028	051	0	1	01	01	H0028_051_0	4		Y	Generic	4	11	3	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	0.00		0.00																									20.00		60.00				0.00		0.00				0.00				0.00		0				0.67	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0028	051	0	1	01	01	H0028_051_0	4		Y	Generic	4	11	3	2	2	3	110		01		110	1	30		90				2	2				30		90	30		31	0.00		0.00																									20.00		60.00				0.00		0.00				0.00				0.00		0				0.67	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		3
H0028	051	0	1	01	01	H0028_051_0	4		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				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												
H0028	051	0	1	01	01	H0028_051_0	4		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	99.00		297.00																									100.00		300.00				99.00		287.00				99.00				99.00		3.30				3.33	3.30	3.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0028	051	0	1	01	01	H0028_051_0	4		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0028	051	0	1	01	01	H0028_051_0	4		Y	Select Care Drugs	4	11	1	2	6	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0				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	3		Y	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	052	0	1	01	01	H0028_052_0	3		Y	Preferred Generic	4	11	3	2	1	3	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H0028	052	0	1	01	01	H0028_052_0	3		Y	Generic	4	11	3	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	5.00		15.00																									20.00		60.00				5.00		0.00				5.00				5.00		0.17				0.67	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	052	0	1	01	01	H0028_052_0	3		Y	Generic	4	11	3	2	2	3	110		01		110	1	30		90				2	2				30		90	30		31	5.00		15.00																									20.00		60.00				5.00		0.00				5.00				5.00		0.17				0.67	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H0028	052	0	1	01	01	H0028_052_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	45.00		135.00																									47.00		141.00				45.00		90.00				45.00				45.00		1.50				1.57	1.50	1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	052	0	1	01	01	H0028_052_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		200.00				100.00				100.00		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	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	053	1	1	01	01	H0028_053_1	3		Y	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	053	1	1	01	01	H0028_053_1	3		Y	Preferred Generic	4	11	3	2	1	3	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H0028	053	1	1	01	01	H0028_053_1	3		Y	Generic	4	11	3	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	0.00		0.00																									20.00		60.00				0.00		0.00				0.00				0.00		0				0.67	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	053	1	1	01	01	H0028_053_1	3		Y	Generic	4	11	3	2	2	3	110		01		110	1	30		90				2	2				30		90	30		31	0.00		0.00																									20.00		60.00				0.00		0.00				0.00				0.00		0				0.67	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H0028	053	1	1	01	01	H0028_053_1	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		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	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		290.00				100.00				100.00		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	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	053	2	1	01	01	H0028_053_2	3		Y	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	053	2	1	01	01	H0028_053_2	3		Y	Preferred Generic	4	11	3	2	1	3	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H0028	053	2	1	01	01	H0028_053_2	3		Y	Generic	4	11	3	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	0.00		0.00																									20.00		60.00				0.00		0.00				0.00				0.00		0				0.67	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	053	2	1	01	01	H0028_053_2	3		Y	Generic	4	11	3	2	2	3	110		01		110	1	30		90				2	2				30		90	30		31	0.00		0.00																									20.00		60.00				0.00		0.00				0.00				0.00		0				0.67	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H0028	053	2	1	01	01	H0028_053_2	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		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	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		290.00				100.00				100.00		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	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	053	3	1	01	01	H0028_053_3	3		Y	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	053	3	1	01	01	H0028_053_3	3		Y	Preferred Generic	4	11	3	2	1	3	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H0028	053	3	1	01	01	H0028_053_3	3		Y	Generic	4	11	3	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	0.00		0.00																									20.00		60.00				0.00		0.00				0.00				0.00		0				0.67	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	053	3	1	01	01	H0028_053_3	3		Y	Generic	4	11	3	2	2	3	110		01		110	1	30		90				2	2				30		90	30		31	0.00		0.00																									20.00		60.00				0.00		0.00				0.00				0.00		0				0.67	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H0028	053	3	1	01	01	H0028_053_3	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		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	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		290.00				100.00				100.00		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	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	053	4	1	01	01	H0028_053_4	3		Y	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	053	4	1	01	01	H0028_053_4	3		Y	Preferred Generic	4	11	3	2	1	3	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H0028	053	4	1	01	01	H0028_053_4	3		Y	Generic	4	11	3	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	0.00		0.00																									20.00		60.00				0.00		0.00				0.00				0.00		0				0.67	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	053	4	1	01	01	H0028_053_4	3		Y	Generic	4	11	3	2	2	3	110		01		110	1	30		90				2	2				30		90	30		31	0.00		0.00																									20.00		60.00				0.00		0.00				0.00				0.00		0				0.67	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H0028	053	4	1	01	01	H0028_053_4	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		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	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		290.00				100.00				100.00		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	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	054	1	1	02	01	H0028_054_1	3		Y	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	054	1	1	02	01	H0028_054_1	3		Y	Preferred Generic	4	11	3	2	1	3	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H0028	054	1	1	02	01	H0028_054_1	3		Y	Generic	4	11	3	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	0.00		0.00																									20.00		60.00				0.00		0.00				0.00				0.00		0				0.67	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	054	1	1	02	01	H0028_054_1	3		Y	Generic	4	11	3	2	2	3	110		01		110	1	30		90				2	2				30		90	30		31	0.00		0.00																									20.00		60.00				0.00		0.00				0.00				0.00		0				0.67	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H0028	054	1	1	02	01	H0028_054_1	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	054	1	1	02	01	H0028_054_1	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	99.00		297.00																									100.00		300.00				99.00		287.00				99.00				99.00		3.30				3.33	3.30	3.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	054	1	1	02	01	H0028_054_1	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	054	2	1	02	01	H0028_054_2	3		Y	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	054	2	1	02	01	H0028_054_2	3		Y	Preferred Generic	4	11	3	2	1	3	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H0028	054	2	1	02	01	H0028_054_2	3		Y	Generic	4	11	3	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	0.00		0.00																									20.00		60.00				0.00		0.00				0.00				0.00		0				0.67	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	054	2	1	02	01	H0028_054_2	3		Y	Generic	4	11	3	2	2	3	110		01		110	1	30		90				2	2				30		90	30		31	0.00		0.00																									20.00		60.00				0.00		0.00				0.00				0.00		0				0.67	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H0028	054	2	1	02	01	H0028_054_2	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	054	2	1	02	01	H0028_054_2	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	99.00		297.00																									100.00		300.00				99.00		287.00				99.00				99.00		3.30				3.33	3.30	3.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	054	2	1	02	01	H0028_054_2	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	055	0	1	02	01	H0028_055_0	4		Y	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0028	055	0	1	02	01	H0028_055_0	4		Y	Preferred Generic	4	11	3	2	1	3	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		3
H0028	055	0	1	02	01	H0028_055_0	4		Y	Generic	4	11	3	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	0.00		0.00																									20.00		60.00				0.00		0.00				0.00				0.00		0				0.67	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0028	055	0	1	02	01	H0028_055_0	4		Y	Generic	4	11	3	2	2	3	110		01		110	1	30		90				2	2				30		90	30		31	0.00		0.00																									20.00		60.00				0.00		0.00				0.00				0.00		0				0.67	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		3
H0028	055	0	1	02	01	H0028_055_0	4		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				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												
H0028	055	0	1	02	01	H0028_055_0	4		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	99.00		297.00																									100.00		300.00				99.00		287.00				99.00				99.00		3.30				3.33	3.30	3.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0028	055	0	1	02	01	H0028_055_0	4		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0028	055	0	1	02	01	H0028_055_0	4		Y	Select Care Drugs	4	11	1	2	6	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0				0	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0028	056	0	1	02	01	H0028_056_0	4		Y	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0028	056	0	1	02	01	H0028_056_0	4		Y	Preferred Generic	4	11	3	2	1	3	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		3
H0028	056	0	1	02	01	H0028_056_0	4		Y	Generic	4	11	3	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	0.00		0.00																									20.00		60.00				0.00		0.00				0.00				0.00		0				0.67	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0028	056	0	1	02	01	H0028_056_0	4		Y	Generic	4	11	3	2	2	3	110		01		110	1	30		90				2	2				30		90	30		31	0.00		0.00																									20.00		60.00				0.00		0.00				0.00				0.00		0				0.67	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		3
H0028	056	0	1	02	01	H0028_056_0	4		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				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												
H0028	056	0	1	02	01	H0028_056_0	4		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	99.00		297.00																									100.00		300.00				99.00		287.00				99.00				99.00		3.30				3.33	3.30	3.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0028	056	0	1	02	01	H0028_056_0	4		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0028	056	0	1	02	01	H0028_056_0	4		Y	Select Care Drugs	4	11	1	2	6	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0				0	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0028	057	0	1	01	01	H0028_057_0	4		Y	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0028	057	0	1	01	01	H0028_057_0	4		Y	Preferred Generic	4	11	3	2	1	3	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		3
H0028	057	0	1	01	01	H0028_057_0	4		Y	Generic	4	11	3	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	0.00		0.00																									20.00		60.00				0.00		0.00				0.00				0.00		0				0.67	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0028	057	0	1	01	01	H0028_057_0	4		Y	Generic	4	11	3	2	2	3	110		01		110	1	30		90				2	2				30		90	30		31	0.00		0.00																									20.00		60.00				0.00		0.00				0.00				0.00		0				0.67	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		3
H0028	057	0	1	01	01	H0028_057_0	4		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				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												
H0028	057	0	1	01	01	H0028_057_0	4		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	99.00		297.00																									100.00		300.00				99.00		287.00				99.00				99.00		3.30				3.33	3.30	3.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0028	057	0	1	01	01	H0028_057_0	4		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0028	057	0	1	01	01	H0028_057_0	4		Y	Select Care Drugs	4	11	1	2	6	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0				0	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0028	059	0	1	01	01	H0028_059_0	3		Y	Preferred Generic	4	11	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	059	0	1	01	01	H0028_059_0	3		Y	Preferred Generic	4	11	1	2	1	3	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H0028	059	0	1	01	01	H0028_059_0	3		Y	Generic	4	11	1	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	5.00		15.00																									20.00		60.00				5.00		0.00				5.00				5.00		0.17				0.67	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	059	0	1	01	01	H0028_059_0	3		Y	Generic	4	11	1	2	2	3	110		01		110	1	30		90				2	2				30		90	30		31	5.00		15.00																									20.00		60.00				5.00		0.00				5.00				5.00		0.17				0.67	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H0028	059	0	1	01	01	H0028_059_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	45.00		135.00																									47.00		141.00				45.00		90.00				45.00				45.00		1.50				1.57	1.50	1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	059	0	1	01	01	H0028_059_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	99.00		297.00																									100.00		300.00				99.00		198.00				99.00				99.00		3.30				3.33	3.30	3.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	059	0	1	01	01	H0028_059_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
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								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												
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								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
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								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00				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												
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								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00				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
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	3	11	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								19.00	38.00	57.00					0.00	0.00	0.00											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	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					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00				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	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	74.00				47.00				47.00			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	3	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											91.91	45	45	45				91.91	45	45	45										45	45	45				45	45	45			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0074	003	0	1	04	01	H0074_003_0	5			Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0074	003	0	1	04	01	H0074_003_0	5			Select Care Drugs	3	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			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	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					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	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												
H0088	002	0	1	04	01	H0088_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												
H0088	002	0	1	04	01	H0088_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											86.38	50	50	50				82.92	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	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												
H0088	002	0	1	04	01	H0088_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												
H0088	002	0	1	04	01	H0088_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	
H0088	003	0	1	04	01	H0088_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								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00				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	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												
H0088	003	0	1	04	01	H0088_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												
H0088	003	0	1	04	01	H0088_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											85.57	50	50	50				82.15	48	48	48										50	50	50				48	48	48			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0088	003	0	1	04	01	H0088_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												
H0088	003	0	1	04	01	H0088_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	003	0	1	04	01	H0088_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	
H0104	012	0	1	04	01	H0104_012_0	6		Y	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											11.00		22.00				4.00		8.00				11.00				11.00			0.36	0.13		0.37	0.13	0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0104	012	0	1	04	01	H0104_012_0	6		Y	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											20.00		40.00				13.00		26.00				20.00				20.00			0.66	0.43		0.66	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	6		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	1	2				30		90	30		31								47.00		141.00					40.00		80.00											47.00		94.00				40.00		80.00				47.00				47.00			1.56	1.33		1.56	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	6		Y	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											79.60	34		34				71.12	29		29										34		34				29		29			34			34								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0104	012	0	1	04	01	H0104_012_0	6		Y	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			30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0104	012	0	1	04	01	H0104_012_0	6		Y	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		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	6		Y	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		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		Y	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											11.00		22.00				4.00		8.00				11.00				11.00			0.36	0.13		0.37	0.13	0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0104	014	0	1	04	01	H0104_014_0	5		Y	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											20.00		40.00				13.00		26.00				20.00				20.00			0.66	0.43		0.66	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		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	1	2				30		90	30		31								47.00		141.00					40.00		80.00											47.00		94.00				40.00		80.00				47.00				47.00			1.56	1.33		1.56	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		Y	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											79.60	34		34				71.12	29		29										34		34				29		29			34			34								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0104	014	0	1	04	01	H0104_014_0	5		Y	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			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		Y	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		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		Y	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		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		Y	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											10.00		20.00				3.00		6.00				10.00				10.00			0.33	0.10		0.33	0.10	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0104	015	0	1	04	01	H0104_015_0	7		Y	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											15.00		30.00				8.00		16.00				15.00				15.00			0.50	0.26		0.50	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		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	1	2				30		90	30		31								47.00		141.00					40.00		80.00											47.00		94.00				40.00		80.00				47.00				47.00			1.56	1.33		1.56	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		Y	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											97.45	47		47				90.26	42		42										47		47				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		Y	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			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		Y	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		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		Y	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		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	6			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											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												
H0107	003	0	1	04	01	H0107_003_0	6			Preferred Generic	4	01	1	2	1	3		111	01		111	1				30	60	100	1	2				30	60	100	30		31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	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		
H0107	003	0	1	04	01	H0107_003_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											20.00	40.00	40.00				8.00	16.00	16.00				20.00				20.00			0.67	0.27		0.67	0.27	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0107	003	0	1	04	01	H0107_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	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												
H0107	003	0	1	04	01	H0107_003_0	6			Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00				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	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	004	0	1	04	01	H0107_004_0	6			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											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												
H0107	004	0	1	04	01	H0107_004_0	6			Preferred Generic	4	01	1	2	1	3		111	01		111	1				30	60	100	1	2				30	60	100	30		31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	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		
H0107	004	0	1	04	01	H0107_004_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											20.00	40.00	40.00				8.00	16.00	16.00				20.00				20.00			0.67	0.27		0.67	0.27	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0107	004	0	1	04	01	H0107_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	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												
H0107	004	0	1	04	01	H0107_004_0	6			Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00				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	6			Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	100	1	2				30	60	100	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												
H0107	005	0	1	04	01	H0107_005_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					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												
H0107	005	0	1	04	01	H0107_005_0	6			Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					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												
H0107	005	0	1	04	01	H0107_005_0	6			Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	300.00					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												
H0107	005	0	1	04	01	H0107_005_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												
H0107	006	0	1	04	01	H0107_006_0	7			Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	100	1	2				30	60	100	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												
H0107	006	0	1	04	01	H0107_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					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00				5.00				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	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					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												
H0107	006	0	1	04	01	H0107_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					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												
H0107	006	0	1	04	01	H0107_006_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												
H0107	007	0	1	04	01	H0107_007_0	6			Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	100	1	2				30	60	100	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												
H0107	007	0	1	04	01	H0107_007_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					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												
H0107	007	0	1	04	01	H0107_007_0	6			Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					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												
H0107	007	0	1	04	01	H0107_007_0	6			Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	300.00					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												
H0107	007	0	1	04	01	H0107_007_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												
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								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00				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			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					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00				15.00				15.00			0.5	0.00		0.5	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, 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											90.23	50	50	50				86.62	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	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								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00				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												
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								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				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												
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											97.88	46	46	46				95.75	45	45	45										46	46	46				45	45	45			46			46								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								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00				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												
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											79.27	50	50	50				76.10	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	
H0137	001	0	1	48	05	H0137_001_0	2			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	2			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	2			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	2			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	2			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			
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		N	Preferred Generic	4	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		N	Generic	4	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		N	Preferred Brand	4	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		N	Non-Preferred Drug	4	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		N	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31					25																																					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred 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	2	4	1		111	01		111	1				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	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		N	Preferred Generic	4	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		N	Generic	4	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		N	Preferred Brand	4	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		N	Non-Preferred Drug	4	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		N	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31					25																																					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred 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								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00				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 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
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								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00				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												
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								47.00	94.00	141.00					25.00	50.00	75.00											47.00	94.00	141.00				25.00	50.00	50.00				47.00				47.00			1.57	0.83		1.57	0.83	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, 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	008	0	1	01	01	H0174_008_0	4		Y	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 Diabetic Drugs												
H0174	008	0	1	01	01	H0174_008_0	4		Y	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 Diabetic Drugs										2	2	3
H0174	008	0	1	01	01	H0174_008_0	4		Y	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00				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		Y	Generic	4	11	1	2	2	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00				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		
H0174	008	0	1	01	01	H0174_008_0	4		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00				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		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	300.00					90.00	180.00	270.00											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		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs												
H0174	008	0	1	01	01	H0174_008_0	4		Y	Select Diabetic Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					10.00	20.00	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		Y	Select Diabetic Drugs	4	11	1	2	6	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					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	1	
H0174	009	0	1	01	01	H0174_009_0	4			Preferred Generic	4	11	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								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												
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	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												
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	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, 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											98.65	44	44	44				98.65	44	44	44										44	44	44				44	44	44			44			44								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			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	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								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00				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 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
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								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00				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												
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								47.00	94.00	141.00					20.00	40.00	60.00											47.00	94.00	141.00				20.00	40.00	40.00				47.00				47.00			1.57	0.67		1.57	0.67	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, 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								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	2.67		3.33	2.67	3.23	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	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								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00				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 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
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								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00				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												
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								47.00	94.00	141.00					20.00	40.00	60.00											47.00	94.00	141.00				20.00	40.00	40.00				47.00				47.00			1.57	0.67		1.57	0.67	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, 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								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 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	
H0174	015	0	1	01	01	H0174_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								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00				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	015	0	1	01	01	H0174_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								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00				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
H0174	015	0	1	01	01	H0174_015_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					3.00	6.00	9.00											10.00	20.00	30.00				3.00	6.00	0.00				10.00				10.00			0.33	0.1		0.33	0.1	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0174	015	0	1	01	01	H0174_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					20.00	40.00	60.00											47.00	94.00	141.00				20.00	40.00	40.00				47.00				47.00			1.57	0.67		1.57	0.67	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0174	015	0	1	01	01	H0174_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					75.00	150.00	225.00											95.00	190.00	285.00				75.00	150.00	150.00				95.00				95.00			3.17	2.5		3.17	2.5	3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0174	015	0	1	01	01	H0174_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												
H0174	015	0	1	01	01	H0174_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												
H0174	015	0	1	01	01	H0174_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	
H0174	016	0	1	01	01	H0174_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								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00				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	016	0	1	01	01	H0174_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								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00				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
H0174	016	0	1	01	01	H0174_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					3.00	6.00	9.00											10.00	20.00	30.00				3.00	6.00	0.00				10.00				10.00			0.33	0.1		0.33	0.1	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0174	016	0	1	01	01	H0174_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					25.00	50.00	75.00											47.00	94.00	141.00				25.00	50.00	50.00				47.00				47.00			1.57	0.83		1.57	0.83	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0174	016	0	1	01	01	H0174_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					80.00	160.00	240.00											100.00	200.00	300.00				80.00	160.00	160.00				100.00				100.00			3.33	2.67		3.33	2.67	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0174	016	0	1	01	01	H0174_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												
H0174	016	0	1	01	01	H0174_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												
H0174	016	0	1	01	01	H0174_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	
H0174	017	0	1	01	01	H0174_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								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00				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	017	0	1	01	01	H0174_017_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												
H0174	017	0	1	01	01	H0174_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					20.00	40.00	60.00											47.00	94.00	141.00				20.00	40.00	40.00				47.00				47.00			1.57	0.67		1.57	0.67	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0174	017	0	1	01	01	H0174_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												
H0174	017	0	1	01	01	H0174_017_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												
H0174	017	0	1	01	01	H0174_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												
H0174	018	0	1	01	01	H0174_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												
H0174	018	0	1	01	01	H0174_018_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												
H0174	018	0	1	01	01	H0174_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					20.00	40.00	60.00											47.00	94.00	141.00				20.00	40.00	40.00				47.00				47.00			1.57	0.67		1.57	0.67	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0174	018	0	1	01	01	H0174_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												
H0174	018	0	1	01	01	H0174_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, Select Care Drugs												
H0174	018	0	1	01	01	H0174_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												
H0174	019	0	1	01	01	H0174_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								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00				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	019	0	1	01	01	H0174_019_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												
H0174	019	0	1	01	01	H0174_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					20.00	40.00	60.00											47.00	94.00	141.00				20.00	40.00	40.00				47.00				47.00			1.57	0.67		1.57	0.67	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0174	019	0	1	01	01	H0174_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												
H0174	019	0	1	01	01	H0174_019_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												
H0174	019	0	1	01	01	H0174_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												
H0174	020	0	1	01	01	H0174_020_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												
H0174	020	0	1	01	01	H0174_020_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												
H0174	020	0	1	01	01	H0174_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					20.00	40.00	60.00											47.00	94.00	141.00				20.00	40.00	40.00				47.00				47.00			1.57	0.67		1.57	0.67	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0174	020	0	1	01	01	H0174_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					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	020	0	1	01	01	H0174_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, Select Care Drugs												
H0174	020	0	1	01	01	H0174_020_0	4			Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0174	021	0	1	01	01	H0174_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								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00				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	021	0	1	01	01	H0174_021_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												
H0174	021	0	1	01	01	H0174_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					20.00	40.00	60.00											47.00	94.00	141.00				20.00	40.00	40.00				47.00				47.00			1.57	0.67		1.57	0.67	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0174	021	0	1	01	01	H0174_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					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	021	0	1	01	01	H0174_021_0	4			Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												27							27												27						27					27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0174	021	0	1	01	01	H0174_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	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0192	001	0	1	48	05	H0192_001_0	4			Generic Drugs	4	01			1	1	111		01	100		1	30	60	100				1	2			100				30		31																																														0.00						0.00	Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	1	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H0192	001	0	1	48	05	H0192_001_0	4			Brand Drugs	4	11			2	1	111		01	100		1	30	60	100				1	2			100				30		31																																														0.00						0.00	Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	1	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H0192	001	0	1	48	05	H0192_001_0	4			Non-Medicare Rx/OTC Drugs	4	11			3	1	111		01	100		1	30	60	100				1	2			100				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	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					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												
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					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	84.00				47.00				47.00			1.57	1.4		1.57	1.4	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, 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					94.00	188.00	282.00											99.00	198.00	297.00				94.00	188.00	188.00				99.00				99.00			3.3	3.13		3.3	3.13	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			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	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0271	052	0	1	04	01	H0271_052_0	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0271	052	0	1	04	01	H0271_052_0	3		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H0271	052	0	1	04	01	H0271_052_0	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	8.00		24.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0271	052	0	1	04	01	H0271_052_0	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	8.00		24.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H0271	052	0	1	04	01	H0271_052_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0271	052	0	1	04	01	H0271_052_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0271	052	0	1	04	01	H0271_052_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				397.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0271	057	0	1	04	01	H0271_057_0	2		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0271	057	0	1	04	01	H0271_057_0	2		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H0271	057	0	1	04	01	H0271_057_0	2		Y	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												
H0271	057	0	1	04	01	H0271_057_0	2		Y	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
H0271	057	0	1	04	01	H0271_057_0	2		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0271	057	0	1	04	01	H0271_057_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0271	057	0	1	04	01	H0271_057_0	2		Y	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												
H0292	001	0	1	01	01	H0292_001_0	5		Y	Preferred Generic	4	11	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0292	001	0	1	01	01	H0292_001_0	5		Y	Preferred Generic	4	11	1	2	1	3	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H0292	001	0	1	01	01	H0292_001_0	5		Y	Generic	4	11	1	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	0.00		0.00																									20.00		60.00				0.00		0.00				0.00				0.00		0				0.67	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0292	001	0	1	01	01	H0292_001_0	5		Y	Generic	4	11	1	2	2	3	110		01		110	1	30		90				2	2				30		90	30		31	0.00		0.00																									20.00		60.00				0.00		0.00				0.00				0.00		0				0.67	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H0292	001	0	1	01	01	H0292_001_0	5		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	47.00		141.00																									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												
H0292	001	0	1	01	01	H0292_001_0	5		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	100.00		300.00																									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												
H0292	001	0	1	01	01	H0292_001_0	5		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0292	002	0	1	01	01	H0292_002_0	4		Y	Preferred Generic	4	11	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0292	002	0	1	01	01	H0292_002_0	4		Y	Preferred Generic	4	11	1	2	1	3	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H0292	002	0	1	01	01	H0292_002_0	4		Y	Generic	4	11	1	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	0.00		0.00																									20.00		60.00				0.00		0.00				0.00				0.00		0				0.67	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0292	002	0	1	01	01	H0292_002_0	4		Y	Generic	4	11	1	2	2	3	110		01		110	1	30		90				2	2				30		90	30		31	0.00		0.00																									20.00		60.00				0.00		0.00				0.00				0.00		0				0.67	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H0292	002	0	1	01	01	H0292_002_0	4		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0292	002	0	1	01	01	H0292_002_0	4		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	97.00		291.00																									100.00		300.00				97.00		281.00				97.00				97.00		3.23				3.33	3.23	3.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0292	002	0	1	01	01	H0292_002_0	4		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0292	003	0	1	01	01	H0292_003_0	4		Y	Preferred Generic	4	11	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0292	003	0	1	01	01	H0292_003_0	4		Y	Preferred Generic	4	11	1	2	1	3	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H0292	003	0	1	01	01	H0292_003_0	4		Y	Generic	4	11	1	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	0.00		0.00																									20.00		60.00				0.00		0.00				0.00				0.00		0				0.67	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0292	003	0	1	01	01	H0292_003_0	4		Y	Generic	4	11	1	2	2	3	110		01		110	1	30		90				2	2				30		90	30		31	0.00		0.00																									20.00		60.00				0.00		0.00				0.00				0.00		0				0.67	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H0292	003	0	1	01	01	H0292_003_0	4		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0292	003	0	1	01	01	H0292_003_0	4		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		290.00				100.00				100.00		3.33				3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0292	003	0	1	01	01	H0292_003_0	4		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0294	002	0	1	04	01	H0294_002_0	2		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0294	002	0	1	04	01	H0294_002_0	2		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H0294	002	0	1	04	01	H0294_002_0	2		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0294	002	0	1	04	01	H0294_002_0	2		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H0294	002	0	1	04	01	H0294_002_0	2		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0294	002	0	1	04	01	H0294_002_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0294	002	0	1	04	01	H0294_002_0	2		Y	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												
H0294	004	0	1	04	01	H0294_004_0	2		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0294	004	0	1	04	01	H0294_004_0	2		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H0294	004	0	1	04	01	H0294_004_0	2		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	14.00		42.00																											42.00						0.00				14.00				14.00		0.46						0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0294	004	0	1	04	01	H0294_004_0	2		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	14.00		42.00																											42.00						0.00				14.00				14.00		0.46						0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H0294	004	0	1	04	01	H0294_004_0	2		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0294	004	0	1	04	01	H0294_004_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0294	004	0	1	04	01	H0294_004_0	2		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				207.00	27																										27						27					27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0294	010	0	1	04	01	H0294_010_0	2		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0294	010	0	1	04	01	H0294_010_0	2		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H0294	010	0	1	04	01	H0294_010_0	2		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0294	010	0	1	04	01	H0294_010_0	2		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H0294	010	0	1	04	01	H0294_010_0	2		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0294	010	0	1	04	01	H0294_010_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0294	010	0	1	04	01	H0294_010_0	2		Y	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												
H0294	011	0	1	04	01	H0294_011_0	2		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0294	011	0	1	04	01	H0294_011_0	2		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H0294	011	0	1	04	01	H0294_011_0	2		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	14.00		42.00																											42.00						0.00				14.00				14.00		0.46						0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0294	011	0	1	04	01	H0294_011_0	2		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	14.00		42.00																											42.00						0.00				14.00				14.00		0.46						0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H0294	011	0	1	04	01	H0294_011_0	2		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0294	011	0	1	04	01	H0294_011_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0294	011	0	1	04	01	H0294_011_0	2		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				329.00	29																										29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0294	012	0	1	04	01	H0294_012_0	2		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0294	012	0	1	04	01	H0294_012_0	2		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H0294	012	0	1	04	01	H0294_012_0	2		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	14.00		42.00																											42.00						0.00				14.00				14.00		0.46						0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0294	012	0	1	04	01	H0294_012_0	2		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	14.00		42.00																											42.00						0.00				14.00				14.00		0.46						0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H0294	012	0	1	04	01	H0294_012_0	2		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0294	012	0	1	04	01	H0294_012_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0294	012	0	1	04	01	H0294_012_0	2		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				371.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0294	015	0	1	04	01	H0294_015_0	2		Y	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		100	2	2						100	30		31								10.00		30.00					0.00		0.00													30.00						0.00				10.00				10.00			0.33	0.00				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0294	015	0	1	04	01	H0294_015_0	2		Y	Preferred Generic	4	01	1	2	1	3		110	01		100	1				30		100	2	2						100	30		31								10.00		30.00					0.00		0.00													30.00						0.00				10.00				10.00			0.33	0.00				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H0294	015	0	1	04	01	H0294_015_0	2		Y	Generic	4	01	3	2	2	1		110	01		100	1				30		100	2	2						100	30		31								20.00		60.00					0.00		0.00													60.00						0.00				20.00				20.00			0.66	0.00				0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0294	015	0	1	04	01	H0294_015_0	2		Y	Generic	4	01	3	2	2	3		110	01		100	1				30		100	2	2						100	30		31								20.00		60.00					0.00		0.00													60.00						0.00				20.00				20.00			0.66	0.00				0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H0294	015	0	1	04	01	H0294_015_0	2		Y	Preferred Brand	4	11	1	2	3	1		110	01		100	1				30		100	2	2						100	30		31								47.00		141.00					47.00		131.00													141.00						131.00				47.00				47.00			1.56	1.56				1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0294	015	0	1	04	01	H0294_015_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1		110	01		100	1				30		100	2	2						100	30		31								100.00		300.00					100.00		290.00													300.00						290.00				100.00				100.00			3.33	3.33				3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0294	015	0	1	04	01	H0294_015_0	2		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											374.00	33						454.00	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0294	016	0	1	04	01	H0294_016_0	2		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0294	016	0	1	04	01	H0294_016_0	2		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H0294	016	0	1	04	01	H0294_016_0	2		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0294	016	0	1	04	01	H0294_016_0	2		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H0294	016	0	1	04	01	H0294_016_0	2		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0294	016	0	1	04	01	H0294_016_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0294	016	0	1	04	01	H0294_016_0	2		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				374.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0294	017	0	1	04	01	H0294_017_0	4		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0294	017	0	1	04	01	H0294_017_0	4		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H0294	017	0	1	04	01	H0294_017_0	4		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0294	017	0	1	04	01	H0294_017_0	4		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H0294	017	0	1	04	01	H0294_017_0	4		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0294	017	0	1	04	01	H0294_017_0	4		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0294	017	0	1	04	01	H0294_017_0	4		Y	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												
H0294	018	0	1	04	01	H0294_018_0	2		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0294	018	0	1	04	01	H0294_018_0	2		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H0294	018	0	1	04	01	H0294_018_0	2		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	8.00		24.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0294	018	0	1	04	01	H0294_018_0	2		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	8.00		24.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H0294	018	0	1	04	01	H0294_018_0	2		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0294	018	0	1	04	01	H0294_018_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0294	018	0	1	04	01	H0294_018_0	2		Y	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												
H0294	019	0	1	04	01	H0294_019_0	2		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0294	019	0	1	04	01	H0294_019_0	2		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H0294	019	0	1	04	01	H0294_019_0	2		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0294	019	0	1	04	01	H0294_019_0	2		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H0294	019	0	1	04	01	H0294_019_0	2		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0294	019	0	1	04	01	H0294_019_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0294	019	0	1	04	01	H0294_019_0	2		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				553.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0294	020	0	1	04	01	H0294_020_0	2		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0294	020	0	1	04	01	H0294_020_0	2		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H0294	020	0	1	04	01	H0294_020_0	2		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0294	020	0	1	04	01	H0294_020_0	2		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H0294	020	0	1	04	01	H0294_020_0	2		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0294	020	0	1	04	01	H0294_020_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0294	020	0	1	04	01	H0294_020_0	2		Y	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												
H0294	021	0	1	04	01	H0294_021_0	2		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0294	021	0	1	04	01	H0294_021_0	2		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H0294	021	0	1	04	01	H0294_021_0	2		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0294	021	0	1	04	01	H0294_021_0	2		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H0294	021	0	1	04	01	H0294_021_0	2		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0294	021	0	1	04	01	H0294_021_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0294	021	0	1	04	01	H0294_021_0	2		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				544.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0294	023	0	1	04	01	H0294_023_0	4		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0294	023	0	1	04	01	H0294_023_0	4		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H0294	023	0	1	04	01	H0294_023_0	4		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	14.00		42.00																											42.00						0.00				14.00				14.00		0.46						0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0294	023	0	1	04	01	H0294_023_0	4		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	14.00		42.00																											42.00						0.00				14.00				14.00		0.46						0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H0294	023	0	1	04	01	H0294_023_0	4		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0294	023	0	1	04	01	H0294_023_0	4		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0294	023	0	1	04	01	H0294_023_0	4		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				216.00	26																										26						26					26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0294	024	0	1	04	01	H0294_024_0	2		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0294	024	0	1	04	01	H0294_024_0	2		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H0294	024	0	1	04	01	H0294_024_0	2		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0294	024	0	1	04	01	H0294_024_0	2		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H0294	024	0	1	04	01	H0294_024_0	2		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0294	024	0	1	04	01	H0294_024_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0294	024	0	1	04	01	H0294_024_0	2		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				444.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0294	025	0	1	04	01	H0294_025_0	2		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0294	025	0	1	04	01	H0294_025_0	2		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H0294	025	0	1	04	01	H0294_025_0	2		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0294	025	0	1	04	01	H0294_025_0	2		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H0294	025	0	1	04	01	H0294_025_0	2		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0294	025	0	1	04	01	H0294_025_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0294	025	0	1	04	01	H0294_025_0	2		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				384.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0294	026	0	1	04	01	H0294_026_0	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0294	026	0	1	04	01	H0294_026_0	3		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H0294	026	0	1	04	01	H0294_026_0	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	14.00		42.00																											42.00						0.00				14.00				14.00		0.46						0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0294	026	0	1	04	01	H0294_026_0	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	14.00		42.00																											42.00						0.00				14.00				14.00		0.46						0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H0294	026	0	1	04	01	H0294_026_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0294	026	0	1	04	01	H0294_026_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0294	026	0	1	04	01	H0294_026_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				474.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0302	001	0	1	01	01	H0302_001_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 Brand, Specialty Tier, Vaccines												
H0302	001	0	1	01	01	H0302_001_0	10			Generic	4	01	1	2	2	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	9.00	9.00	9.00																			9.00	9.00	9.00																9.00				9.00		0.30			0.30			0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0302	001	0	1	01	01	H0302_001_0	10			Preferred Brand	4	10	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	141.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0302	001	0	1	01	01	H0302_001_0	10			Non-Preferred Brand	4	10	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	100.00	200.00	300.00																			100.00	200.00	300.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0302	001	0	1	01	01	H0302_001_0	10			Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31					33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0302	001	0	1	01	01	H0302_001_0	10			Vaccines	4	11	1	2	6	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0302	006	0	1	01	01	H0302_006_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 Brand, Specialty Tier, Vaccines												
H0302	006	0	1	01	01	H0302_006_0	10			Generic	4	01	1	2	2	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	9.00	9.00	9.00																			9.00	9.00	9.00																9.00				9.00		0.30			0.30			0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0302	006	0	1	01	01	H0302_006_0	10			Preferred Brand	4	10	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	141.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0302	006	0	1	01	01	H0302_006_0	10			Non-Preferred Brand	4	10	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	100.00	200.00	300.00																			100.00	200.00	300.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0302	006	0	1	01	01	H0302_006_0	10			Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31					33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0302	006	0	1	01	01	H0302_006_0	10			Vaccines	4	11	1	2	6	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0302	008	0	1	01	01	H0302_008_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 Brand, Specialty Tier, Vaccines												
H0302	008	0	1	01	01	H0302_008_0	10			Generic	4	01	1	2	2	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	9.00	9.00	9.00																			9.00	9.00	9.00																9.00				9.00		0.30			0.30			0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0302	008	0	1	01	01	H0302_008_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	141.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0302	008	0	1	01	01	H0302_008_0	10			Non-Preferred Brand	4	10	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	100.00	200.00	300.00																			100.00	200.00	300.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0302	008	0	1	01	01	H0302_008_0	10			Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31					33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0302	008	0	1	01	01	H0302_008_0	10			Vaccines	4	11	1	2	6	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0302	009	0	1	01	01	H0302_009_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 Brand, Specialty Tier, Vaccines												
H0302	009	0	1	01	01	H0302_009_0	10			Generic	4	01	1	2	2	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	9.00	9.00	9.00																			9.00	9.00	9.00																9.00				9.00		0.30			0.30			0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0302	009	0	1	01	01	H0302_009_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	141.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0302	009	0	1	01	01	H0302_009_0	10			Non-Preferred Brand	4	10	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	100.00	200.00	300.00																			100.00	200.00	300.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0302	009	0	1	01	01	H0302_009_0	10			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												
H0302	009	0	1	01	01	H0302_009_0	10			Vaccines	4	11	1	2	6	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0332	002	0	1	01	01	H0332_002_0	6		Y	Preferred Generic	4	11	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								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												
H0332	002	0	1	01	01	H0332_002_0	6		Y	Preferred Generic	4	11	1	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								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		
H0332	002	0	1	01	01	H0332_002_0	6		Y	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, Select Care Drugs												
H0332	002	0	1	01	01	H0332_002_0	6		Y	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, Select Care Drugs										1		3
H0332	002	0	1	01	01	H0332_002_0	6		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								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, Select Care Drugs												
H0332	002	0	1	01	01	H0332_002_0	6		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								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, Select Care Drugs												
H0332	002	0	1	01	01	H0332_002_0	6		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												31							31												31						31					31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0332	002	0	1	01	01	H0332_002_0	6		Y	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0332	002	0	1	01	01	H0332_002_0	6		Y	Select Care Drugs	4	11	1	2	6	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H0332	004	0	1	02	01	H0332_004_0	6		Y	Preferred Generic	4	11	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								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												
H0332	004	0	1	02	01	H0332_004_0	6		Y	Preferred Generic	4	11	1	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								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		
H0332	004	0	1	02	01	H0332_004_0	6		Y	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, Select Care Drugs												
H0332	004	0	1	02	01	H0332_004_0	6		Y	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, Select Care Drugs										1		3
H0332	004	0	1	02	01	H0332_004_0	6		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								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, Select Care Drugs												
H0332	004	0	1	02	01	H0332_004_0	6		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								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, Select Care Drugs												
H0332	004	0	1	02	01	H0332_004_0	6		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												31							31												31						31					31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0332	004	0	1	02	01	H0332_004_0	6		Y	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0332	004	0	1	02	01	H0332_004_0	6		Y	Select Care Drugs	4	11	1	2	6	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H0332	008	0	1	02	01	H0332_008_0	6		Y	Preferred Generic	4	11	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								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												
H0332	008	0	1	02	01	H0332_008_0	6		Y	Preferred Generic	4	11	1	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								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		
H0332	008	0	1	02	01	H0332_008_0	6		Y	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, Select Care Drugs												
H0332	008	0	1	02	01	H0332_008_0	6		Y	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, Select Care Drugs										1		3
H0332	008	0	1	02	01	H0332_008_0	6		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								45.00	90.00	135.00					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, Select Care Drugs												
H0332	008	0	1	02	01	H0332_008_0	6		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								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, Select Care Drugs												
H0332	008	0	1	02	01	H0332_008_0	6		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												31							31												31						31					31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0332	008	0	1	02	01	H0332_008_0	6		Y	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0332	008	0	1	02	01	H0332_008_0	6		Y	Select Care Drugs	4	11	1	2	6	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H0332	009	0	1	01	01	H0332_009_0	6		Y	Preferred Generic	4	11	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								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												
H0332	009	0	1	01	01	H0332_009_0	6		Y	Preferred Generic	4	11	1	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								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		
H0332	009	0	1	01	01	H0332_009_0	6		Y	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, Select Care Drugs												
H0332	009	0	1	01	01	H0332_009_0	6		Y	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, Select Care Drugs										1		3
H0332	009	0	1	01	01	H0332_009_0	6		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								45.00	90.00	135.00					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, Select Care Drugs												
H0332	009	0	1	01	01	H0332_009_0	6		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								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, Select Care Drugs												
H0332	009	0	1	01	01	H0332_009_0	6		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												31							31												31						31					31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0332	009	0	1	01	01	H0332_009_0	6		Y	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0332	009	0	1	01	01	H0332_009_0	6		Y	Select Care Drugs	4	11	1	2	6	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H0336	001	0	1	48	05	H0336_001_0	2			Generic Drugs	4	01			1	1	110		01	110		1	30		90				2	2	30		90				30		31																																																					Generic Drugs, Brand Drugs, Non-Medicare Rx Drugs, Non-Medicare OTC Drugs	1	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H0336	001	0	1	48	05	H0336_001_0	2			Brand Drugs	4	10			2	1	110		01	110		1	30		90				2	2	30		90				30		31																																																					Generic Drugs, Brand Drugs, Non-Medicare Rx Drugs, Non-Medicare OTC Drugs	1	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H0336	001	0	1	48	05	H0336_001_0	2			Non-Medicare Rx Drugs	4	11			3	1	110		01	110		1	30		90				1	2	30		90				30		31																																																					Generic Drugs, Brand Drugs, Non-Medicare Rx Drugs, Non-Medicare OTC Drugs	2	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H0336	001	0	1	48	05	H0336_001_0	2			Non-Medicare OTC Drugs	4	11			4	1	110		01	110		1	30		90				1	2	30		90				30		31																																																					Generic Drugs, Brand Drugs, Non-Medicare Rx Drugs, Non-Medicare OTC Drugs	2	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H0342	001	0	1	04	01	H0342_001_0	6		Y	Preferred Generic	4	01	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		Y	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								15.00	30.00	45.00					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		Y	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					47.00	94.00	141.00					47.00	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		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	300.00					100.00	200.00	300.00					100.00	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		Y	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H0342	001	0	1	04	01	H0342_001_0	6		Y	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												
H0342	001	0	1	04	01	H0342_001_0	6		Y	Vaccines	4	11	1	2	6	3		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										1		
H0351	038	0	1	01	01	H0351_038_0	5		Y	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 Diabetic Drugs												
H0351	038	0	1	01	01	H0351_038_0	5		Y	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 Diabetic Drugs										2	2	3
H0351	038	0	1	01	01	H0351_038_0	5		Y	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					5.00	10.00	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	5		Y	Generic	4	11	1	2	2	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					5.00	10.00	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	5		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											47.00	94.00	141.00				37.00	74.00	74.00				47.00				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	5		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	300.00					90.00	180.00	270.00											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	5		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs												
H0351	038	0	1	01	01	H0351_038_0	5		Y	Select Diabetic Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				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	5		Y	Select Diabetic 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 Diabetic Drugs										2	1	
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								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												
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	5			Preferred Generic	4	11	3	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	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												
H0351	054	0	1	01	01	H0351_054_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												
H0351	054	0	1	01	01	H0351_054_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	054	0	1	01	01	H0351_054_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	054	0	1	01	01	H0351_054_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												
H0351	054	0	1	01	01	H0351_054_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	057	0	1	01	01	H0351_057_0	5		Y	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 Diabetic Drugs												
H0351	057	0	1	01	01	H0351_057_0	5		Y	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 Diabetic Drugs										2	2	3
H0351	057	0	1	01	01	H0351_057_0	5		Y	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					1.00	2.00	3.00											15.00	30.00	45.00				1.00	2.00	0.00				15.00				15.00			0.5	0.03		0.5	0.03	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs												
H0351	057	0	1	01	01	H0351_057_0	5		Y	Generic	4	11	1	2	2	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					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, Select Diabetic Drugs										1		
H0351	057	0	1	01	01	H0351_057_0	5		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											47.00	94.00	141.00				37.00	74.00	74.00				47.00				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	5		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	300.00					90.00	180.00	270.00											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	5		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs												
H0351	057	0	1	01	01	H0351_057_0	5		Y	Select Diabetic Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					10.00	20.00	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												
H0351	057	0	1	01	01	H0351_057_0	5		Y	Select Diabetic Drugs	4	11	1	2	6	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					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	1	
H0351	058	1	1	01	01	H0351_058_1	4			Preferred Generic	4	11	3	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			0.5	0.00		0.5	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0351	058	1	1	01	01	H0351_058_1	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	058	1	1	01	01	H0351_058_1	4			Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											47.00	94.00	141.00				37.00	74.00	74.00				47.00				47.00			1.57	1.23		1.57	1.23	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0351	058	1	1	01	01	H0351_058_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												
H0351	058	1	1	01	01	H0351_058_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												
H0351	058	1	1	01	01	H0351_058_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												
H0351	058	1	1	01	01	H0351_058_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	
H0351	058	2	1	01	01	H0351_058_2	4			Preferred Generic	4	11	3	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			0.5	0.00		0.5	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0351	058	2	1	01	01	H0351_058_2	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	058	2	1	01	01	H0351_058_2	4			Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											47.00	94.00	141.00				37.00	74.00	74.00				47.00				47.00			1.57	1.23		1.57	1.23	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0351	058	2	1	01	01	H0351_058_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												
H0351	058	2	1	01	01	H0351_058_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												
H0351	058	2	1	01	01	H0351_058_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												
H0351	058	2	1	01	01	H0351_058_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	
H0351	059	1	1	01	01	H0351_059_1	4			Preferred Generic	4	11	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								19.00	38.00	57.00					0.00	0.00	0.00											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												
H0351	059	1	1	01	01	H0351_059_1	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	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												
H0351	059	1	1	01	01	H0351_059_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					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, Select Care Drugs												
H0351	059	1	1	01	01	H0351_059_1	4			Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											99.53	46	46	46				99.53	46	46	46										46	46	46				46	46	46			46			46								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0351	059	1	1	01	01	H0351_059_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, Select Care Drugs												
H0351	059	1	1	01	01	H0351_059_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												
H0351	059	2	1	01	01	H0351_059_2	4			Preferred Generic	4	11	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								19.00	38.00	57.00					0.00	0.00	0.00											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												
H0351	059	2	1	01	01	H0351_059_2	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	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												
H0351	059	2	1	01	01	H0351_059_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					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, Select Care Drugs												
H0351	059	2	1	01	01	H0351_059_2	4			Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											99.53	46	46	46				99.53	46	46	46										46	46	46				46	46	46			46			46								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0351	059	2	1	01	01	H0351_059_2	4			Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0351	059	2	1	01	01	H0351_059_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												
H0351	060	1	1	01	01	H0351_060_1	4			Preferred Generic	4	11	3	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			0.5	0.00		0.5	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0351	060	1	1	01	01	H0351_060_1	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	060	1	1	01	01	H0351_060_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					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	84.00				47.00				47.00			1.57	1.4		1.57	1.4	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0351	060	1	1	01	01	H0351_060_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					95.00	190.00	285.00											100.00	200.00	300.00				95.00	190.00	190.00				100.00				100.00			3.33	3.17		3.33	3.17	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0351	060	1	1	01	01	H0351_060_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, Select Care Drugs												
H0351	060	1	1	01	01	H0351_060_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												
H0351	060	2	1	01	01	H0351_060_2	5			Preferred Generic	4	11	3	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			0.5	0.00		0.5	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0351	060	2	1	01	01	H0351_060_2	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												
H0351	060	2	1	01	01	H0351_060_2	5			Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	84.00				47.00				47.00			1.57	1.4		1.57	1.4	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0351	060	2	1	01	01	H0351_060_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	300.00				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 Drug, Specialty Tier, Select Care Drugs												
H0351	060	2	1	01	01	H0351_060_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, Select Care Drugs												
H0351	060	2	1	01	01	H0351_060_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												
H0351	061	0	1	01	01	H0351_061_0	5			Preferred Generic	4	11	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								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												
H0351	061	0	1	01	01	H0351_061_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	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												
H0351	061	0	1	01	01	H0351_061_0	5			Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	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, Select Care Drugs												
H0351	061	0	1	01	01	H0351_061_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											98.46	43	43	43				98.46	43	43	43										43	43	43				43	43	43			43			43								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0351	061	0	1	01	01	H0351_061_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												
H0351	061	0	1	01	01	H0351_061_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												
H0354	001	0	1	01	01	H0354_001_0	4		Y	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												
H0354	001	0	1	01	01	H0354_001_0	4		Y	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
H0354	001	0	1	01	01	H0354_001_0	4		Y	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					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	4		Y	Generic	4	01	1	2	2	3		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					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	4		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00				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	4		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00				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	4		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											687.19	33						749.00	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0354	027	0	1	01	01	H0354_027_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, Select Diabetic Drugs												
H0354	027	0	1	01	01	H0354_027_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, Select Diabetic Drugs										1		3
H0354	027	0	1	01	01	H0354_027_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					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	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					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	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, Select Diabetic Drugs												
H0354	027	0	1	01	01	H0354_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					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00				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	4			Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											573.45	33						658.93	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	4			Select Diabetic Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								11.00	22.00	33.00					9.00	18.00	18.00											11.00	22.00	33.00				9.00	18.00	18.00				11.00				11.00			0.37	0.30		0.37	0.30	0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs												
H0354	028	0	1	01	01	H0354_028_0	4		Y	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												
H0354	028	0	1	01	01	H0354_028_0	4		Y	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
H0354	028	0	1	01	01	H0354_028_0	4		Y	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					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	4		Y	Generic	4	01	1	2	2	3		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					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	4		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0354	028	0	1	01	01	H0354_028_0	4		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0354	028	0	1	01	01	H0354_028_0	4		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											843.74	33						720.71	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0354	029	0	1	01	01	H0354_029_0	4		Y	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												
H0354	029	0	1	01	01	H0354_029_0	4		Y	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
H0354	029	0	1	01	01	H0354_029_0	4		Y	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					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	029	0	1	01	01	H0354_029_0	4		Y	Generic	4	01	1	2	2	3		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					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	029	0	1	01	01	H0354_029_0	4		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00				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	029	0	1	01	01	H0354_029_0	4		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00				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	029	0	1	01	01	H0354_029_0	4		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											733.36	33						757.53	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0363	003	0	1	01	01	H0363_003_0	11		Y	Preferred Generic	4	11	1	2	1	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												
H0363	003	0	1	01	01	H0363_003_0	11		Y	Preferred Generic	4	11	1	2	1	3	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										1		
H0363	003	0	1	01	01	H0363_003_0	11		Y	Generic	4	11	1	2	2	1	111		01			1	30	60	90				1	2							30		31	12.00	24.00	36.00																																					12.00				12.00		0.40						0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0363	003	0	1	01	01	H0363_003_0	11		Y	Generic	4	11	1	2	2	3	111		01			1	30	60	90				1	2							30		31	12.00	24.00	36.00																																					12.00				12.00		0.40						0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H0363	003	0	1	01	01	H0363_003_0	11		Y	Preferred Brand	4	11	1	2	3	1	111		01			1	30	60	90				1	2							30		31	47.00	94.00	141.00																																					47.00				47.00		1.57						1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0363	003	0	1	01	01	H0363_003_0	11		Y	Non-Preferred Drug	4	11	1	2	4	1	111		01			1	30	60	90				1	2							30		31	100.00	200.00	300.00																																					100.00				100.00		3.33						3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0363	003	0	1	01	01	H0363_003_0	11		Y	Specialty Tier	4	11	1	1	5	1	111		01			1	30	60	90				1	2							30		31					33	33	33																																			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0422	001	0	1	02	01	H0422_001_0	6		Y	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	6		Y	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	6		Y	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		29	31								47.00	94.00	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	6		Y	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		29	31											73.97	50	50	50				73.97	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	6		Y	Specialty Tier	4	11	1	1	5	1		111	10		111	1				30	60	90	1	2				30	60	90		29	31											1907.34	26	26	26				1907.34	26	26	26										26	26	26				26	26	26				26		26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0422	003	0	1	02	01	H0422_003_0	7		Y	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	7		Y	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	7		Y	Preferred Brand	4	11	1	1	3	1		111	10		111	1				30	60	90	1	2				30	60	90		29	31											76.00	25	25	25				51.00	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	7		Y	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		29	31											97.00	50	50	50				97.00	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	7		Y	Specialty Tier	4	11	1	1	5	1		111	10		111	1				30	60	90	1	2				30	60	90		29	31											2359.00	25	25	25				2359.00	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	02	01	H0432_003_0	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0432	003	0	1	02	01	H0432_003_0	3		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H0432	003	0	1	02	01	H0432_003_0	3		Y	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												
H0432	003	0	1	02	01	H0432_003_0	3		Y	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
H0432	003	0	1	02	01	H0432_003_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0432	003	0	1	02	01	H0432_003_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0432	003	0	1	02	01	H0432_003_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				517.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0432	004	0	1	02	01	H0432_004_0	2		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0432	004	0	1	02	01	H0432_004_0	2		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H0432	004	0	1	02	01	H0432_004_0	2		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	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												
H0432	004	0	1	02	01	H0432_004_0	2		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	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
H0432	004	0	1	02	01	H0432_004_0	2		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0432	004	0	1	02	01	H0432_004_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0432	004	0	1	02	01	H0432_004_0	2		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				454.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0432	010	0	1	02	01	H0432_010_0	2		Y	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		100	2	2						100	30		31								10.00		30.00					0.00		0.00													30.00						0.00				10.00				10.00			0.33	0.00				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0432	010	0	1	02	01	H0432_010_0	2		Y	Preferred Generic	4	01	1	2	1	3		110	01		100	1				30		100	2	2						100	30		31								10.00		30.00					0.00		0.00													30.00						0.00				10.00				10.00			0.33	0.00				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H0432	010	0	1	02	01	H0432_010_0	2		Y	Generic	4	01	3	2	2	1		110	01		100	1				30		100	2	2						100	30		31								18.00		54.00					0.00		0.00													54.00						0.00				18.00				18.00			0.60	0.00				0.58	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0432	010	0	1	02	01	H0432_010_0	2		Y	Generic	4	01	3	2	2	3		110	01		100	1				30		100	2	2						100	30		31								18.00		54.00					0.00		0.00													54.00						0.00				18.00				18.00			0.60	0.00				0.58	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H0432	010	0	1	02	01	H0432_010_0	2		Y	Preferred Brand	4	11	1	2	3	1		110	01		100	1				30		100	2	2						100	30		31								47.00		141.00					47.00		131.00													141.00						131.00				47.00				47.00			1.56	1.56				1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0432	010	0	1	02	01	H0432_010_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1		110	01		100	1				30		100	2	2						100	30		31								100.00		300.00					100.00		290.00													300.00						290.00				100.00				100.00			3.33	3.33				3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0432	010	0	1	02	01	H0432_010_0	2		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											448.00	33						427.00	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0439	003	1	1	01	01	H0439_003_1	4		Y	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								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	4		Y	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					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	4		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0439	003	1	1	01	01	H0439_003_1	4		Y	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											99.40	38	38	38				80.41	38	38	38										38	38	38				38	38	38			38			38								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0439	003	1	1	01	01	H0439_003_1	4		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											763.76	28						508.75	28												28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0439	003	2	1	01	01	H0439_003_2	4		Y	Preferred Generic	4	01	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	4		Y	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					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	4		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0439	003	2	1	01	01	H0439_003_2	4		Y	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											99.40	38	38	38				80.41	38	38	38										38	38	38				38	38	38			38			38								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0439	003	2	1	01	01	H0439_003_2	4		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											763.76	28						508.75	28												28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0439	006	0	1	01	01	H0439_006_0	4		Y	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00				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	4		Y	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	4		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0439	006	0	1	01	01	H0439_006_0	4		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								100.00	200.00	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	4		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											868.32	33						632.43	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0439	007	0	1	01	01	H0439_007_0	4		Y	Preferred Generic	4	01	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	4		Y	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					10.00	20.00	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												
H0439	007	0	1	01	01	H0439_007_0	4		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0439	007	0	1	01	01	H0439_007_0	4		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								100.00	200.00	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	4		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											885.74	33						778.90	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0439	008	0	1	01	01	H0439_008_0	4		Y	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								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	008	0	1	01	01	H0439_008_0	4		Y	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	4		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0439	008	0	1	01	01	H0439_008_0	4		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								100.00	200.00	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	4		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											906.49	31						775.63	31												31						31					31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0439	009	0	1	01	01	H0439_009_0	4		Y	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00				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	4		Y	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					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	4		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0439	009	0	1	01	01	H0439_009_0	4		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								100.00	200.00	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	4		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											849.56	33						768.68	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0439	010	0	1	01	01	H0439_010_0	4		Y	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								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	4		Y	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	4		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0439	010	0	1	01	01	H0439_010_0	4		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								100.00	200.00	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	4		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											731.70	33						779.91	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0439	011	0	1	01	01	H0439_011_0	4		Y	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								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	4		Y	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	4		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0439	011	0	1	01	01	H0439_011_0	4		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								100.00	200.00	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	4		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											864.12	33						822.43	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0439	013	0	1	01	01	H0439_013_0	4		Y	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00				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	013	0	1	01	01	H0439_013_0	4		Y	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					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												
H0439	013	0	1	01	01	H0439_013_0	4		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0439	013	0	1	01	01	H0439_013_0	4		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								100.00	200.00	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	013	0	1	01	01	H0439_013_0	4		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											905.77	33						793.56	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		Y	Preferred Generic	4	11	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0473	001	0	1	04	01	H0473_001_0	4		Y	Preferred Generic	4	11	1	2	1	3	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H0473	001	0	1	04	01	H0473_001_0	4		Y	Generic	4	11	1	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	0.00		0.00																									20.00		60.00				0.00		0.00				0.00				0.00		0				0.67	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0473	001	0	1	04	01	H0473_001_0	4		Y	Generic	4	11	1	2	2	3	110		01		110	1	30		90				2	2				30		90	30		31	0.00		0.00																									20.00		60.00				0.00		0.00				0.00				0.00		0				0.67	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H0473	001	0	1	04	01	H0473_001_0	4		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		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		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	99.00		297.00																									100.00		300.00				99.00		287.00				99.00				99.00		3.30				3.33	3.30	3.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0473	001	0	1	04	01	H0473_001_0	4		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0473	003	0	1	04	01	H0473_003_0	3		Y	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	4.00		12.00																									10.00		30.00				4.00		0.00				4.00				4.00		0.13				0.33	0.13	0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0473	003	0	1	04	01	H0473_003_0	3		Y	Generic	4	11	3	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	12.00		36.00																									20.00		60.00				12.00		0.00				12.00				12.00		0.40				0.67	0.40	0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0473	003	0	1	04	01	H0473_003_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		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	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	99.00		297.00																									100.00		300.00				99.00		287.00				99.00				99.00		3.30				3.33	3.30	3.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0473	003	0	1	04	01	H0473_003_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					29																										29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0473	004	0	1	04	01	H0473_004_0	3		Y	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0473	004	0	1	04	01	H0473_004_0	3		Y	Preferred Generic	4	11	3	2	1	3	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H0473	004	0	1	04	01	H0473_004_0	3		Y	Generic	4	11	3	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	5.00		15.00																									20.00		60.00				5.00		0.00				5.00				5.00		0.17				0.67	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0473	004	0	1	04	01	H0473_004_0	3		Y	Generic	4	11	3	2	2	3	110		01		110	1	30		90				2	2				30		90	30		31	5.00		15.00																									20.00		60.00				5.00		0.00				5.00				5.00		0.17				0.67	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H0473	004	0	1	04	01	H0473_004_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		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	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	99.00		297.00																									100.00		300.00				99.00		287.00				99.00				99.00		3.30				3.33	3.30	3.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0473	004	0	1	04	01	H0473_004_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0473	005	0	1	04	01	H0473_005_0	3		Y	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0473	005	0	1	04	01	H0473_005_0	3		Y	Preferred Generic	4	11	3	2	1	3	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H0473	005	0	1	04	01	H0473_005_0	3		Y	Generic	4	11	3	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	0.00		0.00																									20.00		60.00				0.00		0.00				0.00				0.00		0				0.67	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0473	005	0	1	04	01	H0473_005_0	3		Y	Generic	4	11	3	2	2	3	110		01		110	1	30		90				2	2				30		90	30		31	0.00		0.00																									20.00		60.00				0.00		0.00				0.00				0.00		0				0.67	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H0473	005	0	1	04	01	H0473_005_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	45.00		135.00																									47.00		141.00				45.00		90.00				45.00				45.00		1.50				1.57	1.50	1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0473	005	0	1	04	01	H0473_005_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	99.00		297.00																									100.00		300.00				99.00		198.00				99.00				99.00		3.30				3.33	3.30	3.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0473	005	0	1	04	01	H0473_005_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0480	001	0	1	48	05	H0480_001_0	6			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	6			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	6			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	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												
H0482	001	0	1	01	01	H0482_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					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	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												
H0482	001	0	1	01	01	H0482_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												
H0482	001	0	1	01	01	H0482_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												
H0482	001	0	1	01	01	H0482_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												
H0482	002	0	1	01	01	H0482_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								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00				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	5			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	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					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												
H0482	002	0	1	01	01	H0482_002_0	5			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		
H0482	002	0	1	01	01	H0482_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												
H0482	002	0	1	01	01	H0482_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												
H0482	002	0	1	01	01	H0482_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												
H0482	002	0	1	01	01	H0482_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												
H0482	002	0	1	01	01	H0482_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	
H0482	003	0	1	01	01	H0482_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								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00				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	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					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	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												
H0482	003	0	1	01	01	H0482_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												
H0482	003	0	1	01	01	H0482_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												
H0482	003	0	1	01	01	H0482_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												
H0482	004	0	1	01	01	H0482_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												
H0482	004	0	1	01	01	H0482_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								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00				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	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												
H0482	004	0	1	01	01	H0482_004_0	5			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	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												
H0482	004	0	1	01	01	H0482_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												
H0482	004	0	1	01	01	H0482_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												
H0482	004	0	1	01	01	H0482_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												
H0482	004	0	1	01	01	H0482_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	
H0482	005	0	1	01	01	H0482_005_0	5		N	Preferred Generic	3	11	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								19.00	38.00	57.00					0.00	0.00	0.00											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												
H0482	005	0	1	01	01	H0482_005_0	5		N	Generic	3	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					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												
H0482	005	0	1	01	01	H0482_005_0	5		N	Preferred Brand	3	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					47.00	94.00	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, Select Care Drugs												
H0482	005	0	1	01	01	H0482_005_0	5		N	Non-Preferred Drug	3	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											98.68	39	39	39				98.68	39	39	39										39	39	39				39	39	39			39			39								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0482	005	0	1	01	01	H0482_005_0	5		N	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0482	005	0	1	01	01	H0482_005_0	5		N	Select Care Drugs	3	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0482	006	0	1	01	01	H0482_006_0	6		N	Preferred Generic	3	11	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								19.00	38.00	57.00					0.00	0.00	0.00											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												
H0482	006	0	1	01	01	H0482_006_0	6		N	Generic	3	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					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												
H0482	006	0	1	01	01	H0482_006_0	6		N	Preferred Brand	3	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					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, Select Care Drugs												
H0482	006	0	1	01	01	H0482_006_0	6		N	Non-Preferred Drug	3	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											93.67	41	41	41				93.67	41	41	41										41	41	41				41	41	41			41			41								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0482	006	0	1	01	01	H0482_006_0	6		N	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0482	006	0	1	01	01	H0482_006_0	6		N	Select Care Drugs	3	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0504	015	0	1	01	01	H0504_015_0	5		N	Preferred Generic	4	01	1	2	1	1		111	01	100		1				30	60	100	2	2			100				30		31								5.00	5.00	5.00					0.00	0.00	0.00							0.00																5.00				5.00			0.17	0.00				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0504	015	0	1	01	01	H0504_015_0	5		N	Preferred Generic	4	01	1	2	1	3		111	01	100		1				30	60	100	2	2			100				30		31								5.00	5.00	5.00					0.00	0.00	0.00							0.00																5.00				5.00			0.17	0.00				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H0504	015	0	1	01	01	H0504_015_0	5		N	Generic	4	01	1	2	2	1		111	01	100		1				30	60	90	2	2			90				30		31								12.00	24.00	36.00					5.00	10.00	7.50							7.50																12.00				12.00			0.40	0.17				0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0504	015	0	1	01	01	H0504_015_0	5		N	Generic	4	01	1	2	2	3		111	01	100		1				30	60	90	2	2			90				30		31								12.00	24.00	36.00					5.00	10.00	7.50							7.50																12.00				12.00			0.40	0.17				0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H0504	015	0	1	01	01	H0504_015_0	5		N	Preferred Brand	4	11	1	2	3	1		111	01	100		1				30	60	90	2	2			90				30		31								47.00	94.00	141.00					38.00	76.00	95.00							95.00																47.00				47.00			1.57	1.27				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0504	015	0	1	01	01	H0504_015_0	5		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	100		1				30	60	90	2	2			90				30		31								100.00	200.00	300.00					95.00	190.00	237.50							237.50																100.00				100.00			3.33	3.17				3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0504	015	0	1	01	01	H0504_015_0	5		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0504	017	0	1	01	01	H0504_017_0	6		N	Preferred Generic	4	01	1	2	1	1		111	01	100		1				30	60	100	2	2			100				30		31								5.00	5.00	5.00					0.00	0.00	0.00							0.00																5.00				5.00			0.17	0.00				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0504	017	0	1	01	01	H0504_017_0	6		N	Preferred Generic	4	01	1	2	1	3		111	01	100		1				30	60	100	2	2			100				30		31								5.00	5.00	5.00					0.00	0.00	0.00							0.00																5.00				5.00			0.17	0.00				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H0504	017	0	1	01	01	H0504_017_0	6		N	Generic	4	01	1	2	2	1		111	01	100		1				30	60	90	2	2			90				30		31								18.00	36.00	54.00					10.00	20.00	15.00							15.00																18.00				18.00			0.60	0.33				0.58	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0504	017	0	1	01	01	H0504_017_0	6		N	Generic	4	01	1	2	2	3		111	01	100		1				30	60	90	2	2			90				30		31								18.00	36.00	54.00					10.00	20.00	15.00							15.00																18.00				18.00			0.60	0.33				0.58	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H0504	017	0	1	01	01	H0504_017_0	6		N	Preferred Brand	4	11	1	2	3	1		111	01	100		1				30	60	90	2	2			90				30		31								47.00	94.00	141.00					40.00	80.00	100.00							100.00																47.00				47.00			1.57	1.33				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0504	017	0	1	01	01	H0504_017_0	6		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	100		1				30	60	90	2	2			90				30		31								100.00	200.00	300.00					95.00	190.00	237.50							237.50																100.00				100.00			3.33	3.17				3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0504	017	0	1	01	01	H0504_017_0	6		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0504	021	0	1	01	01	H0504_021_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	021	0	1	01	01	H0504_021_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	021	0	1	01	01	H0504_021_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	021	0	1	01	01	H0504_021_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	021	0	1	01	01	H0504_021_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	021	0	1	01	01	H0504_021_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	021	0	1	01	01	H0504_021_0	5			Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
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		Y	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		Y	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		Y	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		Y	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		Y	Preferred Brand	4	11	1	2	3	1		111	01	100		1				30	60	90	2	2			90				30		31								47.00	94.00	141.00					35.00	70.00	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		Y	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		Y	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0504	029	0	1	01	01	H0504_029_0	5		Y	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		Y	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		Y	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		Y	Preferred Brand	4	11	1	2	3	1		111	01	100		1				30	60	90	2	2			90				30		31								47.00	94.00	141.00					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		Y	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		Y	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0504	037	0	1	01	01	H0504_037_0	5		Y	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		Y	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		Y	Generic	4	01	3	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		Y	Preferred Brand	4	11	1	2	3	1		111	01	100		1				30	60	90	2	2			90				30		31								47.00	94.00	141.00					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		Y	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		Y	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		Y	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		Y	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		Y	Generic	4	01	1	2	2	1		111	01	100		1				30	60	90	2	2			90				30		31								20.00	40.00	60.00					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		Y	Preferred Brand	4	11	1	2	3	1		111	01	100		1				30	60	90	2	2			90				30		31								47.00	94.00	141.00					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		Y	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		Y	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0504	039	0	1	01	01	H0504_039_0	5		Y	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		Y	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		Y	Generic	4	01	3	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		Y	Generic	4	01	3	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		3
H0504	039	0	1	01	01	H0504_039_0	5		Y	Preferred Brand	4	11	1	2	3	1		111	01	100		1				30	60	90	2	2			90				30		31								47.00	94.00	141.00					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		Y	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		Y	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0504	040	0	1	01	01	H0504_040_0	5		Y	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		Y	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		Y	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		Y	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		Y	Preferred Brand	4	11	1	2	3	1		111	01	100		1				30	60	90	2	2			90				30		31								47.00	94.00	141.00					35.00	70.00	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		Y	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		Y	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0504	041	0	1	01	01	H0504_041_0	5		Y	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		Y	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		Y	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		Y	Preferred Brand	4	11	1	2	3	1		111	01	100		1				30	60	90	2	2			90				30		31								47.00	94.00	141.00					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		Y	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		Y	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0504	043	0	1	01	01	H0504_043_0	5		Y	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		Y	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		Y	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		Y	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		Y	Preferred Brand	4	11	1	2	3	1		111	01	100		1				30	60	90	2	2			90				30		31								47.00	94.00	141.00					35.00	70.00	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		Y	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		Y	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0504	047	0	1	01	01	H0504_047_0	5		Y	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	5		Y	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	5		Y	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	5		Y	Preferred Brand	4	11	1	2	3	1		111	01	100		1				30	60	90	2	2			90				30		31								47.00	94.00	141.00					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	5		Y	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	5		Y	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0504	048	0	1	01	01	H0504_048_0	5		Y	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	5		Y	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	5		Y	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	5		Y	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	5		Y	Preferred Brand	4	11	1	2	3	1		111	01	100		1				30	60	90	2	2			90				30		31								47.00	94.00	141.00					35.00	70.00	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	5		Y	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	5		Y	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0504	049	0	1	01	01	H0504_049_0	5		Y	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	049	0	1	01	01	H0504_049_0	5		Y	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	049	0	1	01	01	H0504_049_0	5		Y	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	049	0	1	01	01	H0504_049_0	5		Y	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	049	0	1	01	01	H0504_049_0	5		Y	Preferred Brand	4	11	1	2	3	1		111	01	100		1				30	60	90	2	2			90				30		31								47.00	94.00	141.00					35.00	70.00	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	049	0	1	01	01	H0504_049_0	5		Y	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	049	0	1	01	01	H0504_049_0	5		Y	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0523	002	0	1	01	01	H0523_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												
H0523	002	0	1	01	01	H0523_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		
H0523	002	0	1	01	01	H0523_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					10.00	20.00	20.00											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												
H0523	002	0	1	01	01	H0523_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					10.00	20.00	20.00											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										1		
H0523	002	0	1	01	01	H0523_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												
H0523	002	0	1	01	01	H0523_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												
H0523	002	0	1	01	01	H0523_002_0	5			Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											840.84	33						679.46	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0523	022	0	1	01	01	H0523_022_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												
H0523	022	0	1	01	01	H0523_022_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		
H0523	022	0	1	01	01	H0523_022_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					10.00	20.00	20.00											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												
H0523	022	0	1	01	01	H0523_022_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					10.00	20.00	20.00											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										1		
H0523	022	0	1	01	01	H0523_022_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												
H0523	022	0	1	01	01	H0523_022_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												
H0523	022	0	1	01	01	H0523_022_0	5			Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1161.87	33						584.12	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0523	031	0	1	01	01	H0523_031_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												
H0523	031	0	1	01	01	H0523_031_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		
H0523	031	0	1	01	01	H0523_031_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					10.00	20.00	20.00											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												
H0523	031	0	1	01	01	H0523_031_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					10.00	20.00	20.00											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										1		
H0523	031	0	1	01	01	H0523_031_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												
H0523	031	0	1	01	01	H0523_031_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												
H0523	031	0	1	01	01	H0523_031_0	5			Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											910.91	33						655.49	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0523	052	0	1	01	01	H0523_052_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												
H0523	052	0	1	01	01	H0523_052_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		
H0523	052	0	1	01	01	H0523_052_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					10.00	20.00	20.00											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												
H0523	052	0	1	01	01	H0523_052_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					10.00	20.00	20.00											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										1		
H0523	052	0	1	01	01	H0523_052_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												
H0523	052	0	1	01	01	H0523_052_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												
H0523	052	0	1	01	01	H0523_052_0	5			Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											534.18	33						577.51	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0523	061	0	1	01	01	H0523_061_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												
H0523	061	0	1	01	01	H0523_061_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		
H0523	061	0	1	01	01	H0523_061_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					10.00	20.00	20.00											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												
H0523	061	0	1	01	01	H0523_061_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					10.00	20.00	20.00											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										1		
H0523	061	0	1	01	01	H0523_061_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												
H0523	061	0	1	01	01	H0523_061_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												
H0523	061	0	1	01	01	H0523_061_0	5			Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											913.81	33						654.59	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0523	065	0	1	01	01	H0523_065_0	6			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												
H0523	065	0	1	01	01	H0523_065_0	6			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
H0523	065	0	1	01	01	H0523_065_0	6			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												
H0523	065	0	1	01	01	H0523_065_0	6			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
H0523	065	0	1	01	01	H0523_065_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					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00					47.00			47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0523	065	0	1	01	01	H0523_065_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					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												
H0523	065	0	1	01	01	H0523_065_0	6			Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											963.33	33						526.08	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0523	066	0	1	01	01	H0523_066_0	5			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												
H0523	066	0	1	01	01	H0523_066_0	5			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
H0523	066	0	1	01	01	H0523_066_0	5			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												
H0523	066	0	1	01	01	H0523_066_0	5			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
H0523	066	0	1	01	01	H0523_066_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					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00					47.00			47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0523	066	0	1	01	01	H0523_066_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					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												
H0523	066	0	1	01	01	H0523_066_0	5			Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											963.33	33						526.08	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0523	067	0	1	01	01	H0523_067_0	5			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												
H0523	067	0	1	01	01	H0523_067_0	5			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
H0523	067	0	1	01	01	H0523_067_0	5			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												
H0523	067	0	1	01	01	H0523_067_0	5			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
H0523	067	0	1	01	01	H0523_067_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					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00					47.00			47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0523	067	0	1	01	01	H0523_067_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					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												
H0523	067	0	1	01	01	H0523_067_0	5			Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											963.33	33						526.08	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0523	068	0	1	01	01	H0523_068_0	5			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												
H0523	068	0	1	01	01	H0523_068_0	5			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
H0523	068	0	1	01	01	H0523_068_0	5			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												
H0523	068	0	1	01	01	H0523_068_0	5			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
H0523	068	0	1	01	01	H0523_068_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					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00					47.00			47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0523	068	0	1	01	01	H0523_068_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					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												
H0523	068	0	1	01	01	H0523_068_0	5			Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											963.33	33						526.08	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0523	069	0	1	01	01	H0523_069_0	5			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												
H0523	069	0	1	01	01	H0523_069_0	5			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
H0523	069	0	1	01	01	H0523_069_0	5			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												
H0523	069	0	1	01	01	H0523_069_0	5			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
H0523	069	0	1	01	01	H0523_069_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					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00					47.00			47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0523	069	0	1	01	01	H0523_069_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					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												
H0523	069	0	1	01	01	H0523_069_0	5			Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											968.70	33						524.86	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0523	070	0	1	01	01	H0523_070_0	5			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												
H0523	070	0	1	01	01	H0523_070_0	5			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
H0523	070	0	1	01	01	H0523_070_0	5			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												
H0523	070	0	1	01	01	H0523_070_0	5			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
H0523	070	0	1	01	01	H0523_070_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					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00					47.00			47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0523	070	0	1	01	01	H0523_070_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					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												
H0523	070	0	1	01	01	H0523_070_0	5			Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											963.33	33						526.08	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0523	071	0	1	01	01	H0523_071_0	5			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												
H0523	071	0	1	01	01	H0523_071_0	5			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
H0523	071	0	1	01	01	H0523_071_0	5			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												
H0523	071	0	1	01	01	H0523_071_0	5			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
H0523	071	0	1	01	01	H0523_071_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					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00					47.00			47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0523	071	0	1	01	01	H0523_071_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					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												
H0523	071	0	1	01	01	H0523_071_0	5			Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											963.33	33						526.08	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0523	072	0	1	01	01	H0523_072_0	5			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												
H0523	072	0	1	01	01	H0523_072_0	5			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
H0523	072	0	1	01	01	H0523_072_0	5			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												
H0523	072	0	1	01	01	H0523_072_0	5			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
H0523	072	0	1	01	01	H0523_072_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					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00					47.00			47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0523	072	0	1	01	01	H0523_072_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					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												
H0523	072	0	1	01	01	H0523_072_0	5			Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											962.83	33						526.19	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0523	073	0	1	01	01	H0523_073_0	5			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												
H0523	073	0	1	01	01	H0523_073_0	5			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
H0523	073	0	1	01	01	H0523_073_0	5			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												
H0523	073	0	1	01	01	H0523_073_0	5			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
H0523	073	0	1	01	01	H0523_073_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					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												
H0523	073	0	1	01	01	H0523_073_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					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												
H0523	073	0	1	01	01	H0523_073_0	5			Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											932.71	33						533.23	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0524	003	0	1	01	01	H0524_003_0	9			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	9			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	9			Generic	4	11	1	2	2	1	111		01	111		1	30	60	100				2	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			0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	003	0	1	01	01	H0524_003_0	9			Generic	4	11	1	2	2	3	111		01	111		1	30	60	100				2	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			0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H0524	003	0	1	01	01	H0524_003_0	9			Preferred Brand	4	10	1	2	3	1	111		01	111		1	30	60	100				2	2	30	60	100				30		31	35.00	70.00	105.00																			35.00	70.00	70.00																35.00				35.00		1.16			1.16			1.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	003	0	1	01	01	H0524_003_0	9			Non-Preferred Brand	4	11	1	2	4	1	111		01	111		1	30	60	100				2	2	30	60	100				30		31	100.00	200.00	300.00																			100.00	200.00	200.00																100.00				100.00		3.33			3.33			3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	003	0	1	01	01	H0524_003_0	9			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	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												
H0524	003	0	1	01	01	H0524_003_0	9			Vaccines	4	10	1	2	6	3	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
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	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	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	0.00	0.00	0.00																			0.00	0.00	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	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	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	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	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	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	45.00	90.00	135.00																			45.00	90.00	90.00																45.00				45.00		1.50			1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	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	013	0	1	01	01	H0524_013_0	9			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	9			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	9			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	013	0	1	01	01	H0524_013_0	9			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	013	0	1	01	01	H0524_013_0	9			Preferred Brand	4	10	1	2	3	1	111		01	111		1	30	60	100				2	2	30	60	100				30		31	45.00	90.00	135.00																			45.00	90.00	90.00																45.00				45.00		1.50			1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	013	0	1	01	01	H0524_013_0	9			Non-Preferred Brand	4	11	1	2	4	1	111		01	111		1	30	60	100				2	2	30	60	100				30		31	100.00	200.00	300.00																			100.00	200.00	200.00																100.00				100.00		3.33			3.33			3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	013	0	1	01	01	H0524_013_0	9			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	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												
H0524	013	0	1	01	01	H0524_013_0	9			Vaccines	4	10	1	2	6	3	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H0524	015	0	1	01	01	H0524_015_0	9			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	9			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	9			Generic	4	11	1	2	2	1	111		01	111		1	30	60	100				2	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			0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	015	0	1	01	01	H0524_015_0	9			Generic	4	11	1	2	2	3	111		01	111		1	30	60	100				2	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			0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H0524	015	0	1	01	01	H0524_015_0	9			Preferred Brand	4	10	1	2	3	1	111		01	111		1	30	60	100				2	2	30	60	100				30		31	35.00	70.00	105.00																			35.00	70.00	70.00																35.00				35.00		1.16			1.16			1.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	015	0	1	01	01	H0524_015_0	9			Non-Preferred Brand	4	11	1	2	4	1	111		01	111		1	30	60	100				2	2	30	60	100				30		31	100.00	200.00	300.00																			100.00	200.00	200.00																100.00				100.00		3.33			3.33			3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	015	0	1	01	01	H0524_015_0	9			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	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												
H0524	015	0	1	01	01	H0524_015_0	9			Vaccines	4	10	1	2	6	3	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H0524	031	0	1	01	01	H0524_031_0	9			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	031	0	1	01	01	H0524_031_0	9			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	031	0	1	01	01	H0524_031_0	9			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	031	0	1	01	01	H0524_031_0	9			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	031	0	1	01	01	H0524_031_0	9			Preferred Brand	4	10	1	2	3	1	111		01	111		1	30	60	100				2	2	30	60	100				30		31	45.00	90.00	135.00																			45.00	90.00	90.00																45.00				45.00		1.50			1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	031	0	1	01	01	H0524_031_0	9			Non-Preferred Brand	4	11	1	2	4	1	111		01	111		1	30	60	100				2	2	30	60	100				30		31	100.00	200.00	300.00																			100.00	200.00	200.00																100.00				100.00		3.33			3.33			3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	031	0	1	01	01	H0524_031_0	9			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	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												
H0524	031	0	1	01	01	H0524_031_0	9			Vaccines	4	10	1	2	6	3	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H0524	032	0	1	01	01	H0524_032_0	9			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	9			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	9			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	032	0	1	01	01	H0524_032_0	9			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	032	0	1	01	01	H0524_032_0	9			Preferred Brand	4	10	1	2	3	1	111		01	111		1	30	60	100				2	2	30	60	100				30		31	45.00	90.00	135.00																			45.00	90.00	90.00																45.00				45.00		1.50			1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	032	0	1	01	01	H0524_032_0	9			Non-Preferred Brand	4	11	1	2	4	1	111		01	111		1	30	60	100				2	2	30	60	100				30		31	100.00	200.00	300.00																			100.00	200.00	200.00																100.00				100.00		3.33			3.33			3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	032	0	1	01	01	H0524_032_0	9			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	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												
H0524	032	0	1	01	01	H0524_032_0	9			Vaccines	4	10	1	2	6	3	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
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	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	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	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	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	45.00	90.00	135.00																			45.00	90.00	90.00																45.00				45.00		1.50			1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	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	9			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	9			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	9			Generic	4	11	1	2	2	1	111		01	111		1	30	60	100				2	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			0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	034	0	1	01	01	H0524_034_0	9			Generic	4	11	1	2	2	3	111		01	111		1	30	60	100				2	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			0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H0524	034	0	1	01	01	H0524_034_0	9			Preferred Brand	4	10	1	2	3	1	111		01	111		1	30	60	100				2	2	30	60	100				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												
H0524	034	0	1	01	01	H0524_034_0	9			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	9			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	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												
H0524	034	0	1	01	01	H0524_034_0	9			Vaccines	4	10	1	2	6	3	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H0524	035	0	1	01	01	H0524_035_0	9			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	9			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	9			Generic	4	11	1	2	2	1	111		01	111		1	30	60	100				2	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			0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	035	0	1	01	01	H0524_035_0	9			Generic	4	11	1	2	2	3	111		01	111		1	30	60	100				2	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			0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H0524	035	0	1	01	01	H0524_035_0	9			Preferred Brand	4	10	1	2	3	1	111		01	111		1	30	60	100				2	2	30	60	100				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												
H0524	035	0	1	01	01	H0524_035_0	9			Non-Preferred Brand	4	11	1	2	4	1	111		01	111		1	30	60	100				2	2	30	60	100				30		31	100.00	200.00	300.00																			100.00	200.00	200.00																100.00				100.00		3.33			3.33			3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	035	0	1	01	01	H0524_035_0	9			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	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												
H0524	035	0	1	01	01	H0524_035_0	9			Vaccines	4	10	1	2	6	3	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H0524	036	0	1	01	01	H0524_036_0	9			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	9			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	9			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	9			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	9			Preferred Brand	4	10	1	2	3	1	111		01	111		1	30	60	100				2	2	30	60	100				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												
H0524	036	0	1	01	01	H0524_036_0	9			Non-Preferred Brand	4	11	1	2	4	1	111		01	111		1	30	60	100				2	2	30	60	100				30		31	100.00	200.00	300.00																			100.00	200.00	200.00																100.00				100.00		3.33			3.33			3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	036	0	1	01	01	H0524_036_0	9			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	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												
H0524	036	0	1	01	01	H0524_036_0	9			Vaccines	4	10	1	2	6	3	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H0524	037	0	1	01	01	H0524_037_0	9			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	9			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	9			Generic	4	11	1	2	2	1	111		01	111		1	30	60	100				2	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			0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	037	0	1	01	01	H0524_037_0	9			Generic	4	11	1	2	2	3	111		01	111		1	30	60	100				2	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			0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H0524	037	0	1	01	01	H0524_037_0	9			Preferred Brand	4	10	1	2	3	1	111		01	111		1	30	60	100				2	2	30	60	100				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												
H0524	037	0	1	01	01	H0524_037_0	9			Non-Preferred Brand	4	11	1	2	4	1	111		01	111		1	30	60	100				2	2	30	60	100				30		31	100.00	200.00	300.00																			100.00	200.00	200.00																100.00				100.00		3.33			3.33			3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	037	0	1	01	01	H0524_037_0	9			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	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												
H0524	037	0	1	01	01	H0524_037_0	9			Vaccines	4	10	1	2	6	3	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H0524	038	0	1	01	01	H0524_038_0	9			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	9			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	9			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	038	0	1	01	01	H0524_038_0	9			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	038	0	1	01	01	H0524_038_0	9			Preferred Brand	4	10	1	2	3	1	111		01	111		1	30	60	100				2	2	30	60	100				30		31	45.00	90.00	135.00																			45.00	90.00	90.00																45.00				45.00		1.50			1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	038	0	1	01	01	H0524_038_0	9			Non-Preferred Brand	4	11	1	2	4	1	111		01	111		1	30	60	100				2	2	30	60	100				30		31	100.00	200.00	300.00																			100.00	200.00	200.00																100.00				100.00		3.33			3.33			3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	038	0	1	01	01	H0524_038_0	9			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	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												
H0524	038	0	1	01	01	H0524_038_0	9			Vaccines	4	10	1	2	6	3	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H0524	039	0	1	01	01	H0524_039_0	9			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	9			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	9			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	039	0	1	01	01	H0524_039_0	9			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	039	0	1	01	01	H0524_039_0	9			Preferred Brand	4	10	1	2	3	1	111		01	111		1	30	60	100				2	2	30	60	100				30		31	45.00	90.00	135.00																			45.00	90.00	90.00																45.00				45.00		1.50			1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	039	0	1	01	01	H0524_039_0	9			Non-Preferred Brand	4	11	1	2	4	1	111		01	111		1	30	60	100				2	2	30	60	100				30		31	100.00	200.00	300.00																			100.00	200.00	200.00																100.00				100.00		3.33			3.33			3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	039	0	1	01	01	H0524_039_0	9			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	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												
H0524	039	0	1	01	01	H0524_039_0	9			Vaccines	4	10	1	2	6	3	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H0524	040	0	1	01	01	H0524_040_0	9			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	9			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	9			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	040	0	1	01	01	H0524_040_0	9			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	040	0	1	01	01	H0524_040_0	9			Preferred Brand	4	10	1	2	3	1	111		01	111		1	30	60	100				2	2	30	60	100				30		31	45.00	90.00	135.00																			45.00	90.00	90.00																45.00				45.00		1.50			1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	040	0	1	01	01	H0524_040_0	9			Non-Preferred Brand	4	11	1	2	4	1	111		01	111		1	30	60	100				2	2	30	60	100				30		31	100.00	200.00	300.00																			100.00	200.00	200.00																100.00				100.00		3.33			3.33			3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	040	0	1	01	01	H0524_040_0	9			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	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												
H0524	040	0	1	01	01	H0524_040_0	9			Vaccines	4	10	1	2	6	3	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H0524	041	0	1	01	01	H0524_041_0	9			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	041	0	1	01	01	H0524_041_0	9			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	041	0	1	01	01	H0524_041_0	9			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	9			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	9			Preferred Brand	4	10	1	2	3	1	111		01	111		1	30	60	100				2	2	30	60	100				30		31	45.00	90.00	135.00																			45.00	90.00	90.00																45.00				45.00		1.50			1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	041	0	1	01	01	H0524_041_0	9			Non-Preferred Brand	4	11	1	2	4	1	111		01	111		1	30	60	100				2	2	30	60	100				30		31	100.00	200.00	300.00																			100.00	200.00	200.00																100.00				100.00		3.33			3.33			3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	041	0	1	01	01	H0524_041_0	9			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	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												
H0524	041	0	1	01	01	H0524_041_0	9			Vaccines	4	10	1	2	6	3	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H0524	042	0	1	01	01	H0524_042_0	9			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	9			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	9			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	042	0	1	01	01	H0524_042_0	9			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	042	0	1	01	01	H0524_042_0	9			Preferred Brand	4	10	1	2	3	1	111		01	111		1	30	60	100				2	2	30	60	100				30		31	45.00	90.00	135.00																			45.00	90.00	90.00																45.00				45.00		1.50			1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	042	0	1	01	01	H0524_042_0	9			Non-Preferred Brand	4	11	1	2	4	1	111		01	111		1	30	60	100				2	2	30	60	100				30		31	100.00	200.00	300.00																			100.00	200.00	200.00																100.00				100.00		3.33			3.33			3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	042	0	1	01	01	H0524_042_0	9			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	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												
H0524	042	0	1	01	01	H0524_042_0	9			Vaccines	4	10	1	2	6	3	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H0524	043	0	1	01	01	H0524_043_0	9			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	043	0	1	01	01	H0524_043_0	9			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	043	0	1	01	01	H0524_043_0	9			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	9			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	9			Preferred Brand	4	10	1	2	3	1	111		01	111		1	30	60	100				2	2	30	60	100				30		31	45.00	90.00	135.00																			45.00	90.00	90.00																45.00				45.00		1.50			1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	043	0	1	01	01	H0524_043_0	9			Non-Preferred Brand	4	11	1	2	4	1	111		01	111		1	30	60	100				2	2	30	60	100				30		31	100.00	200.00	300.00																			100.00	200.00	200.00																100.00				100.00		3.33			3.33			3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	043	0	1	01	01	H0524_043_0	9			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	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												
H0524	043	0	1	01	01	H0524_043_0	9			Vaccines	4	10	1	2	6	3	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H0524	046	0	1	01	01	H0524_046_0	9			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	046	0	1	01	01	H0524_046_0	9			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	046	0	1	01	01	H0524_046_0	9			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	9			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	9			Preferred Brand	4	10	1	2	3	1	111		01	111		1	30	60	100				2	2	30	60	100				30		31	45.00	90.00	135.00																			45.00	90.00	90.00																45.00				45.00		1.50			1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	046	0	1	01	01	H0524_046_0	9			Non-Preferred Brand	4	11	1	2	4	1	111		01	111		1	30	60	100				2	2	30	60	100				30		31	100.00	200.00	300.00																			100.00	200.00	200.00																100.00				100.00		3.33			3.33			3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	046	0	1	01	01	H0524_046_0	9			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	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												
H0524	046	0	1	01	01	H0524_046_0	9			Vaccines	4	10	1	2	6	3	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H0524	051	0	1	01	01	H0524_051_0	9			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	051	0	1	01	01	H0524_051_0	9			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	051	0	1	01	01	H0524_051_0	9			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	051	0	1	01	01	H0524_051_0	9			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	051	0	1	01	01	H0524_051_0	9			Preferred Brand	4	10	1	2	3	1	111		01	111		1	30	60	100				2	2	30	60	100				30		31	45.00	90.00	135.00																			45.00	90.00	90.00																45.00				45.00		1.50			1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	051	0	1	01	01	H0524_051_0	9			Non-Preferred Brand	4	11	1	2	4	1	111		01	111		1	30	60	100				2	2	30	60	100				30		31	100.00	200.00	300.00																			100.00	200.00	200.00																100.00				100.00		3.33			3.33			3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	051	0	1	01	01	H0524_051_0	9			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	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												
H0524	051	0	1	01	01	H0524_051_0	9			Vaccines	4	10	1	2	6	3	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H0524	054	0	1	01	01	H0524_054_0	9			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	9			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	9			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	054	0	1	01	01	H0524_054_0	9			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	054	0	1	01	01	H0524_054_0	9			Preferred Brand	4	10	1	2	3	1	111		01	111		1	30	60	100				2	2	30	60	100				30		31	45.00	90.00	135.00																			45.00	90.00	90.00																45.00				45.00		1.50			1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	054	0	1	01	01	H0524_054_0	9			Non-Preferred Brand	4	11	1	2	4	1	111		01	111		1	30	60	100				2	2	30	60	100				30		31	100.00	200.00	300.00																			100.00	200.00	200.00																100.00				100.00		3.33			3.33			3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	054	0	1	01	01	H0524_054_0	9			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	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												
H0524	054	0	1	01	01	H0524_054_0	9			Vaccines	4	10	1	2	6	3	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H0524	059	0	1	01	01	H0524_059_0	9			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	059	0	1	01	01	H0524_059_0	9			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	059	0	1	01	01	H0524_059_0	9			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	059	0	1	01	01	H0524_059_0	9			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	059	0	1	01	01	H0524_059_0	9			Preferred Brand	4	10	1	2	3	1	111		01	111		1	30	60	100				2	2	30	60	100				30		31	45.00	90.00	135.00																			45.00	90.00	90.00																45.00				45.00		1.50			1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	059	0	1	01	01	H0524_059_0	9			Non-Preferred Brand	4	11	1	2	4	1	111		01	111		1	30	60	100				2	2	30	60	100				30		31	100.00	200.00	300.00																			100.00	200.00	200.00																100.00				100.00		3.33			3.33			3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	059	0	1	01	01	H0524_059_0	9			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	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												
H0524	059	0	1	01	01	H0524_059_0	9			Vaccines	4	10	1	2	6	3	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H0524	060	0	1	01	01	H0524_060_0	9			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	060	0	1	01	01	H0524_060_0	9			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	060	0	1	01	01	H0524_060_0	9			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	060	0	1	01	01	H0524_060_0	9			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	060	0	1	01	01	H0524_060_0	9			Preferred Brand	4	10	1	2	3	1	111		01	111		1	30	60	100				2	2	30	60	100				30		31	45.00	90.00	135.00																			45.00	90.00	90.00																45.00				45.00		1.50			1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	060	0	1	01	01	H0524_060_0	9			Non-Preferred Brand	4	11	1	2	4	1	111		01	111		1	30	60	100				2	2	30	60	100				30		31	100.00	200.00	300.00																			100.00	200.00	200.00																100.00				100.00		3.33			3.33			3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	060	0	1	01	01	H0524_060_0	9			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	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												
H0524	060	0	1	01	01	H0524_060_0	9			Vaccines	4	10	1	2	6	3	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
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	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	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	0.00	0.00	0.00																			0.00	0.00	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	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	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	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	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	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	45.00	90.00	135.00																			45.00	90.00	90.00																45.00				45.00		1.50			1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	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	9			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	062	0	1	01	01	H0524_062_0	9			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	062	0	1	01	01	H0524_062_0	9			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	062	0	1	01	01	H0524_062_0	9			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	062	0	1	01	01	H0524_062_0	9			Preferred Brand	4	10	1	2	3	1	111		01	111		1	30	60	100				2	2	30	60	100				30		31	45.00	90.00	135.00																			45.00	90.00	90.00																45.00				45.00		1.50			1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	062	0	1	01	01	H0524_062_0	9			Non-Preferred Brand	4	11	1	2	4	1	111		01	111		1	30	60	100				2	2	30	60	100				30		31	100.00	200.00	300.00																			100.00	200.00	200.00																100.00				100.00		3.33			3.33			3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	062	0	1	01	01	H0524_062_0	9			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	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												
H0524	062	0	1	01	01	H0524_062_0	9			Vaccines	4	10	1	2	6	3	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
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	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	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	0.00	0.00	0.00																			0.00	0.00	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	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	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	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	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	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	45.00	90.00	135.00																			45.00	90.00	90.00																45.00				45.00		1.50			1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	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	9			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	064	0	1	01	01	H0524_064_0	9			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	064	0	1	01	01	H0524_064_0	9			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	064	0	1	01	01	H0524_064_0	9			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	064	0	1	01	01	H0524_064_0	9			Preferred Brand	4	10	1	2	3	1	111		01	111		1	30	60	100				2	2	30	60	100				30		31	45.00	90.00	135.00																			45.00	90.00	90.00																45.00				45.00		1.50			1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	064	0	1	01	01	H0524_064_0	9			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	9			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	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												
H0524	064	0	1	01	01	H0524_064_0	9			Vaccines	4	10	1	2	6	3	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H0524	065	0	1	01	01	H0524_065_0	9			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	065	0	1	01	01	H0524_065_0	9			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	065	0	1	01	01	H0524_065_0	9			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	065	0	1	01	01	H0524_065_0	9			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	065	0	1	01	01	H0524_065_0	9			Preferred Brand	4	10	1	2	3	1	111		01	111		1	30	60	100				2	2	30	60	100				30		31	45.00	90.00	135.00																			45.00	90.00	90.00																45.00				45.00		1.50			1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	065	0	1	01	01	H0524_065_0	9			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	9			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	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												
H0524	065	0	1	01	01	H0524_065_0	9			Vaccines	4	10	1	2	6	3	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H0524	078	0	1	01	01	H0524_078_0	9			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	078	0	1	01	01	H0524_078_0	9			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	078	0	1	01	01	H0524_078_0	9			Generic	4	11	1	2	2	1	111		01	111		1	30	60	100				2	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			0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	078	0	1	01	01	H0524_078_0	9			Generic	4	11	1	2	2	3	111		01	111		1	30	60	100				2	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			0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H0524	078	0	1	01	01	H0524_078_0	9			Preferred Brand	4	10	1	2	3	1	111		01	111		1	30	60	100				2	2	30	60	100				30		31	35.00	70.00	105.00																			35.00	70.00	70.00																35.00				35.00		1.16			1.16			1.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	078	0	1	01	01	H0524_078_0	9			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	078	0	1	01	01	H0524_078_0	9			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	078	0	1	01	01	H0524_078_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												
H0524	078	0	1	01	01	H0524_078_0	9			Vaccines	4	10	1	2	6	3	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H0524	081	0	1	01	01	H0524_081_0	9			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	081	0	1	01	01	H0524_081_0	9			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	081	0	1	01	01	H0524_081_0	9			Generic	4	11	1	2	2	1	111		01	111		1	30	60	100				2	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			0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	081	0	1	01	01	H0524_081_0	9			Generic	4	11	1	2	2	3	111		01	111		1	30	60	100				2	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			0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H0524	081	0	1	01	01	H0524_081_0	9			Preferred Brand	4	10	1	2	3	1	111		01	111		1	30	60	100				2	2	30	60	100				30		31	35.00	70.00	105.00																			35.00	70.00	70.00																35.00				35.00		1.16			1.16			1.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	081	0	1	01	01	H0524_081_0	9			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	081	0	1	01	01	H0524_081_0	9			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	081	0	1	01	01	H0524_081_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												
H0524	081	0	1	01	01	H0524_081_0	9			Vaccines	4	10	1	2	6	3	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H0524	082	0	1	01	01	H0524_082_0	9			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	082	0	1	01	01	H0524_082_0	9			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	082	0	1	01	01	H0524_082_0	9			Generic	4	11	1	2	2	1	111		01	111		1	30	60	100				2	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			0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	082	0	1	01	01	H0524_082_0	9			Generic	4	11	1	2	2	3	111		01	111		1	30	60	100				2	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			0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H0524	082	0	1	01	01	H0524_082_0	9			Preferred Brand	4	10	1	2	3	1	111		01	111		1	30	60	100				2	2	30	60	100				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												
H0524	082	0	1	01	01	H0524_082_0	9			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	082	0	1	01	01	H0524_082_0	9			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	082	0	1	01	01	H0524_082_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												
H0524	082	0	1	01	01	H0524_082_0	9			Vaccines	4	10	1	2	6	3	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H0524	083	0	1	01	01	H0524_083_0	8			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	083	0	1	01	01	H0524_083_0	8			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	083	0	1	01	01	H0524_083_0	8			Generic	4	11	1	2	2	1	111		01	111		1	30	60	100				2	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			0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	083	0	1	01	01	H0524_083_0	8			Generic	4	11	1	2	2	3	111		01	111		1	30	60	100				2	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			0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H0524	083	0	1	01	01	H0524_083_0	8			Preferred Brand	4	10	1	2	3	1	111		01	111		1	30	60	100				2	2	30	60	100				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												
H0524	083	0	1	01	01	H0524_083_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	200.00																100.00				100.00		3.33			3.33			3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	083	0	1	01	01	H0524_083_0	8			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	083	0	1	01	01	H0524_083_0	8			Vaccines	4	10	1	2	6	1	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	083	0	1	01	01	H0524_083_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		
H0543	013	0	1	02	01	H0543_013_0	2		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	4.00		12.00																											12.00						0.00				4.00				4.00		0.13						0.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	013	0	1	02	01	H0543_013_0	2		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	4.00		12.00																											12.00						0.00				4.00				4.00		0.13						0.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H0543	013	0	1	02	01	H0543_013_0	2		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	013	0	1	02	01	H0543_013_0	2		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H0543	013	0	1	02	01	H0543_013_0	2		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	013	0	1	02	01	H0543_013_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	013	0	1	02	01	H0543_013_0	2		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				389.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	019	0	1	02	01	H0543_019_0	2		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	019	0	1	02	01	H0543_019_0	2		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H0543	019	0	1	02	01	H0543_019_0	2		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	019	0	1	02	01	H0543_019_0	2		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H0543	019	0	1	02	01	H0543_019_0	2		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	019	0	1	02	01	H0543_019_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	019	0	1	02	01	H0543_019_0	2		Y	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	022	0	1	02	01	H0543_022_0	2		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	022	0	1	02	01	H0543_022_0	2		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H0543	022	0	1	02	01	H0543_022_0	2		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	022	0	1	02	01	H0543_022_0	2		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H0543	022	0	1	02	01	H0543_022_0	2		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	022	0	1	02	01	H0543_022_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	022	0	1	02	01	H0543_022_0	2		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				573.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	028	0	1	02	01	H0543_028_0	2		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	028	0	1	02	01	H0543_028_0	2		Y	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	02	01	H0543_028_0	2		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	028	0	1	02	01	H0543_028_0	2		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H0543	028	0	1	02	01	H0543_028_0	2		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	028	0	1	02	01	H0543_028_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	028	0	1	02	01	H0543_028_0	2		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				296.00	27																										27						27					27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	029	0	1	02	01	H0543_029_0	2		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	029	0	1	02	01	H0543_029_0	2		Y	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	02	01	H0543_029_0	2		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	029	0	1	02	01	H0543_029_0	2		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H0543	029	0	1	02	01	H0543_029_0	2		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	029	0	1	02	01	H0543_029_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	029	0	1	02	01	H0543_029_0	2		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				320.00	27																										27						27					27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	035	0	1	02	01	H0543_035_0	2		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	035	0	1	02	01	H0543_035_0	2		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H0543	035	0	1	02	01	H0543_035_0	2		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	035	0	1	02	01	H0543_035_0	2		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H0543	035	0	1	02	01	H0543_035_0	2		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	035	0	1	02	01	H0543_035_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	035	0	1	02	01	H0543_035_0	2		Y	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	036	0	1	02	01	H0543_036_0	2		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	036	0	1	02	01	H0543_036_0	2		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H0543	036	0	1	02	01	H0543_036_0	2		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	036	0	1	02	01	H0543_036_0	2		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H0543	036	0	1	02	01	H0543_036_0	2		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	036	0	1	02	01	H0543_036_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	036	0	1	02	01	H0543_036_0	2		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				435.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	060	0	1	02	01	H0543_060_0	2		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	4.00		12.00																											12.00						0.00				4.00				4.00		0.13						0.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	060	0	1	02	01	H0543_060_0	2		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	4.00		12.00																											12.00						0.00				4.00				4.00		0.13						0.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H0543	060	0	1	02	01	H0543_060_0	2		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	060	0	1	02	01	H0543_060_0	2		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H0543	060	0	1	02	01	H0543_060_0	2		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	060	0	1	02	01	H0543_060_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	060	0	1	02	01	H0543_060_0	2		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				424.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	070	0	1	02	01	H0543_070_0	2		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	070	0	1	02	01	H0543_070_0	2		Y	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	02	01	H0543_070_0	2		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	070	0	1	02	01	H0543_070_0	2		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H0543	070	0	1	02	01	H0543_070_0	2		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	070	0	1	02	01	H0543_070_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	070	0	1	02	01	H0543_070_0	2		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				385.00	27																										27						27					27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	086	0	1	02	01	H0543_086_0	2		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	086	0	1	02	01	H0543_086_0	2		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H0543	086	0	1	02	01	H0543_086_0	2		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	086	0	1	02	01	H0543_086_0	2		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H0543	086	0	1	02	01	H0543_086_0	2		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	086	0	1	02	01	H0543_086_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	086	0	1	02	01	H0543_086_0	2		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				500.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	089	0	1	02	01	H0543_089_0	2		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	089	0	1	02	01	H0543_089_0	2		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H0543	089	0	1	02	01	H0543_089_0	2		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	089	0	1	02	01	H0543_089_0	2		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H0543	089	0	1	02	01	H0543_089_0	2		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	089	0	1	02	01	H0543_089_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	089	0	1	02	01	H0543_089_0	2		Y	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												
H0543	140	0	1	02	01	H0543_140_0	2		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	140	0	1	02	01	H0543_140_0	2		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H0543	140	0	1	02	01	H0543_140_0	2		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	140	0	1	02	01	H0543_140_0	2		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H0543	140	0	1	02	01	H0543_140_0	2		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	140	0	1	02	01	H0543_140_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	140	0	1	02	01	H0543_140_0	2		Y	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	145	0	1	02	01	H0543_145_0	2		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	4.00		12.00																											12.00						0.00				4.00				4.00		0.13						0.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	145	0	1	02	01	H0543_145_0	2		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	4.00		12.00																											12.00						0.00				4.00				4.00		0.13						0.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H0543	145	0	1	02	01	H0543_145_0	2		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	145	0	1	02	01	H0543_145_0	2		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H0543	145	0	1	02	01	H0543_145_0	2		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	145	0	1	02	01	H0543_145_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	145	0	1	02	01	H0543_145_0	2		Y	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												
H0543	146	0	1	02	01	H0543_146_0	2		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	146	0	1	02	01	H0543_146_0	2		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H0543	146	0	1	02	01	H0543_146_0	2		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	146	0	1	02	01	H0543_146_0	2		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H0543	146	0	1	02	01	H0543_146_0	2		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	146	0	1	02	01	H0543_146_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	146	0	1	02	01	H0543_146_0	2		Y	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	147	0	1	02	01	H0543_147_0	2		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	147	0	1	02	01	H0543_147_0	2		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H0543	147	0	1	02	01	H0543_147_0	2		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	147	0	1	02	01	H0543_147_0	2		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H0543	147	0	1	02	01	H0543_147_0	2		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	147	0	1	02	01	H0543_147_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	147	0	1	02	01	H0543_147_0	2		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				650.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	148	0	1	02	01	H0543_148_0	2		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	148	0	1	02	01	H0543_148_0	2		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H0543	148	0	1	02	01	H0543_148_0	2		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	148	0	1	02	01	H0543_148_0	2		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H0543	148	0	1	02	01	H0543_148_0	2		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	148	0	1	02	01	H0543_148_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	148	0	1	02	01	H0543_148_0	2		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				530.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	151	0	1	02	01	H0543_151_0	2		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	151	0	1	02	01	H0543_151_0	2		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H0543	151	0	1	02	01	H0543_151_0	2		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	151	0	1	02	01	H0543_151_0	2		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H0543	151	0	1	02	01	H0543_151_0	2		Y	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	02	01	H0543_151_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	151	0	1	02	01	H0543_151_0	2		Y	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												
H0543	152	0	1	02	01	H0543_152_0	2		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	152	0	1	02	01	H0543_152_0	2		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H0543	152	0	1	02	01	H0543_152_0	2		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	5.00		15.00																											15.00						0.00				5.00				5.00		0.16						0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	152	0	1	02	01	H0543_152_0	2		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	5.00		15.00																											15.00						0.00				5.00				5.00		0.16						0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H0543	152	0	1	02	01	H0543_152_0	2		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	152	0	1	02	01	H0543_152_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	152	0	1	02	01	H0543_152_0	2		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				568.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	164	0	1	02	01	H0543_164_0	2		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	164	0	1	02	01	H0543_164_0	2		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H0543	164	0	1	02	01	H0543_164_0	2		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	164	0	1	02	01	H0543_164_0	2		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H0543	164	0	1	02	01	H0543_164_0	2		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	164	0	1	02	01	H0543_164_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	164	0	1	02	01	H0543_164_0	2		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				488.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	165	0	1	02	01	H0543_165_0	2		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	165	0	1	02	01	H0543_165_0	2		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H0543	165	0	1	02	01	H0543_165_0	2		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	165	0	1	02	01	H0543_165_0	2		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H0543	165	0	1	02	01	H0543_165_0	2		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	165	0	1	02	01	H0543_165_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	165	0	1	02	01	H0543_165_0	2		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				441.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	166	0	1	02	01	H0543_166_0	2		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	166	0	1	02	01	H0543_166_0	2		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H0543	166	0	1	02	01	H0543_166_0	2		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	166	0	1	02	01	H0543_166_0	2		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H0543	166	0	1	02	01	H0543_166_0	2		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	166	0	1	02	01	H0543_166_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	166	0	1	02	01	H0543_166_0	2		Y	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												
H0543	167	0	1	02	01	H0543_167_0	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	167	0	1	02	01	H0543_167_0	3		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H0543	167	0	1	02	01	H0543_167_0	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	167	0	1	02	01	H0543_167_0	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H0543	167	0	1	02	01	H0543_167_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	167	0	1	02	01	H0543_167_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	167	0	1	02	01	H0543_167_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				400.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	168	0	1	02	01	H0543_168_0	2		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	168	0	1	02	01	H0543_168_0	2		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H0543	168	0	1	02	01	H0543_168_0	2		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	168	0	1	02	01	H0543_168_0	2		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H0543	168	0	1	02	01	H0543_168_0	2		Y	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	02	01	H0543_168_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	168	0	1	02	01	H0543_168_0	2		Y	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												
H0543	169	0	1	02	01	H0543_169_0	2		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	169	0	1	02	01	H0543_169_0	2		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H0543	169	0	1	02	01	H0543_169_0	2		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	169	0	1	02	01	H0543_169_0	2		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H0543	169	0	1	02	01	H0543_169_0	2		Y	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	02	01	H0543_169_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	169	0	1	02	01	H0543_169_0	2		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				503.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	170	0	1	02	01	H0543_170_0	2		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	170	0	1	02	01	H0543_170_0	2		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H0543	170	0	1	02	01	H0543_170_0	2		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	170	0	1	02	01	H0543_170_0	2		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H0543	170	0	1	02	01	H0543_170_0	2		Y	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	02	01	H0543_170_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	170	0	1	02	01	H0543_170_0	2		Y	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												
H0543	176	0	1	02	01	H0543_176_0	2		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	176	0	1	02	01	H0543_176_0	2		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H0543	176	0	1	02	01	H0543_176_0	2		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	176	0	1	02	01	H0543_176_0	2		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H0543	176	0	1	02	01	H0543_176_0	2		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	176	0	1	02	01	H0543_176_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	176	0	1	02	01	H0543_176_0	2		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				488.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	177	0	1	02	01	H0543_177_0	2		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	177	0	1	02	01	H0543_177_0	2		Y	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	02	01	H0543_177_0	2		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	177	0	1	02	01	H0543_177_0	2		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H0543	177	0	1	02	01	H0543_177_0	2		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	177	0	1	02	01	H0543_177_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	177	0	1	02	01	H0543_177_0	2		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				362.00	29																										29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	178	0	1	02	01	H0543_178_0	2		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	178	0	1	02	01	H0543_178_0	2		Y	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	02	01	H0543_178_0	2		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	178	0	1	02	01	H0543_178_0	2		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H0543	178	0	1	02	01	H0543_178_0	2		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	178	0	1	02	01	H0543_178_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	178	0	1	02	01	H0543_178_0	2		Y	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	179	0	1	02	01	H0543_179_0	2		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	179	0	1	02	01	H0543_179_0	2		Y	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	02	01	H0543_179_0	2		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	179	0	1	02	01	H0543_179_0	2		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H0543	179	0	1	02	01	H0543_179_0	2		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	179	0	1	02	01	H0543_179_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	179	0	1	02	01	H0543_179_0	2		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				233.00	27																										27						27					27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	188	0	1	02	01	H0543_188_0	2		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	188	0	1	02	01	H0543_188_0	2		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H0543	188	0	1	02	01	H0543_188_0	2		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	188	0	1	02	01	H0543_188_0	2		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H0543	188	0	1	02	01	H0543_188_0	2		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	188	0	1	02	01	H0543_188_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	188	0	1	02	01	H0543_188_0	2		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				444.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	189	0	1	02	01	H0543_189_0	2		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	189	0	1	02	01	H0543_189_0	2		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H0543	189	0	1	02	01	H0543_189_0	2		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	189	0	1	02	01	H0543_189_0	2		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H0543	189	0	1	02	01	H0543_189_0	2		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	189	0	1	02	01	H0543_189_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	189	0	1	02	01	H0543_189_0	2		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				416.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	191	0	1	02	01	H0543_191_0	2		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	191	0	1	02	01	H0543_191_0	2		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H0543	191	0	1	02	01	H0543_191_0	2		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	191	0	1	02	01	H0543_191_0	2		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H0543	191	0	1	02	01	H0543_191_0	2		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	191	0	1	02	01	H0543_191_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	191	0	1	02	01	H0543_191_0	2		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				524.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	193	0	1	02	01	H0543_193_0	2		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	193	0	1	02	01	H0543_193_0	2		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H0543	193	0	1	02	01	H0543_193_0	2		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	193	0	1	02	01	H0543_193_0	2		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H0543	193	0	1	02	01	H0543_193_0	2		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	193	0	1	02	01	H0543_193_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	193	0	1	02	01	H0543_193_0	2		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				504.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	195	0	1	02	01	H0543_195_0	2		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	195	0	1	02	01	H0543_195_0	2		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H0543	195	0	1	02	01	H0543_195_0	2		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	195	0	1	02	01	H0543_195_0	2		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H0543	195	0	1	02	01	H0543_195_0	2		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	195	0	1	02	01	H0543_195_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	195	0	1	02	01	H0543_195_0	2		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				365.00	30																										30						30					30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	196	0	1	02	01	H0543_196_0	2		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	196	0	1	02	01	H0543_196_0	2		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H0543	196	0	1	02	01	H0543_196_0	2		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	196	0	1	02	01	H0543_196_0	2		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H0543	196	0	1	02	01	H0543_196_0	2		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	196	0	1	02	01	H0543_196_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	196	0	1	02	01	H0543_196_0	2		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				319.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	204	0	1	02	01	H0543_204_0	2		Y	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		100	2	2						100	30		31								10.00		30.00					0.00		0.00													30.00						0.00				10.00				10.00			0.33	0.00				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	204	0	1	02	01	H0543_204_0	2		Y	Preferred Generic	4	01	1	2	1	3		110	01		100	1				30		100	2	2						100	30		31								10.00		30.00					0.00		0.00													30.00						0.00				10.00				10.00			0.33	0.00				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H0543	204	0	1	02	01	H0543_204_0	2		Y	Generic	4	01	3	2	2	1		110	01		100	1				30		100	2	2						100	30		31								20.00		60.00					0.00		0.00													60.00						0.00				20.00				20.00			0.66	0.00				0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	204	0	1	02	01	H0543_204_0	2		Y	Generic	4	01	3	2	2	3		110	01		100	1				30		100	2	2						100	30		31								20.00		60.00					0.00		0.00													60.00						0.00				20.00				20.00			0.66	0.00				0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H0543	204	0	1	02	01	H0543_204_0	2		Y	Preferred Brand	4	11	1	2	3	1		110	01		100	1				30		100	2	2						100	30		31								47.00		141.00					47.00		131.00													141.00						131.00				47.00				47.00			1.56	1.56				1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	204	0	1	02	01	H0543_204_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1		110	01		100	1				30		100	2	2						100	30		31								100.00		300.00					100.00		290.00													300.00						290.00				100.00				100.00			3.33	3.33				3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	204	0	1	02	01	H0543_204_0	2		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											453.00	33						463.00	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	205	0	1	02	01	H0543_205_0	2		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	205	0	1	02	01	H0543_205_0	2		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H0543	205	0	1	02	01	H0543_205_0	2		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	205	0	1	02	01	H0543_205_0	2		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H0543	205	0	1	02	01	H0543_205_0	2		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	205	0	1	02	01	H0543_205_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	205	0	1	02	01	H0543_205_0	2		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				433.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	209	0	1	02	01	H0543_209_0	2		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	209	0	1	02	01	H0543_209_0	2		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H0543	209	0	1	02	01	H0543_209_0	2		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	209	0	1	02	01	H0543_209_0	2		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H0543	209	0	1	02	01	H0543_209_0	2		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	209	0	1	02	01	H0543_209_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	209	0	1	02	01	H0543_209_0	2		Y	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	210	0	1	02	01	H0543_210_0	2		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	210	0	1	02	01	H0543_210_0	2		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H0543	210	0	1	02	01	H0543_210_0	2		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	210	0	1	02	01	H0543_210_0	2		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H0543	210	0	1	02	01	H0543_210_0	2		Y	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	2		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	210	0	1	02	01	H0543_210_0	2		Y	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												
H0543	214	0	1	02	01	H0543_214_0	2		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	214	0	1	02	01	H0543_214_0	2		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H0543	214	0	1	02	01	H0543_214_0	2		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	214	0	1	02	01	H0543_214_0	2		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H0543	214	0	1	02	01	H0543_214_0	2		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	214	0	1	02	01	H0543_214_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	214	0	1	02	01	H0543_214_0	2		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				536.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	215	0	1	02	01	H0543_215_0	2		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	215	0	1	02	01	H0543_215_0	2		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H0543	215	0	1	02	01	H0543_215_0	2		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	215	0	1	02	01	H0543_215_0	2		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H0543	215	0	1	02	01	H0543_215_0	2		Y	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	2		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	215	0	1	02	01	H0543_215_0	2		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				524.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	216	0	1	02	01	H0543_216_0	2		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	216	0	1	02	01	H0543_216_0	2		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H0543	216	0	1	02	01	H0543_216_0	2		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	216	0	1	02	01	H0543_216_0	2		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H0543	216	0	1	02	01	H0543_216_0	2		Y	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	2		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	216	0	1	02	01	H0543_216_0	2		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				590.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	217	0	1	02	01	H0543_217_0	2		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	217	0	1	02	01	H0543_217_0	2		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H0543	217	0	1	02	01	H0543_217_0	2		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	217	0	1	02	01	H0543_217_0	2		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H0543	217	0	1	02	01	H0543_217_0	2		Y	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	02	01	H0543_217_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	217	0	1	02	01	H0543_217_0	2		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				454.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	218	0	1	02	01	H0543_218_0	2		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	218	0	1	02	01	H0543_218_0	2		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H0543	218	0	1	02	01	H0543_218_0	2		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	218	0	1	02	01	H0543_218_0	2		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H0543	218	0	1	02	01	H0543_218_0	2		Y	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	02	01	H0543_218_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	218	0	1	02	01	H0543_218_0	2		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				469.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	219	0	1	02	01	H0543_219_0	2		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	219	0	1	02	01	H0543_219_0	2		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H0543	219	0	1	02	01	H0543_219_0	2		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	219	0	1	02	01	H0543_219_0	2		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H0543	219	0	1	02	01	H0543_219_0	2		Y	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	02	01	H0543_219_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	219	0	1	02	01	H0543_219_0	2		Y	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												
H0543	220	0	1	02	01	H0543_220_0	2		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	220	0	1	02	01	H0543_220_0	2		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H0543	220	0	1	02	01	H0543_220_0	2		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	220	0	1	02	01	H0543_220_0	2		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H0543	220	0	1	02	01	H0543_220_0	2		Y	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	02	01	H0543_220_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	220	0	1	02	01	H0543_220_0	2		Y	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												
H0543	221	0	1	02	01	H0543_221_0	2		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	221	0	1	02	01	H0543_221_0	2		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H0543	221	0	1	02	01	H0543_221_0	2		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	221	0	1	02	01	H0543_221_0	2		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H0543	221	0	1	02	01	H0543_221_0	2		Y	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	02	01	H0543_221_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	221	0	1	02	01	H0543_221_0	2		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				474.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	222	0	1	02	01	H0543_222_0	2		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	222	0	1	02	01	H0543_222_0	2		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H0543	222	0	1	02	01	H0543_222_0	2		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	222	0	1	02	01	H0543_222_0	2		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H0543	222	0	1	02	01	H0543_222_0	2		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	222	0	1	02	01	H0543_222_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	222	0	1	02	01	H0543_222_0	2		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				518.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	223	0	1	02	01	H0543_223_0	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	223	0	1	02	01	H0543_223_0	3		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H0543	223	0	1	02	01	H0543_223_0	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	223	0	1	02	01	H0543_223_0	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H0543	223	0	1	02	01	H0543_223_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	223	0	1	02	01	H0543_223_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	223	0	1	02	01	H0543_223_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				475.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	224	0	1	02	01	H0543_224_0	2		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	224	0	1	02	01	H0543_224_0	2		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H0543	224	0	1	02	01	H0543_224_0	2		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	224	0	1	02	01	H0543_224_0	2		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H0543	224	0	1	02	01	H0543_224_0	2		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	224	0	1	02	01	H0543_224_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	224	0	1	02	01	H0543_224_0	2		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				481.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	225	0	1	02	01	H0543_225_0	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	225	0	1	02	01	H0543_225_0	3		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H0543	225	0	1	02	01	H0543_225_0	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	225	0	1	02	01	H0543_225_0	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H0543	225	0	1	02	01	H0543_225_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	225	0	1	02	01	H0543_225_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	225	0	1	02	01	H0543_225_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				568.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	226	0	1	02	01	H0543_226_0	2		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	226	0	1	02	01	H0543_226_0	2		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H0543	226	0	1	02	01	H0543_226_0	2		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	226	0	1	02	01	H0543_226_0	2		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H0543	226	0	1	02	01	H0543_226_0	2		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	226	0	1	02	01	H0543_226_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	226	0	1	02	01	H0543_226_0	2		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				469.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	227	0	1	02	01	H0543_227_0	2		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	227	0	1	02	01	H0543_227_0	2		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H0543	227	0	1	02	01	H0543_227_0	2		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	227	0	1	02	01	H0543_227_0	2		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H0543	227	0	1	02	01	H0543_227_0	2		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	227	0	1	02	01	H0543_227_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	227	0	1	02	01	H0543_227_0	2		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				469.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	228	0	1	02	01	H0543_228_0	2		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	228	0	1	02	01	H0543_228_0	2		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H0543	228	0	1	02	01	H0543_228_0	2		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	228	0	1	02	01	H0543_228_0	2		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H0543	228	0	1	02	01	H0543_228_0	2		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	228	0	1	02	01	H0543_228_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	228	0	1	02	01	H0543_228_0	2		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				474.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	229	0	1	02	01	H0543_229_0	2		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	229	0	1	02	01	H0543_229_0	2		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H0543	229	0	1	02	01	H0543_229_0	2		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	229	0	1	02	01	H0543_229_0	2		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H0543	229	0	1	02	01	H0543_229_0	2		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	229	0	1	02	01	H0543_229_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	229	0	1	02	01	H0543_229_0	2		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				320.00	27																										27						27					27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	230	0	1	02	01	H0543_230_0	2		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	230	0	1	02	01	H0543_230_0	2		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H0543	230	0	1	02	01	H0543_230_0	2		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	230	0	1	02	01	H0543_230_0	2		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H0543	230	0	1	02	01	H0543_230_0	2		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	230	0	1	02	01	H0543_230_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	230	0	1	02	01	H0543_230_0	2		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				338.00	29																										29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	231	0	1	02	01	H0543_231_0	2		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	231	0	1	02	01	H0543_231_0	2		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H0543	231	0	1	02	01	H0543_231_0	2		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	231	0	1	02	01	H0543_231_0	2		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H0543	231	0	1	02	01	H0543_231_0	2		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	231	0	1	02	01	H0543_231_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	231	0	1	02	01	H0543_231_0	2		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				474.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	232	0	1	02	01	H0543_232_0	2		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	232	0	1	02	01	H0543_232_0	2		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H0543	232	0	1	02	01	H0543_232_0	2		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	232	0	1	02	01	H0543_232_0	2		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H0543	232	0	1	02	01	H0543_232_0	2		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	232	0	1	02	01	H0543_232_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	232	0	1	02	01	H0543_232_0	2		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				474.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	234	0	1	02	01	H0543_234_0	2		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	234	0	1	02	01	H0543_234_0	2		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H0543	234	0	1	02	01	H0543_234_0	2		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	234	0	1	02	01	H0543_234_0	2		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H0543	234	0	1	02	01	H0543_234_0	2		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	234	0	1	02	01	H0543_234_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	234	0	1	02	01	H0543_234_0	2		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				474.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	235	0	1	02	01	H0543_235_0	2		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	235	0	1	02	01	H0543_235_0	2		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H0543	235	0	1	02	01	H0543_235_0	2		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	235	0	1	02	01	H0543_235_0	2		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H0543	235	0	1	02	01	H0543_235_0	2		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	235	0	1	02	01	H0543_235_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	235	0	1	02	01	H0543_235_0	2		Y	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												
H0543	236	0	1	02	01	H0543_236_0	2		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	236	0	1	02	01	H0543_236_0	2		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H0543	236	0	1	02	01	H0543_236_0	2		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	14.00		42.00																											42.00						0.00				14.00				14.00		0.46						0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	236	0	1	02	01	H0543_236_0	2		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	14.00		42.00																											42.00						0.00				14.00				14.00		0.46						0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H0543	236	0	1	02	01	H0543_236_0	2		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	236	0	1	02	01	H0543_236_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	236	0	1	02	01	H0543_236_0	2		Y	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												
H0543	237	0	1	02	01	H0543_237_0	2		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	237	0	1	02	01	H0543_237_0	2		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H0543	237	0	1	02	01	H0543_237_0	2		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	14.00		42.00																											42.00						0.00				14.00				14.00		0.46						0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	237	0	1	02	01	H0543_237_0	2		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	14.00		42.00																											42.00						0.00				14.00				14.00		0.46						0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H0543	237	0	1	02	01	H0543_237_0	2		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	237	0	1	02	01	H0543_237_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	237	0	1	02	01	H0543_237_0	2		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				503.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	238	0	1	02	01	H0543_238_0	2		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	238	0	1	02	01	H0543_238_0	2		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H0543	238	0	1	02	01	H0543_238_0	2		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	14.00		42.00																											42.00						0.00				14.00				14.00		0.46						0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	238	0	1	02	01	H0543_238_0	2		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	14.00		42.00																											42.00						0.00				14.00				14.00		0.46						0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H0543	238	0	1	02	01	H0543_238_0	2		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	238	0	1	02	01	H0543_238_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	238	0	1	02	01	H0543_238_0	2		Y	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												
H0544	002	0	1	01	01	H0544_002_0	6		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	002	0	1	01	01	H0544_002_0	6		N	Preferred Generic	4	01	1	2	1	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H0544	002	0	1	01	01	H0544_002_0	6		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	002	0	1	01	01	H0544_002_0	6		N	Generic	4	01	1	2	2	3		111	01	111		1				30	60	90	2	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H0544	002	0	1	01	01	H0544_002_0	6		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								35.00	70.00	105.00					30.00	60.00	90.00					30.00	60.00	60.00																35.00				35.00			1.17	1.00	1.00			1.03	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	002	0	1	01	01	H0544_002_0	6		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								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	6		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	002	0	1	01	01	H0544_002_0	6		N	Select Care Drugs	4	11	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	002	0	1	01	01	H0544_002_0	6		N	Select Care Drugs	4	11	1	2	6	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			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	6		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								10.00	20.00	30.00					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												
H0544	003	0	1	01	01	H0544_003_0	6		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								20.00	40.00	60.00					20.00	40.00	60.00					20.00	60.00	60.00																20.00				20.00			0.67	0.67	0.67			0.59	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	003	0	1	01	01	H0544_003_0	6		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		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	003	0	1	01	01	H0544_003_0	6		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	285.00	285.00																100.00				100.00			3.33	3.17	3.17			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	003	0	1	01	01	H0544_003_0	6		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												25							25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	003	0	1	01	01	H0544_003_0	6		N	Select Care Drugs	4	11	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								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												
H0544	004	0	1	01	01	H0544_004_0	6		Y	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	6		Y	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	6		Y	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												
H0544	004	0	1	01	01	H0544_004_0	6		Y	Generic	4	01	1	2	2	3		111	01	111		1				30	60	90	2	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H0544	004	0	1	01	01	H0544_004_0	6		Y	Preferred Brand	4	11	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	60.00	90.00					30.00	60.00	60.00																30.00				30.00			1.00	1.00	1.00			0.88	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	004	0	1	01	01	H0544_004_0	6		Y	Preferred Brand	4	11	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	60.00	90.00					30.00	60.00	60.00																30.00				30.00			1.00	1.00	1.00			0.88	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	1	
H0544	004	0	1	01	01	H0544_004_0	6		Y	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	6		Y	Specialty Tier	4	11	1	1	5	1		010	01	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	6		Y	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	6		Y	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	6		N	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		34	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	005	0	1	01	01	H0544_005_0	6		N	Preferred Generic	4	01	1	2	1	3	111		01	111		1	30	60	90				1	2	30	60	90				30		34	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H0544	005	0	1	01	01	H0544_005_0	6		N	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				2	2	30	60	90				30		34	0.00	0.00	0.00																			0.00	0.00	0.00																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	6		N	Generic	4	01	1	2	2	3	111		01	111		1	30	60	90				2	2	30	60	90				30		34	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H0544	005	0	1	01	01	H0544_005_0	6		N	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				2	2	30	60	90				30		34	35.00	70.00	105.00																			35.00	70.00	70.00																35.00				35.00		1.17			1.17			1.03	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	005	0	1	01	01	H0544_005_0	6		N	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	90				2	2	30	60	90				30		34	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	6		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		34					33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	005	0	1	01	01	H0544_005_0	6		N	Select Care Drugs	4	11	1	2	6	1	111		01	111		1	30	60	100				1	2	30	60	100				30		34	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	005	0	1	01	01	H0544_005_0	6		N	Select Care Drugs	4	11	1	2	6	3	111		01	111		1	30	60	100				1	2	30	60	100				30		34	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H0544	007	0	1	01	01	H0544_007_0	6		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								5.00	10.00	15.00					5.00	10.00	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	6		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								14.50	29.00	43.50					14.50	29.00	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	6		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								45.00	90.00	135.00					45.00	90.00	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	6		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	190.00	190.00																100.00				100.00			3.33	3.17	3.17			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	007	0	1	01	01	H0544_007_0	6		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	007	0	1	01	01	H0544_007_0	6		N	Select Care Drugs	4	11	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								10.00	20.00	30.00					10.00	20.00	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	6		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								5.00	10.00	15.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.15	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	008	0	1	01	01	H0544_008_0	6		N	Preferred Generic	4	01	1	2	1	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								5.00	10.00	15.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.15	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H0544	008	0	1	01	01	H0544_008_0	6		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								14.50	29.00	43.50					9.50	19.00	28.50					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	6		N	Generic	4	01	1	2	2	3		111	01	111		1				30	60	90	2	2	30	60	90				30		34								14.50	29.00	43.50					9.50	19.00	28.50					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	6		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								45.00	90.00	135.00					40.00	80.00	120.00					40.00	80.00	80.00																45.00				45.00			1.50	1.33	1.33			1.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	008	0	1	01	01	H0544_008_0	6		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								95.00	190.00	285.00					85.00	170.00	255.00					85.00	170.00	170.00																95.00				95.00			3.17	2.83	2.83			2.79	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	008	0	1	01	01	H0544_008_0	6		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	008	0	1	01	01	H0544_008_0	6		N	Select Care Drugs	4	11	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	008	0	1	01	01	H0544_008_0	6		N	Select Care Drugs	4	11	1	2	6	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	3	
H0544	010	0	1	01	01	H0544_010_0	8		Y	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		Y	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		Y	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		Y	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		Y	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		Y	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		Y	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		Y	Specialty Tier	4	11	1	1	5	1		010	01	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		Y	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		Y	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	6		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	013	0	1	01	01	H0544_013_0	6		N	Preferred Generic	4	01	1	2	1	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H0544	013	0	1	01	01	H0544_013_0	6		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	013	0	1	01	01	H0544_013_0	6		N	Generic	4	01	1	2	2	3		111	01	111		1				30	60	90	2	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H0544	013	0	1	01	01	H0544_013_0	6		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								35.00	70.00	105.00					30.00	60.00	90.00					30.00	60.00	60.00																35.00				35.00			1.17	1.00	1.00			1.03	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	013	0	1	01	01	H0544_013_0	6		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								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	6		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	013	0	1	01	01	H0544_013_0	6		N	Select Care Drugs	4	11	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	013	0	1	01	01	H0544_013_0	6		N	Select Care Drugs	4	11	1	2	6	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H0544	014	0	1	01	01	H0544_014_0	6		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				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	6		N	Preferred Generic	4	01	1	2	1	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H0544	014	0	1	01	01	H0544_014_0	6		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				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	6		N	Generic	4	01	1	2	2	3		111	01	111		1				30	60	90	2	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H0544	014	0	1	01	01	H0544_014_0	6		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								35.00	70.00	105.00					30.00	60.00	90.00					30.00	60.00	60.00																35.00				35.00			1.17	1.00	1.00			1.03	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	014	0	1	01	01	H0544_014_0	6		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								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	6		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	014	0	1	01	01	H0544_014_0	6		N	Select Care Drugs	4	11	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	014	0	1	01	01	H0544_014_0	6		N	Select Care Drugs	4	11	1	2	6	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H0544	015	0	1	01	01	H0544_015_0	8		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				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		N	Preferred Generic	4	01	1	2	1	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H0544	015	0	1	01	01	H0544_015_0	8		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	015	0	1	01	01	H0544_015_0	8		N	Generic	4	01	1	2	2	3		111	01	111		1				30	60	90	2	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H0544	015	0	1	01	01	H0544_015_0	8		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								35.00	70.00	105.00					30.00	60.00	90.00					30.00	60.00	60.00																35.00				35.00			1.17	1.00	1.00			1.03	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	015	0	1	01	01	H0544_015_0	8		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								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		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	015	0	1	01	01	H0544_015_0	8		N	Select Care Drugs	4	11	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	015	0	1	01	01	H0544_015_0	8		N	Select Care Drugs	4	11	1	2	6	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H0544	019	0	1	01	01	H0544_019_0	7		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								5.00	10.00	15.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.15	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	019	0	1	01	01	H0544_019_0	7		N	Preferred Generic	4	01	1	2	1	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								5.00	10.00	15.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.15	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H0544	019	0	1	01	01	H0544_019_0	7		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								14.50	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	7		N	Generic	4	01	1	2	2	3		111	01	111		1				30	60	90	2	2	30	60	90				30		34								14.50	29.00	43.50					9.50	19.00	28.50					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	7		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								45.00	90.00	135.00					40.00	80.00	120.00					40.00	80.00	80.00																45.00				45.00			1.50	1.33	1.33			1.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	019	0	1	01	01	H0544_019_0	7		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								95.00	190.00	285.00					85.00	170.00	255.00					85.00	170.00	170.00																95.00				95.00			3.17	2.83	2.83			2.79	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	019	0	1	01	01	H0544_019_0	7		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	019	0	1	01	01	H0544_019_0	7		N	Select Care Drugs	4	11	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	019	0	1	01	01	H0544_019_0	7		N	Select Care Drugs	4	11	1	2	6	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	3	
H0544	020	0	1	01	01	H0544_020_0	7		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								5.00	10.00	15.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.15	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	020	0	1	01	01	H0544_020_0	7		N	Preferred Generic	4	01	1	2	1	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								5.00	10.00	15.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.15	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H0544	020	0	1	01	01	H0544_020_0	7		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								14.50	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	7		N	Generic	4	01	1	2	2	3		111	01	111		1				30	60	90	2	2	30	60	90				30		34								14.50	29.00	43.50					9.50	19.00	28.50					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	7		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								45.00	90.00	135.00					40.00	80.00	120.00					40.00	80.00	80.00																45.00				45.00			1.50	1.33	1.33			1.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	020	0	1	01	01	H0544_020_0	7		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								95.00	190.00	285.00					85.00	170.00	255.00					85.00	170.00	170.00																95.00				95.00			3.17	2.83	2.83			2.79	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	020	0	1	01	01	H0544_020_0	7		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	020	0	1	01	01	H0544_020_0	7		N	Select Care Drugs	4	11	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	020	0	1	01	01	H0544_020_0	7		N	Select Care Drugs	4	11	1	2	6	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	3	
H0544	027	0	1	01	01	H0544_027_0	6		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								5.00	10.00	15.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				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	6		N	Preferred Generic	4	01	1	2	1	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								5.00	10.00	15.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.15	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H0544	027	0	1	01	01	H0544_027_0	6		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								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	6		N	Generic	4	01	1	2	2	3		111	01	111		1				30	60	90	2	2	30	60	90				30		34								14.50	29.00	43.50					9.50	19.00	28.50					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	6		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								45.00	90.00	135.00					40.00	80.00	120.00					40.00	80.00	80.00																45.00				45.00			1.50	1.33	1.33			1.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	027	0	1	01	01	H0544_027_0	6		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								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	6		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	027	0	1	01	01	H0544_027_0	6		N	Select Care Drugs	4	11	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	027	0	1	01	01	H0544_027_0	6		N	Select Care Drugs	4	11	1	2	6	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	3	
H0544	031	0	1	01	01	H0544_031_0	6		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								5.00	10.00	15.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				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	6		N	Preferred Generic	4	01	1	2	1	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								5.00	10.00	15.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.15	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H0544	031	0	1	01	01	H0544_031_0	6		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								12.50	25.00	37.50					7.50	15.00	22.50					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	6		N	Generic	4	01	1	2	2	3		111	01	111		1				30	60	90	2	2	30	60	90				30		34								12.50	25.00	37.50					7.50	15.00	22.50					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	6		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								45.00	90.00	135.00					40.00	80.00	120.00					40.00	80.00	80.00																45.00				45.00			1.50	1.33	1.33			1.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	031	0	1	01	01	H0544_031_0	6		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		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	6		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	031	0	1	01	01	H0544_031_0	6		N	Select Care Drugs	4	11	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	031	0	1	01	01	H0544_031_0	6		N	Select Care Drugs	4	11	1	2	6	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	3	
H0544	032	0	1	01	01	H0544_032_0	6		Y	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	6		Y	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	6		Y	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	6		Y	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	6		Y	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	6		Y	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	6		Y	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	6		Y	Specialty Tier	4	11	1	1	5	1		010	01	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	6		Y	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	6		Y	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	6		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								5.00	10.00	15.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.15	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	036	0	1	01	01	H0544_036_0	6		N	Preferred Generic	4	01	1	2	1	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								5.00	10.00	15.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				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	6		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								12.50	25.00	37.50					7.50	15.00	22.50					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	6		N	Generic	4	01	1	2	2	3		111	01	111		1				30	60	90	2	2	30	60	90				30		34								12.50	25.00	37.50					7.50	15.00	22.50					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	6		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								45.00	90.00	135.00					40.00	80.00	120.00					40.00	80.00	80.00																45.00				45.00			1.50	1.33	1.33			1.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	036	0	1	01	01	H0544_036_0	6		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		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	6		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	036	0	1	01	01	H0544_036_0	6		N	Select Care Drugs	4	11	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	036	0	1	01	01	H0544_036_0	6		N	Select Care Drugs	4	11	1	2	6	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	3	
H0544	038	0	1	01	01	H0544_038_0	7		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								5.00	10.00	15.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				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	7		N	Preferred Generic	4	01	1	2	1	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								5.00	10.00	15.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.15	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H0544	038	0	1	01	01	H0544_038_0	7		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								14.50	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	7		N	Generic	4	01	1	2	2	3		111	01	111		1				30	60	90	2	2	30	60	90				30		34								14.50	29.00	43.50					9.50	19.00	28.50					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	7		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								45.00	90.00	135.00					40.00	80.00	120.00					40.00	80.00	80.00																45.00				45.00			1.50	1.33	1.33			1.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	038	0	1	01	01	H0544_038_0	7		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		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	7		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	038	0	1	01	01	H0544_038_0	7		N	Select Care Drugs	4	11	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	038	0	1	01	01	H0544_038_0	7		N	Select Care Drugs	4	11	1	2	6	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	3	
H0544	050	0	1	01	01	H0544_050_0	6		N	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		34	0.00	0.00	0.00																			0.00	0.00	0.00																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	6		N	Preferred Generic	4	01	1	2	1	3	111		01	111		1	30	60	90				1	2	30	60	90				30		34	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H0544	050	0	1	01	01	H0544_050_0	6		N	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				2	2	30	60	90				30		34	7.50	15.00	22.50																			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	6		N	Generic	4	01	1	2	2	3	111		01	111		1	30	60	90				2	2	30	60	90				30		34	7.50	15.00	22.50																			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	6		N	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				2	2	30	60	90				30		34	40.00	80.00	120.00																			40.00	80.00	80.00																40.00				40.00		1.33			1.33			1.18	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	050	0	1	01	01	H0544_050_0	6		N	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	90				2	2	30	60	90				30		34	85.00	170.00	255.00																			85.00	170.00	170.00																85.00				85.00		2.83			2.83			2.50	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	050	0	1	01	01	H0544_050_0	6		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		34					33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	050	0	1	01	01	H0544_050_0	6		N	Select Care Drugs	4	11	1	2	6	1	111		01	111		1	30	60	100				1	2	30	60	100				30		34	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	050	0	1	01	01	H0544_050_0	6		N	Select Care Drugs	4	11	1	2	6	3	111		01	111		1	30	60	100				1	2	30	60	100				30		34	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	3	
H0544	052	0	1	01	01	H0544_052_0	5		N	Preferred Generic	4	01	3	2	1	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								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												
H0544	052	0	1	01	01	H0544_052_0	5		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								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	052	0	1	01	01	H0544_052_0	5		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								47.00	94.00	141.00					47.00	94.00	141.00					47.00	141.00	141.00																47.00				47.00			1.57	1.57	1.57			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0544	052	0	1	01	01	H0544_052_0	5		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	285.00	285.00																100.00				100.00			3.33	3.17	3.17			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0544	052	0	1	01	01	H0544_052_0	5		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												26							26						26																	26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0544	053	0	1	01	01	H0544_053_0	6		N	Preferred Generic	4	01	3	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	053	0	1	01	01	H0544_053_0	6		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								20.00	40.00	60.00					20.00	40.00	60.00					20.00	60.00	60.00																20.00				20.00			0.67	0.67	0.67			0.59	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0544	053	0	1	01	01	H0544_053_0	6		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								47.00	94.00	141.00					47.00	94.00	141.00					47.00	141.00	141.00																47.00				47.00			1.57	1.57	1.57			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0544	053	0	1	01	01	H0544_053_0	6		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	285.00	285.00																100.00				100.00			3.33	3.17	3.17			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0544	053	0	1	01	01	H0544_053_0	6		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												25							25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0544	054	0	1	01	01	H0544_054_0	5		N	Preferred Generic	4	01	3	2	1	1		111	01	111		1				30	60	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	054	0	1	01	01	H0544_054_0	5		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								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	054	0	1	01	01	H0544_054_0	5		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								47.00	94.00	141.00					47.00	94.00	141.00					47.00	141.00	141.00																47.00				47.00			1.57	1.57	1.57			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0544	054	0	1	01	01	H0544_054_0	5		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	285.00	285.00																100.00				100.00			3.33	3.17	3.17			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0544	054	0	1	01	01	H0544_054_0	5		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												25							25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0544	055	0	1	01	01	H0544_055_0	5		N	Preferred Generic	4	01	3	2	1	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								15.00	30.00	45.00					15.00	30.00	45.00					15.00	45.00	45.00																15.00				15.00			0.50	0.50	0.50			0.44	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0544	055	0	1	01	01	H0544_055_0	5		N	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												
H0544	055	0	1	01	01	H0544_055_0	5		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								47.00	94.00	141.00					47.00	94.00	141.00					47.00	141.00	141.00																47.00				47.00			1.57	1.57	1.57			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0544	055	0	1	01	01	H0544_055_0	5		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	285.00	285.00																100.00				100.00			3.33	3.17	3.17			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0544	055	0	1	01	01	H0544_055_0	5		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												25							25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0544	056	0	1	01	01	H0544_056_0	5		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								10.00	20.00	30.00					5.00	10.00	15.00					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	5		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								20.00	40.00	60.00					15.00	30.00	45.00					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	5		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00	126.00	126.00																47.00				47.00			1.57	1.40	1.40			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	056	0	1	01	01	H0544_056_0	5		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	285.00	285.00																100.00				100.00			3.33	3.17	3.17			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	056	0	1	01	01	H0544_056_0	5		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	056	0	1	01	01	H0544_056_0	5		N	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	056	0	1	01	01	H0544_056_0	5		N	Select Care Drugs	4	01	1	2	6	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H0544	058	0	1	01	01	H0544_058_0	5		Y	Preferred Generic	4	01	3	2	1	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0544	058	0	1	01	01	H0544_058_0	5		Y	Preferred Generic	4	01	3	2	1	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H0544	058	0	1	01	01	H0544_058_0	5		Y	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												
H0544	058	0	1	01	01	H0544_058_0	5		Y	Generic	4	01	1	2	2	3		111	01	111		1				30	60	90	2	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H0544	058	0	1	01	01	H0544_058_0	5		Y	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00	84.00	84.00																47.00				47.00			1.57	1.40	1.40			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0544	058	0	1	01	01	H0544_058_0	5		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	190.00	190.00																100.00				100.00			3.33	3.17	3.17			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0544	058	0	1	01	01	H0544_058_0	5		Y	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0544	061	0	1	01	01	H0544_061_0	5		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0544	061	0	1	01	01	H0544_061_0	5		N	Preferred Generic	4	01	1	2	1	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H0544	061	0	1	01	01	H0544_061_0	5		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								20.00	40.00	60.00					15.00	30.00	45.00					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	5		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00	126.00	126.00																47.00				47.00			1.57	1.40	1.40			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0544	061	0	1	01	01	H0544_061_0	5		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	285.00	285.00																100.00				100.00			3.33	3.17	3.17			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0544	061	0	1	01	01	H0544_061_0	5		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0544	062	0	1	01	01	H0544_062_0	5		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0544	062	0	1	01	01	H0544_062_0	5		N	Preferred Generic	4	01	1	2	1	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H0544	062	0	1	01	01	H0544_062_0	5		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								15.00	30.00	45.00					10.00	20.00	30.00					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	5		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00	84.00	84.00																47.00				47.00			1.57	1.40	1.40			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0544	062	0	1	01	01	H0544_062_0	5		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	190.00	190.00																100.00				100.00			3.33	3.17	3.17			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0544	062	0	1	01	01	H0544_062_0	5		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0544	063	0	1	01	01	H0544_063_0	5		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0544	063	0	1	01	01	H0544_063_0	5		N	Preferred Generic	4	01	1	2	1	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H0544	063	0	1	01	01	H0544_063_0	5		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								14.00	28.00	42.00					5.00	10.00	15.00					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	5		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00	126.00	126.00																47.00				47.00			1.57	1.40	1.40			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0544	063	0	1	01	01	H0544_063_0	5		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	285.00	285.00																100.00				100.00			3.33	3.17	3.17			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0544	063	0	1	01	01	H0544_063_0	5		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0544	064	0	1	01	01	H0544_064_0	5		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								10.00	20.00	30.00					5.00	10.00	15.00					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	5		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								15.00	30.00	45.00					10.00	20.00	30.00					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	5		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00	126.00	126.00																47.00				47.00			1.57	1.40	1.40			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	064	0	1	01	01	H0544_064_0	5		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	285.00	285.00																100.00				100.00			3.33	3.17	3.17			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	064	0	1	01	01	H0544_064_0	5		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	064	0	1	01	01	H0544_064_0	5		N	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	064	0	1	01	01	H0544_064_0	5		N	Select Care Drugs	4	01	1	2	6	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H0544	065	0	1	01	01	H0544_065_0	5		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								5.00	10.00	15.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.15	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	065	0	1	01	01	H0544_065_0	5		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								12.00	24.00	36.00					7.00	14.00	21.00					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	5		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00	126.00	126.00																47.00				47.00			1.57	1.40	1.40			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	065	0	1	01	01	H0544_065_0	5		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	285.00	285.00																100.00				100.00			3.33	3.17	3.17			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	065	0	1	01	01	H0544_065_0	5		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	065	0	1	01	01	H0544_065_0	5		N	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	065	0	1	01	01	H0544_065_0	5		N	Select Care Drugs	4	01	1	2	6	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H0544	066	0	1	01	01	H0544_066_0	5		N	Preferred Generic	4	01	3	2	1	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0544	066	0	1	01	01	H0544_066_0	5		N	Preferred Generic	4	01	3	2	1	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H0544	066	0	1	01	01	H0544_066_0	5		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								10.00	20.00	30.00					5.00	10.00	15.00					0.00	0.00	0.00																10.00				10.00			0.33	0.17	0.00			0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0544	066	0	1	01	01	H0544_066_0	5		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00	84.00	84.00																47.00				47.00			1.57	1.40	1.40			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0544	066	0	1	01	01	H0544_066_0	5		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	190.00	190.00																100.00				100.00			3.33	3.17	3.17			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0544	066	0	1	01	01	H0544_066_0	5		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0544	069	0	1	01	01	H0544_069_0	5		N	Preferred Generic	4	01	3	2	1	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0544	069	0	1	01	01	H0544_069_0	5		N	Preferred Generic	4	01	3	2	1	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H0544	069	0	1	01	01	H0544_069_0	5		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								15.00	30.00	45.00					10.00	20.00	30.00					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	5		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00	84.00	84.00																47.00				47.00			1.57	1.40	1.40			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0544	069	0	1	01	01	H0544_069_0	5		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	190.00	190.00																100.00				100.00			3.33	3.17	3.17			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0544	069	0	1	01	01	H0544_069_0	5		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0544	081	0	1	01	01	H0544_081_0	5		N	Preferred Generic	4	01	3	2	1	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0544	081	0	1	01	01	H0544_081_0	5		N	Preferred Generic	4	01	3	2	1	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H0544	081	0	1	01	01	H0544_081_0	5		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								2.00	4.00	6.00					2.00	4.00	6.00					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	5		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								47.00	94.00	141.00					47.00	94.00	141.00					47.00	141.00	141.00																47.00				47.00			1.57	1.57	1.57			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0544	081	0	1	01	01	H0544_081_0	5		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	285.00	285.00																100.00				100.00			3.33	3.17	3.17			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0544	081	0	1	01	01	H0544_081_0	5		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												25							25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0544	087	0	1	01	01	H0544_087_0	6		N	Preferred Generic	4	01	1	2	1	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												
H0544	087	0	1	01	01	H0544_087_0	6		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								20.00	40.00	60.00					20.00	40.00	60.00					20.00	60.00	60.00																20.00				20.00			0.67	0.67	0.67			0.59	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0544	087	0	1	01	01	H0544_087_0	6		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								47.00	94.00	141.00					47.00	94.00	141.00					47.00	141.00	141.00																47.00				47.00			1.57	1.57	1.57			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0544	087	0	1	01	01	H0544_087_0	6		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	285.00	285.00																100.00				100.00			3.33	3.17	3.17			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0544	087	0	1	01	01	H0544_087_0	6		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												27							27						27																	27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0544	088	0	1	01	01	H0544_088_0	5		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								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												
H0544	088	0	1	01	01	H0544_088_0	5		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								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	088	0	1	01	01	H0544_088_0	5		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								47.00	94.00	141.00					47.00	94.00	141.00					47.00	141.00	141.00																47.00				47.00			1.57	1.57	1.57			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0544	088	0	1	01	01	H0544_088_0	5		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	285.00	285.00																100.00				100.00			3.33	3.17	3.17			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0544	088	0	1	01	01	H0544_088_0	5		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												27							27						27																	27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0544	089	0	1	01	01	H0544_089_0	5		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								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	089	0	1	01	01	H0544_089_0	5		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								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	089	0	1	01	01	H0544_089_0	5		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								47.00	94.00	141.00					47.00	94.00	141.00					47.00	141.00	141.00																47.00				47.00			1.57	1.57	1.57			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0544	089	0	1	01	01	H0544_089_0	5		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	285.00	285.00																100.00				100.00			3.33	3.17	3.17			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0544	089	0	1	01	01	H0544_089_0	5		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												25							25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0544	090	0	1	01	01	H0544_090_0	5		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								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	090	0	1	01	01	H0544_090_0	5		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								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	090	0	1	01	01	H0544_090_0	5		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								47.00	94.00	141.00					47.00	94.00	141.00					47.00	141.00	141.00																47.00				47.00			1.57	1.57	1.57			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0544	090	0	1	01	01	H0544_090_0	5		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	285.00	285.00																100.00				100.00			3.33	3.17	3.17			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0544	090	0	1	01	01	H0544_090_0	5		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												25							25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0544	091	0	1	01	01	H0544_091_0	5		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0544	091	0	1	01	01	H0544_091_0	5		N	Preferred Generic	4	01	1	2	1	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H0544	091	0	1	01	01	H0544_091_0	5		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								12.00	24.00	36.00					7.00	14.00	21.00					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	5		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00	84.00	84.00																47.00				47.00			1.57	1.40	1.40			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0544	091	0	1	01	01	H0544_091_0	5		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	190.00	190.00																100.00				100.00			3.33	3.17	3.17			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0544	091	0	1	01	01	H0544_091_0	5		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0544	093	0	1	01	01	H0544_093_0	5		N	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		34	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	093	0	1	01	01	H0544_093_0	5		N	Preferred Generic	4	01	1	2	1	3	111		01	111		1	30	60	90				1	2	30	60	90				30		34	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H0544	093	0	1	01	01	H0544_093_0	5		N	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				2	2	30	60	90				30		34	7.50	15.00	22.50																			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	5		N	Generic	4	01	1	2	2	3	111		01	111		1	30	60	90				2	2	30	60	90				30		34	7.50	15.00	22.50																			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	5		N	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				2	2	30	60	90				30		34	40.00	80.00	120.00																			40.00	80.00	80.00																40.00				40.00		1.33			1.33			1.18	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	093	0	1	01	01	H0544_093_0	5		N	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	90				2	2	30	60	90				30		34	85.00	170.00	255.00																			85.00	170.00	170.00																85.00				85.00		2.83			2.83			2.50	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	093	0	1	01	01	H0544_093_0	5		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		34					33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	093	0	1	01	01	H0544_093_0	5		N	Select Care Drugs	4	11	1	2	6	1	111		01	111		1	30	60	100				1	2	30	60	100				30		34	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	093	0	1	01	01	H0544_093_0	5		N	Select Care Drugs	4	11	1	2	6	3	111		01	111		1	30	60	100				1	2	30	60	100				30		34	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	3	
H0544	094	0	1	01	01	H0544_094_0	5		Y	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								5.00	10.00	15.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.15	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	094	0	1	01	01	H0544_094_0	5		Y	Preferred Generic	4	01	1	2	1	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								5.00	10.00	15.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.15	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H0544	094	0	1	01	01	H0544_094_0	5		Y	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	5		Y	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	5		Y	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	5		Y	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	5		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								95.00	190.00	285.00					85.00	170.00	255.00					85.00	170.00	170.00																95.00				95.00			3.17	2.83	2.83			2.79	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	094	0	1	01	01	H0544_094_0	5		Y	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	094	0	1	01	01	H0544_094_0	5		Y	Select Care Drugs	4	11	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	094	0	1	01	01	H0544_094_0	5		Y	Select Care Drugs	4	11	1	2	6	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	3	
H0544	095	0	1	01	01	H0544_095_0	5		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								10.00	20.00	30.00					5.00	10.00	15.00					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	5		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								15.00	30.00	45.00					10.00	20.00	30.00					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	5		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00	126.00	126.00																47.00				47.00			1.57	1.40	1.40			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	095	0	1	01	01	H0544_095_0	5		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	285.00	285.00																100.00				100.00			3.33	3.17	3.17			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	095	0	1	01	01	H0544_095_0	5		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	095	0	1	01	01	H0544_095_0	5		N	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	095	0	1	01	01	H0544_095_0	5		N	Select Care Drugs	4	01	1	2	6	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H0544	096	0	1	01	01	H0544_096_0	5		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0544	096	0	1	01	01	H0544_096_0	5		N	Preferred Generic	4	01	1	2	1	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H0544	096	0	1	01	01	H0544_096_0	5		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								15.00	30.00	45.00					10.00	20.00	30.00					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	5		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00	84.00	84.00																47.00				47.00			1.57	1.40	1.40			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0544	096	0	1	01	01	H0544_096_0	5		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	190.00	190.00																100.00				100.00			3.33	3.17	3.17			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0544	096	0	1	01	01	H0544_096_0	5		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0544	098	0	1	01	01	H0544_098_0	5		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0544	098	0	1	01	01	H0544_098_0	5		N	Preferred Generic	4	01	1	2	1	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H0544	098	0	1	01	01	H0544_098_0	5		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								15.00	30.00	45.00					10.00	20.00	30.00					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	5		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00	84.00	84.00																47.00				47.00			1.57	1.40	1.40			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0544	098	0	1	01	01	H0544_098_0	5		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	190.00	190.00																100.00				100.00			3.33	3.17	3.17			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0544	098	0	1	01	01	H0544_098_0	5		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0544	099	0	1	01	01	H0544_099_0	5		N	Preferred Generic	4	01	3	2	1	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0544	099	0	1	01	01	H0544_099_0	5		N	Preferred Generic	4	01	3	2	1	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H0544	099	0	1	01	01	H0544_099_0	5		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								13.00	26.00	39.00					13.00	26.00	39.00					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	5		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								47.00	94.00	141.00					47.00	94.00	141.00					47.00	141.00	141.00																47.00				47.00			1.57	1.57	1.57			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0544	099	0	1	01	01	H0544_099_0	5		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	285.00	285.00																100.00				100.00			3.33	3.17	3.17			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0544	099	0	1	01	01	H0544_099_0	5		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												25							25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0544	100	0	1	01	01	H0544_100_0	5		N	Preferred Generic	4	01	3	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								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												
H0544	100	0	1	01	01	H0544_100_0	5		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								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												
H0544	100	0	1	01	01	H0544_100_0	5		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								47.00	94.00	141.00					47.00	94.00	141.00					47.00	141.00	141.00																47.00				47.00			1.57	1.57	1.57			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	100	0	1	01	01	H0544_100_0	5		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	285.00	285.00																100.00				100.00			3.33	3.17	3.17			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	100	0	1	01	01	H0544_100_0	5		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												25							25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	100	0	1	01	01	H0544_100_0	5		N	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								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												
H0544	101	0	1	01	01	H0544_101_0	6		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								5.00	10.00	15.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.15	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	101	0	1	01	01	H0544_101_0	6		N	Preferred Generic	4	01	1	2	1	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								5.00	10.00	15.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.15	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H0544	101	0	1	01	01	H0544_101_0	6		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								12.50	25.00	37.50					7.50	15.00	22.50					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	6		N	Generic	4	01	1	2	2	3		111	01	111		1				30	60	90	2	2	30	60	90				30		34								12.50	25.00	37.50					7.50	15.00	22.50					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	6		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								45.00	90.00	135.00					40.00	80.00	120.00					40.00	80.00	80.00																45.00				45.00			1.50	1.33	1.33			1.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	101	0	1	01	01	H0544_101_0	6		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								95.00	190.00	285.00					85.00	170.00	255.00					85.00	170.00	170.00																95.00				95.00			3.17	2.83	2.83			2.79	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	101	0	1	01	01	H0544_101_0	6		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	101	0	1	01	01	H0544_101_0	6		N	Select Care Drugs	4	11	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	101	0	1	01	01	H0544_101_0	6		N	Select Care Drugs	4	11	1	2	6	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	3	
H0544	102	0	1	01	01	H0544_102_0	6		Y	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	6		Y	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	6		Y	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	6		Y	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	6		Y	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	6		Y	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	6		Y	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	6		Y	Specialty Tier	4	11	1	1	5	1		010	01	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	6		Y	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	6		Y	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	7		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								5.00	10.00	15.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.15	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	103	0	1	01	01	H0544_103_0	7		N	Preferred Generic	4	01	1	2	1	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								5.00	10.00	15.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.15	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H0544	103	0	1	01	01	H0544_103_0	7		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								12.50	25.00	37.50					7.50	15.00	22.50					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	7		N	Generic	4	01	1	2	2	3		111	01	111		1				30	60	90	2	2	30	60	90				30		34								12.50	25.00	37.50					7.50	15.00	22.50					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	7		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								45.00	90.00	135.00					40.00	80.00	120.00					40.00	80.00	80.00																45.00				45.00			1.50	1.33	1.33			1.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	103	0	1	01	01	H0544_103_0	7		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								95.00	190.00	285.00					85.00	170.00	255.00					85.00	170.00	170.00																95.00				95.00			3.17	2.83	2.83			2.79	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	103	0	1	01	01	H0544_103_0	7		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	103	0	1	01	01	H0544_103_0	7		N	Select Care Drugs	4	11	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	103	0	1	01	01	H0544_103_0	7		N	Select Care Drugs	4	11	1	2	6	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	3	
H0544	104	0	1	01	01	H0544_104_0	6		Y	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	6		Y	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	6		Y	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	6		Y	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	6		Y	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	6		Y	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	6		Y	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	6		Y	Specialty Tier	4	11	1	1	5	1		010	01	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	6		Y	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	6		Y	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	6		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								5.00	10.00	15.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.15	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	105	0	1	01	01	H0544_105_0	6		N	Preferred Generic	4	01	1	2	1	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								5.00	10.00	15.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.15	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H0544	105	0	1	01	01	H0544_105_0	6		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								12.50	25.00	37.50					7.50	15.00	22.50					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	6		N	Generic	4	01	1	2	2	3		111	01	111		1				30	60	90	2	2	30	60	90				30		34								12.50	25.00	37.50					7.50	15.00	22.50					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	6		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								45.00	90.00	135.00					40.00	80.00	120.00					40.00	80.00	80.00																45.00				45.00			1.50	1.33	1.33			1.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	105	0	1	01	01	H0544_105_0	6		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								95.00	190.00	285.00					85.00	170.00	255.00					85.00	170.00	170.00																95.00				95.00			3.17	2.83	2.83			2.79	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	105	0	1	01	01	H0544_105_0	6		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	105	0	1	01	01	H0544_105_0	6		N	Select Care Drugs	4	11	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	105	0	1	01	01	H0544_105_0	6		N	Select Care Drugs	4	11	1	2	6	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	3	
H0544	106	0	1	01	01	H0544_106_0	6		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								5.00	10.00	15.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.15	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	106	0	1	01	01	H0544_106_0	6		N	Preferred Generic	4	01	1	2	1	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								5.00	10.00	15.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.15	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H0544	106	0	1	01	01	H0544_106_0	6		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								12.50	25.00	37.50					7.50	15.00	22.50					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	6		N	Generic	4	01	1	2	2	3		111	01	111		1				30	60	90	2	2	30	60	90				30		34								12.50	25.00	37.50					7.50	15.00	22.50					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	6		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								45.00	90.00	135.00					40.00	80.00	120.00					40.00	80.00	80.00																45.00				45.00			1.50	1.33	1.33			1.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	106	0	1	01	01	H0544_106_0	6		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								95.00	190.00	285.00					85.00	170.00	255.00					85.00	170.00	170.00																95.00				95.00			3.17	2.83	2.83			2.79	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	106	0	1	01	01	H0544_106_0	6		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	106	0	1	01	01	H0544_106_0	6		N	Select Care Drugs	4	11	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	106	0	1	01	01	H0544_106_0	6		N	Select Care Drugs	4	11	1	2	6	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	3	
H0544	107	0	1	01	01	H0544_107_0	6		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								5.00	10.00	15.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.15	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	107	0	1	01	01	H0544_107_0	6		N	Preferred Generic	4	01	1	2	1	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								5.00	10.00	15.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.15	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H0544	107	0	1	01	01	H0544_107_0	6		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								14.50	29.00	43.50					9.50	19.00	28.50					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	6		N	Generic	4	01	1	2	2	3		111	01	111		1				30	60	90	2	2	30	60	90				30		34								14.50	29.00	43.50					9.50	19.00	28.50					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	6		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								45.00	90.00	135.00					40.00	80.00	120.00					40.00	80.00	80.00																45.00				45.00			1.50	1.33	1.33			1.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	107	0	1	01	01	H0544_107_0	6		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								95.00	190.00	285.00					85.00	170.00	255.00					85.00	170.00	170.00																95.00				95.00			3.17	2.83	2.83			2.79	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	107	0	1	01	01	H0544_107_0	6		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	107	0	1	01	01	H0544_107_0	6		N	Select Care Drugs	4	11	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	107	0	1	01	01	H0544_107_0	6		N	Select Care Drugs	4	11	1	2	6	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	3	
H0544	108	0	1	01	01	H0544_108_0	5		N	Preferred Generic	4	01	3	2	1	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0544	108	0	1	01	01	H0544_108_0	5		N	Preferred Generic	4	01	3	2	1	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H0544	108	0	1	01	01	H0544_108_0	5		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								10.00	20.00	30.00					5.00	10.00	15.00					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	5		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00	84.00	84.00																47.00				47.00			1.57	1.40	1.40			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0544	108	0	1	01	01	H0544_108_0	5		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	190.00	190.00																100.00				100.00			3.33	3.17	3.17			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0544	108	0	1	01	01	H0544_108_0	5		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0544	110	0	1	01	01	H0544_110_0	5		N	Preferred Generic	4	01	3	2	1	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0544	110	0	1	01	01	H0544_110_0	5		N	Preferred Generic	4	01	3	2	1	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H0544	110	0	1	01	01	H0544_110_0	5		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								15.00	30.00	45.00					15.00	30.00	45.00					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	5		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								47.00	94.00	141.00					47.00	94.00	141.00					47.00	141.00	141.00																47.00				47.00			1.57	1.57	1.57			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0544	110	0	1	01	01	H0544_110_0	5		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	285.00	285.00																100.00				100.00			3.33	3.17	3.17			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0544	110	0	1	01	01	H0544_110_0	5		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												25							25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0544	117	1	1	01	01	H0544_117_1	6		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								5.00	10.00	15.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.15	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	117	1	1	01	01	H0544_117_1	6		N	Preferred Generic	4	01	1	2	1	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								5.00	10.00	15.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.15	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H0544	117	1	1	01	01	H0544_117_1	6		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								12.50	25.00	37.50					7.50	15.00	22.50					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	6		N	Generic	4	01	1	2	2	3		111	01	111		1				30	60	90	2	2	30	60	90				30		34								12.50	25.00	37.50					7.50	15.00	22.50					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	6		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								45.00	90.00	135.00					40.00	80.00	120.00					40.00	80.00	80.00																45.00				45.00			1.50	1.33	1.33			1.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	117	1	1	01	01	H0544_117_1	6		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								95.00	190.00	285.00					85.00	170.00	255.00					85.00	170.00	170.00																95.00				95.00			3.17	2.83	2.83			2.79	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	117	1	1	01	01	H0544_117_1	6		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	117	1	1	01	01	H0544_117_1	6		N	Select Care Drugs	4	11	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	117	1	1	01	01	H0544_117_1	6		N	Select Care Drugs	4	11	1	2	6	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	3	
H0544	117	2	1	01	01	H0544_117_2	6		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								5.00	10.00	15.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.15	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	117	2	1	01	01	H0544_117_2	6		N	Preferred Generic	4	01	1	2	1	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								5.00	10.00	15.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.15	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H0544	117	2	1	01	01	H0544_117_2	6		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								12.50	25.00	37.50					7.50	15.00	22.50					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	6		N	Generic	4	01	1	2	2	3		111	01	111		1				30	60	90	2	2	30	60	90				30		34								12.50	25.00	37.50					7.50	15.00	22.50					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	6		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								45.00	90.00	135.00					40.00	80.00	120.00					40.00	80.00	80.00																45.00				45.00			1.50	1.33	1.33			1.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	117	2	1	01	01	H0544_117_2	6		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								95.00	190.00	285.00					85.00	170.00	255.00					85.00	170.00	170.00																95.00				95.00			3.17	2.83	2.83			2.79	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	117	2	1	01	01	H0544_117_2	6		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	117	2	1	01	01	H0544_117_2	6		N	Select Care Drugs	4	11	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	117	2	1	01	01	H0544_117_2	6		N	Select Care Drugs	4	11	1	2	6	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	3	
H0544	118	1	1	01	01	H0544_118_1	6		Y	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								5.00	10.00	15.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.15	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	118	1	1	01	01	H0544_118_1	6		Y	Preferred Generic	4	01	1	2	1	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								5.00	10.00	15.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.15	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H0544	118	1	1	01	01	H0544_118_1	6		Y	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	6		Y	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	6		Y	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	6		Y	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	6		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								95.00	190.00	285.00					85.00	170.00	255.00					85.00	170.00	170.00																95.00				95.00			3.17	2.83	2.83			2.79	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	118	1	1	01	01	H0544_118_1	6		Y	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	118	1	1	01	01	H0544_118_1	6		Y	Select Care Drugs	4	11	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	118	1	1	01	01	H0544_118_1	6		Y	Select Care Drugs	4	11	1	2	6	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	3	
H0544	118	2	1	01	01	H0544_118_2	6		Y	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								5.00	10.00	15.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.15	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	118	2	1	01	01	H0544_118_2	6		Y	Preferred Generic	4	01	1	2	1	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								5.00	10.00	15.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.15	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H0544	118	2	1	01	01	H0544_118_2	6		Y	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	6		Y	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	6		Y	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	6		Y	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	6		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								95.00	190.00	285.00					85.00	170.00	255.00					85.00	170.00	170.00																95.00				95.00			3.17	2.83	2.83			2.79	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	118	2	1	01	01	H0544_118_2	6		Y	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	118	2	1	01	01	H0544_118_2	6		Y	Select Care Drugs	4	11	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	118	2	1	01	01	H0544_118_2	6		Y	Select Care Drugs	4	11	1	2	6	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	3	
H0544	119	1	1	01	01	H0544_119_1	6		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								5.00	10.00	15.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.15	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	119	1	1	01	01	H0544_119_1	6		N	Preferred Generic	4	01	1	2	1	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								5.00	10.00	15.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.15	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H0544	119	1	1	01	01	H0544_119_1	6		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								12.50	25.00	37.50					7.50	15.00	22.50					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	6		N	Generic	4	01	1	2	2	3		111	01	111		1				30	60	90	2	2	30	60	90				30		34								12.50	25.00	37.50					7.50	15.00	22.50					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	6		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								45.00	90.00	135.00					40.00	80.00	120.00					40.00	80.00	80.00																45.00				45.00			1.50	1.33	1.33			1.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	119	1	1	01	01	H0544_119_1	6		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								95.00	190.00	285.00					85.00	170.00	255.00					85.00	170.00	170.00																95.00				95.00			3.17	2.83	2.83			2.79	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	119	1	1	01	01	H0544_119_1	6		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	119	1	1	01	01	H0544_119_1	6		N	Select Care Drugs	4	11	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	119	1	1	01	01	H0544_119_1	6		N	Select Care Drugs	4	11	1	2	6	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	3	
H0544	119	2	1	01	01	H0544_119_2	6		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								5.00	10.00	15.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.15	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	119	2	1	01	01	H0544_119_2	6		N	Preferred Generic	4	01	1	2	1	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								5.00	10.00	15.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.15	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H0544	119	2	1	01	01	H0544_119_2	6		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								12.50	25.00	37.50					7.50	15.00	22.50					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	6		N	Generic	4	01	1	2	2	3		111	01	111		1				30	60	90	2	2	30	60	90				30		34								12.50	25.00	37.50					7.50	15.00	22.50					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	6		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								45.00	90.00	135.00					40.00	80.00	120.00					40.00	80.00	80.00																45.00				45.00			1.50	1.33	1.33			1.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	119	2	1	01	01	H0544_119_2	6		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								95.00	190.00	285.00					85.00	170.00	255.00					85.00	170.00	170.00																95.00				95.00			3.17	2.83	2.83			2.79	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	119	2	1	01	01	H0544_119_2	6		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	119	2	1	01	01	H0544_119_2	6		N	Select Care Drugs	4	11	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	119	2	1	01	01	H0544_119_2	6		N	Select Care Drugs	4	11	1	2	6	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	3	
H0544	120	1	1	01	01	H0544_120_1	5		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								5.00	10.00	15.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.15	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	120	1	1	01	01	H0544_120_1	5		N	Preferred Generic	4	01	1	2	1	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								5.00	10.00	15.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.15	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H0544	120	1	1	01	01	H0544_120_1	5		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								14.50	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	5		N	Generic	4	01	1	2	2	3		111	01	111		1				30	60	90	2	2	30	60	90				30		34								14.50	29.00	43.50					9.50	19.00	28.50					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	5		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								45.00	90.00	135.00					40.00	80.00	120.00					40.00	80.00	80.00																45.00				45.00			1.50	1.33	1.33			1.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	120	1	1	01	01	H0544_120_1	5		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								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	5		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	120	1	1	01	01	H0544_120_1	5		N	Select Care Drugs	4	11	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	120	1	1	01	01	H0544_120_1	5		N	Select Care Drugs	4	11	1	2	6	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	3	
H0544	120	2	1	01	01	H0544_120_2	5		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								5.00	10.00	15.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				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	5		N	Preferred Generic	4	01	1	2	1	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								5.00	10.00	15.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.15	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H0544	120	2	1	01	01	H0544_120_2	5		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								14.50	29.00	43.50					9.50	19.00	28.50					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	5		N	Generic	4	01	1	2	2	3		111	01	111		1				30	60	90	2	2	30	60	90				30		34								14.50	29.00	43.50					9.50	19.00	28.50					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	5		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								45.00	90.00	135.00					40.00	80.00	120.00					40.00	80.00	80.00																45.00				45.00			1.50	1.33	1.33			1.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	120	2	1	01	01	H0544_120_2	5		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								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	5		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	120	2	1	01	01	H0544_120_2	5		N	Select Care Drugs	4	11	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	120	2	1	01	01	H0544_120_2	5		N	Select Care Drugs	4	11	1	2	6	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	3	
H0544	121	1	1	01	01	H0544_121_1	6		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								10.00	20.00	30.00					5.00	10.00	15.00					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	6		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								17.50	35.00	52.50					12.50	25.00	37.50					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	6		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								45.00	90.00	135.00					40.00	80.00	120.00					40.00	80.00	80.00																45.00				45.00			1.50	1.33	1.33			1.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	121	1	1	01	01	H0544_121_1	6		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								95.00	190.00	285.00					90.00	180.00	270.00					90.00	180.00	180.00																95.00				95.00			3.17	3.00	3.00			2.79	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	121	1	1	01	01	H0544_121_1	6		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	121	1	1	01	01	H0544_121_1	6		N	Select Care Drugs	4	11	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								10.00	20.00	30.00					10.00	20.00	30.00					10.00	20.00	20.00																10.00				10.00			0.33	0.33	0.33			0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	121	2	1	01	01	H0544_121_2	6		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								10.00	20.00	30.00					5.00	10.00	15.00					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	6		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								17.50	35.00	52.50					12.50	25.00	37.50					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	6		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								45.00	90.00	135.00					40.00	80.00	120.00					40.00	80.00	80.00																45.00				45.00			1.50	1.33	1.33			1.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	121	2	1	01	01	H0544_121_2	6		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								95.00	190.00	285.00					90.00	180.00	270.00					90.00	180.00	180.00																95.00				95.00			3.17	3.00	3.00			2.79	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	121	2	1	01	01	H0544_121_2	6		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	121	2	1	01	01	H0544_121_2	6		N	Select Care Drugs	4	11	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								10.00	20.00	30.00					10.00	20.00	30.00					10.00	20.00	20.00																10.00				10.00			0.33	0.33	0.33			0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	125	0	1	01	01	H0544_125_0	5		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								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	5		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								20.00	40.00	60.00					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	5		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								47.00	94.00	141.00					47.00	94.00	141.00					47.00	141.00	141.00																47.00				47.00			1.57	1.57	1.57			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0544	125	0	1	01	01	H0544_125_0	5		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	285.00	285.00																100.00				100.00			3.33	3.17	3.17			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0544	125	0	1	01	01	H0544_125_0	5		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												25							25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0544	126	0	1	01	01	H0544_126_0	8		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								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												
H0544	126	0	1	01	01	H0544_126_0	8		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								20.00	40.00	60.00					20.00	40.00	60.00					20.00	60.00	60.00																20.00				20.00			0.67	0.67	0.67			0.59	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	126	0	1	01	01	H0544_126_0	8		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								47.00	94.00	141.00					47.00	94.00	141.00					47.00	141.00	141.00																47.00				47.00			1.57	1.57	1.57			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	126	0	1	01	01	H0544_126_0	8		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	285.00	285.00																100.00				100.00			3.33	3.17	3.17			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	126	0	1	01	01	H0544_126_0	8		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												25							25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	126	0	1	01	01	H0544_126_0	8		N	Select Care Drugs	4	11	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								10.00	20.00	30.00					10.00	20.00	30.00					10.00	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												
H0544	127	0	1	01	01	H0544_127_0	5		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0544	127	0	1	01	01	H0544_127_0	5		N	Preferred Generic	4	01	1	2	1	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H0544	127	0	1	01	01	H0544_127_0	5		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								20.00	40.00	60.00					15.00	30.00	45.00					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	5		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00	126.00	126.00																47.00				47.00			1.57	1.40	1.40			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0544	127	0	1	01	01	H0544_127_0	5		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	285.00	285.00																100.00				100.00			3.33	3.17	3.17			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0544	127	0	1	01	01	H0544_127_0	5		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0544	129	0	1	01	01	H0544_129_0	7		N	Preferred Generic	4	01	3	2	1	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												
H0544	129	0	1	01	01	H0544_129_0	7		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								20.00	40.00	60.00					20.00	40.00	60.00					20.00	60.00	60.00																20.00				20.00			0.67	0.67	0.67			0.59	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0544	129	0	1	01	01	H0544_129_0	7		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								47.00	94.00	141.00					47.00	94.00	141.00					47.00	141.00	141.00																47.00				47.00			1.57	1.57	1.57			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0544	129	0	1	01	01	H0544_129_0	7		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	285.00	285.00																100.00				100.00			3.33	3.17	3.17			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0544	129	0	1	01	01	H0544_129_0	7		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												27							27						27																	27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0562	009	0	1	01	01	H0562_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								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00				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	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					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												
H0562	009	0	1	01	01	H0562_009_0	5			Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											47.00	94.00	141.00				37.00	74.00	74.00				47.00				47.00			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	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												
H0562	009	0	1	01	01	H0562_009_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												
H0562	009	0	1	01	01	H0562_009_0	5			Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred 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					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00				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	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								15.00	30.00	45.00					7.00	14.00	21.00											15.00	30.00	45.00				7.00	14.00	0.00				15.00				15.00			0.5	0.23		0.5	0.23	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, 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								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	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	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												
H0562	079	0	1	01	01	H0562_079_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 Care Drugs												
H0562	079	0	1	01	01	H0562_079_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												
H0562	079	0	1	01	01	H0562_079_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												
H0562	079	0	1	01	01	H0562_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, Select Care Drugs												
H0562	079	0	1	01	01	H0562_079_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												
H0562	084	0	1	01	01	H0562_084_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					3.00	6.00	9.00											10.00	20.00	30.00				3.00	6.00	0.00				10.00				10.00			0.33	0.1		0.33	0.1	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0562	084	0	1	01	01	H0562_084_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					11.00	22.00	33.00											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, Select Care Drugs												
H0562	084	0	1	01	01	H0562_084_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												
H0562	084	0	1	01	01	H0562_084_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												
H0562	084	0	1	01	01	H0562_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, Select Care Drugs												
H0562	084	0	1	01	01	H0562_084_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												
H0562	092	0	1	01	01	H0562_092_0	4		Y	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	092	0	1	01	01	H0562_092_0	4		Y	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					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		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											47.00	94.00	141.00				37.00	74.00	74.00				47.00				47.00			1.57	1.23		1.57	1.23	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs												
H0562	092	0	1	01	01	H0562_092_0	4		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	300.00					90.00	180.00	270.00											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		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs												
H0562	092	0	1	01	01	H0562_092_0	4		Y	Select Diabetic Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				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	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												
H0562	097	0	1	01	01	H0562_097_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					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00				15.00				15.00			0.5	0.00		0.5	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0562	097	0	1	01	01	H0562_097_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												
H0562	097	0	1	01	01	H0562_097_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												
H0562	097	0	1	01	01	H0562_097_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												
H0562	097	0	1	01	01	H0562_097_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												
H0562	103	0	1	01	01	H0562_103_0	5			Preferred Generic	4	11	3	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			0.5	0.00		0.5	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0562	103	0	1	01	01	H0562_103_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 Care Drugs												
H0562	103	0	1	01	01	H0562_103_0	5			Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											47.00	94.00	141.00				37.00	74.00	74.00				47.00				47.00			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	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												
H0562	103	0	1	01	01	H0562_103_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												
H0562	103	0	1	01	01	H0562_103_0	5			Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0562	113	0	1	01	01	H0562_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								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00				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	113	0	1	01	01	H0562_113_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					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												
H0562	113	0	1	01	01	H0562_113_0	5			Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											47.00	94.00	141.00				37.00	74.00	74.00				47.00				47.00			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	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												
H0562	113	0	1	01	01	H0562_113_0	5			Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0562	113	0	1	01	01	H0562_113_0	5			Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0562	114	0	1	01	01	H0562_114_0	5		Y	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	114	0	1	01	01	H0562_114_0	5		Y	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					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		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											47.00	94.00	141.00				37.00	74.00	74.00				47.00				47.00			1.57	1.23		1.57	1.23	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs												
H0562	114	0	1	01	01	H0562_114_0	5		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	300.00					90.00	180.00	270.00											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		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs												
H0562	114	0	1	01	01	H0562_114_0	5		Y	Select Diabetic Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				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		Y	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		Y	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					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 Diabetic Drugs												
H0562	118	0	1	01	01	H0562_118_0	4		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					25.00	50.00	75.00											47.00	94.00	141.00				25.00	50.00	50.00				47.00				47.00			1.57	0.83		1.57	0.83	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs												
H0562	118	0	1	01	01	H0562_118_0	4		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	300.00					90.00	180.00	270.00											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	118	0	1	01	01	H0562_118_0	4		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs												
H0562	118	0	1	01	01	H0562_118_0	4		Y	Select Diabetic Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				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					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00				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	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					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	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	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								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00				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	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								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00				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
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	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												
H0562	124	0	1	01	01	H0562_124_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					12.00	24.00	36.00											20.00	40.00	60.00				12.00	24.00	0.00				20.00				20.00			0.67	0.4		0.67	0.4	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0562	124	0	1	01	01	H0562_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					37.00	74.00	111.00											47.00	94.00	141.00				37.00	74.00	74.00				47.00				47.00			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	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												
H0562	124	0	1	01	01	H0562_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, Select Care Drugs												
H0562	124	0	1	01	01	H0562_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	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								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00				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	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								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00				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
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								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	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								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00				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	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								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00				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
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								10.00	20.00	30.00					1.00	2.00	3.00											10.00	20.00	30.00				1.00	2.00	0.00				10.00				10.00			0.33	0.03		0.33	0.03	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
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	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, 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	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												
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	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, 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											98.73	49	49	49				98.73	49	49	49										49	49	49				49	49	49			49			49								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			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	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0562	128	0	1	01	01	H0562_128_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	128	0	1	01	01	H0562_128_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
H0562	128	0	1	01	01	H0562_128_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												
H0562	128	0	1	01	01	H0562_128_0	4			Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											47.00	94.00	141.00				37.00	74.00	74.00				47.00				47.00			1.57	1.23		1.57	1.23	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0562	128	0	1	01	01	H0562_128_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	128	0	1	01	01	H0562_128_0	4			Specialty Tier	4	11	1	1	5	1		010	01		010	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	128	0	1	01	01	H0562_128_0	4			Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0562	128	0	1	01	01	H0562_128_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	
H0571	001	0	1	01	01	H0571_001_0	4		Y	Preferred Generic	4	01	1	2	1	1		111	10	100		1				30	60	90	1	2			90					14	31								3.00	6.00	9.00					0.00	0.00	0.00							6.00																	3.00			3.00			0.10	0.00				0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0571	001	0	1	01	01	H0571_001_0	4		Y	Generic	4	01	1	2	2	1		111	10	100		1				30	60	90	1	2			90					14	31								7.00	14.00	21.00					7.00	14.00	14.00							14.00																	7.00			7.00			0.23	0.23				0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0571	001	0	1	01	01	H0571_001_0	4		Y	Preferred Brand	4	11	1	2	3	1		111	10	100		1				30	60	90	1	2			90					14	31								40.00	80.00	120.00					40.00	80.00	80.00							80.00																	40.00			40.00			1.33	1.33				1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0571	001	0	1	01	01	H0571_001_0	4		Y	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	4		Y	Specialty Tier	4	11	1	1	5	1		010	10	010		1				30					30							14	31											243.21	33						243.21	33						33																		33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0571	007	0	1	01	01	H0571_007_0	4		Y	Preferred Generic	4	01	1	2	1	1		111	10	100		1				30	60	90	1	2			90					14	31								5.00	10.00	15.00					0.00	0.00	0.00							10.00																	5.00			5.00			0.17	0.00				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0571	007	0	1	01	01	H0571_007_0	4		Y	Generic	4	01	1	2	2	1		111	10	100		1				30	60	90	1	2			90					14	31								12.00	24.00	36.00					12.00	24.00	24.00							24.00																	12.00			12.00			0.40	0.40				0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0571	007	0	1	01	01	H0571_007_0	4		Y	Preferred Brand	4	11	1	2	3	1		111	10	100		1				30	60	90	1	2			90					14	31								47.00	94.00	141.00					47.00	94.00	94.00							94.00																	47.00			47.00			1.57	1.57				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0571	007	0	1	01	01	H0571_007_0	4		Y	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	4		Y	Specialty Tier	4	11	1	1	5	1		010	10	010		1				30					30							14	31											245.51	31						245.51	31						31																		31		31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0609	007	0	1	02	01	H0609_007_0	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		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	02	01	H0609_007_0	3		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H0609	007	0	1	02	01	H0609_007_0	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0609	007	0	1	02	01	H0609_007_0	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H0609	007	0	1	02	01	H0609_007_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0609	007	0	1	02	01	H0609_007_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0609	007	0	1	02	01	H0609_007_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				497.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0609	012	0	1	02	01	H0609_012_0	2		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0609	012	0	1	02	01	H0609_012_0	2		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H0609	012	0	1	02	01	H0609_012_0	2		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0609	012	0	1	02	01	H0609_012_0	2		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H0609	012	0	1	02	01	H0609_012_0	2		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0609	012	0	1	02	01	H0609_012_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0609	012	0	1	02	01	H0609_012_0	2		Y	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												
H0609	025	0	1	02	01	H0609_025_0	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0609	025	0	1	02	01	H0609_025_0	3		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H0609	025	0	1	02	01	H0609_025_0	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	8.00		24.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0609	025	0	1	02	01	H0609_025_0	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	8.00		24.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H0609	025	0	1	02	01	H0609_025_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0609	025	0	1	02	01	H0609_025_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0609	025	0	1	02	01	H0609_025_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				400.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0609	026	0	1	02	01	H0609_026_0	2		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0609	026	0	1	02	01	H0609_026_0	2		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H0609	026	0	1	02	01	H0609_026_0	2		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0609	026	0	1	02	01	H0609_026_0	2		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H0609	026	0	1	02	01	H0609_026_0	2		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0609	026	0	1	02	01	H0609_026_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0609	026	0	1	02	01	H0609_026_0	2		Y	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												
H0609	027	0	1	02	01	H0609_027_0	2		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0609	027	0	1	02	01	H0609_027_0	2		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H0609	027	0	1	02	01	H0609_027_0	2		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	8.00		24.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0609	027	0	1	02	01	H0609_027_0	2		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	8.00		24.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H0609	027	0	1	02	01	H0609_027_0	2		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0609	027	0	1	02	01	H0609_027_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0609	027	0	1	02	01	H0609_027_0	2		Y	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												
H0609	028	0	1	02	01	H0609_028_0	2		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0609	028	0	1	02	01	H0609_028_0	2		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H0609	028	0	1	02	01	H0609_028_0	2		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	8.00		24.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0609	028	0	1	02	01	H0609_028_0	2		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	8.00		24.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H0609	028	0	1	02	01	H0609_028_0	2		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0609	028	0	1	02	01	H0609_028_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0609	028	0	1	02	01	H0609_028_0	2		Y	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												
H0609	031	0	1	02	01	H0609_031_0	2		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0609	031	0	1	02	01	H0609_031_0	2		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H0609	031	0	1	02	01	H0609_031_0	2		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	8.00		24.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0609	031	0	1	02	01	H0609_031_0	2		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	8.00		24.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H0609	031	0	1	02	01	H0609_031_0	2		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0609	031	0	1	02	01	H0609_031_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0609	031	0	1	02	01	H0609_031_0	2		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				463.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0609	032	0	1	02	01	H0609_032_0	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		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	032	0	1	02	01	H0609_032_0	3		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H0609	032	0	1	02	01	H0609_032_0	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	8.00		24.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0609	032	0	1	02	01	H0609_032_0	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	8.00		24.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H0609	032	0	1	02	01	H0609_032_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0609	032	0	1	02	01	H0609_032_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0609	032	0	1	02	01	H0609_032_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				461.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0609	033	0	1	02	01	H0609_033_0	2		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0609	033	0	1	02	01	H0609_033_0	2		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H0609	033	0	1	02	01	H0609_033_0	2		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	8.00		24.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0609	033	0	1	02	01	H0609_033_0	2		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	8.00		24.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H0609	033	0	1	02	01	H0609_033_0	2		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0609	033	0	1	02	01	H0609_033_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0609	033	0	1	02	01	H0609_033_0	2		Y	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												
H0609	034	1	1	02	01	H0609_034_1	2		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0609	034	1	1	02	01	H0609_034_1	2		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H0609	034	1	1	02	01	H0609_034_1	2		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	8.00		24.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0609	034	1	1	02	01	H0609_034_1	2		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	8.00		24.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H0609	034	1	1	02	01	H0609_034_1	2		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0609	034	1	1	02	01	H0609_034_1	2		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0609	034	1	1	02	01	H0609_034_1	2		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				422.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0609	034	2	1	02	01	H0609_034_2	2		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0609	034	2	1	02	01	H0609_034_2	2		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H0609	034	2	1	02	01	H0609_034_2	2		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	8.00		24.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0609	034	2	1	02	01	H0609_034_2	2		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	8.00		24.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H0609	034	2	1	02	01	H0609_034_2	2		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0609	034	2	1	02	01	H0609_034_2	2		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0609	034	2	1	02	01	H0609_034_2	2		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				422.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0609	036	1	1	02	01	H0609_036_1	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		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	02	01	H0609_036_1	3		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H0609	036	1	1	02	01	H0609_036_1	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	8.00		24.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0609	036	1	1	02	01	H0609_036_1	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	8.00		24.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H0609	036	1	1	02	01	H0609_036_1	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0609	036	1	1	02	01	H0609_036_1	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0609	036	1	1	02	01	H0609_036_1	3		Y	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	036	2	1	02	01	H0609_036_2	2		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0609	036	2	1	02	01	H0609_036_2	2		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H0609	036	2	1	02	01	H0609_036_2	2		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	8.00		24.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0609	036	2	1	02	01	H0609_036_2	2		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	8.00		24.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H0609	036	2	1	02	01	H0609_036_2	2		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0609	036	2	1	02	01	H0609_036_2	2		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0609	036	2	1	02	01	H0609_036_2	2		Y	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	037	0	1	02	01	H0609_037_0	2		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0609	037	0	1	02	01	H0609_037_0	2		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H0609	037	0	1	02	01	H0609_037_0	2		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	8.00		24.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0609	037	0	1	02	01	H0609_037_0	2		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	8.00		24.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H0609	037	0	1	02	01	H0609_037_0	2		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0609	037	0	1	02	01	H0609_037_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0609	037	0	1	02	01	H0609_037_0	2		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				391.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0609	038	0	1	02	01	H0609_038_0	2		Y	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		100	2	2						100	30		31								10.00		30.00					0.00		0.00													30.00						0.00				10.00				10.00			0.33	0.00				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0609	038	0	1	02	01	H0609_038_0	2		Y	Preferred Generic	4	01	1	2	1	3		110	01		100	1				30		100	2	2						100	30		31								10.00		30.00					0.00		0.00													30.00						0.00				10.00				10.00			0.33	0.00				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H0609	038	0	1	02	01	H0609_038_0	2		Y	Generic	4	01	3	2	2	1		110	01		100	1				30		100	2	2						100	30		31								15.00		45.00					0.00		0.00													45.00						0.00				15.00				15.00			0.50	0.00				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0609	038	0	1	02	01	H0609_038_0	2		Y	Generic	4	01	3	2	2	3		110	01		100	1				30		100	2	2						100	30		31								15.00		45.00					0.00		0.00													45.00						0.00				15.00				15.00			0.50	0.00				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H0609	038	0	1	02	01	H0609_038_0	2		Y	Preferred Brand	4	11	1	2	3	1		110	01		100	1				30		100	2	2						100	30		31								47.00		141.00					47.00		131.00													141.00						131.00				47.00				47.00			1.56	1.56				1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0609	038	0	1	02	01	H0609_038_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1		110	01		100	1				30		100	2	2						100	30		31								100.00		300.00					100.00		290.00													300.00						290.00				100.00				100.00			3.33	3.33				3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0609	038	0	1	02	01	H0609_038_0	2		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											534.00	33						379.00	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0609	040	0	1	02	01	H0609_040_0	2		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0609	040	0	1	02	01	H0609_040_0	2		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H0609	040	0	1	02	01	H0609_040_0	2		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0609	040	0	1	02	01	H0609_040_0	2		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H0609	040	0	1	02	01	H0609_040_0	2		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0609	040	0	1	02	01	H0609_040_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0609	040	0	1	02	01	H0609_040_0	2		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				505.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0609	042	0	1	02	01	H0609_042_0	2		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0609	042	0	1	02	01	H0609_042_0	2		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H0609	042	0	1	02	01	H0609_042_0	2		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	8.00		24.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0609	042	0	1	02	01	H0609_042_0	2		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	8.00		24.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H0609	042	0	1	02	01	H0609_042_0	2		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0609	042	0	1	02	01	H0609_042_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0609	042	0	1	02	01	H0609_042_0	2		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				466.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0609	043	0	1	02	01	H0609_043_0	2		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0609	043	0	1	02	01	H0609_043_0	2		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H0609	043	0	1	02	01	H0609_043_0	2		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	8.00		24.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0609	043	0	1	02	01	H0609_043_0	2		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	8.00		24.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H0609	043	0	1	02	01	H0609_043_0	2		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0609	043	0	1	02	01	H0609_043_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0609	043	0	1	02	01	H0609_043_0	2		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				461.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0609	044	0	1	02	01	H0609_044_0	2		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0609	044	0	1	02	01	H0609_044_0	2		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H0609	044	0	1	02	01	H0609_044_0	2		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	8.00		24.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0609	044	0	1	02	01	H0609_044_0	2		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	8.00		24.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H0609	044	0	1	02	01	H0609_044_0	2		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0609	044	0	1	02	01	H0609_044_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0609	044	0	1	02	01	H0609_044_0	2		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				358.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0609	045	0	1	02	01	H0609_045_0	2		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0609	045	0	1	02	01	H0609_045_0	2		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H0609	045	0	1	02	01	H0609_045_0	2		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0609	045	0	1	02	01	H0609_045_0	2		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H0609	045	0	1	02	01	H0609_045_0	2		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0609	045	0	1	02	01	H0609_045_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0609	045	0	1	02	01	H0609_045_0	2		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				424.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0609	046	0	1	02	01	H0609_046_0	2		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0609	046	0	1	02	01	H0609_046_0	2		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H0609	046	0	1	02	01	H0609_046_0	2		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0609	046	0	1	02	01	H0609_046_0	2		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H0609	046	0	1	02	01	H0609_046_0	2		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0609	046	0	1	02	01	H0609_046_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0609	046	0	1	02	01	H0609_046_0	2		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				453.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0609	047	0	1	02	01	H0609_047_0	2		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0609	047	0	1	02	01	H0609_047_0	2		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H0609	047	0	1	02	01	H0609_047_0	2		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	5.00		15.00																											15.00						0.00				5.00				5.00		0.16						0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0609	047	0	1	02	01	H0609_047_0	2		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	5.00		15.00																											15.00						0.00				5.00				5.00		0.16						0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H0609	047	0	1	02	01	H0609_047_0	2		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0609	047	0	1	02	01	H0609_047_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0609	047	0	1	02	01	H0609_047_0	2		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				445.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0609	048	0	1	02	01	H0609_048_0	2		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0609	048	0	1	02	01	H0609_048_0	2		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H0609	048	0	1	02	01	H0609_048_0	2		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0609	048	0	1	02	01	H0609_048_0	2		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H0609	048	0	1	02	01	H0609_048_0	2		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0609	048	0	1	02	01	H0609_048_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0609	048	0	1	02	01	H0609_048_0	2		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				509.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0609	049	0	1	02	01	H0609_049_0	2		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0609	049	0	1	02	01	H0609_049_0	2		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H0609	049	0	1	02	01	H0609_049_0	2		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	5.00		15.00																											15.00						0.00				5.00				5.00		0.16						0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0609	049	0	1	02	01	H0609_049_0	2		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	5.00		15.00																											15.00						0.00				5.00				5.00		0.16						0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H0609	049	0	1	02	01	H0609_049_0	2		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0609	049	0	1	02	01	H0609_049_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0609	049	0	1	02	01	H0609_049_0	2		Y	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												
H0628	001	0	1	02	01	H0628_001_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	001	0	1	02	01	H0628_001_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	001	0	1	02	01	H0628_001_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	001	0	1	02	01	H0628_001_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	001	0	1	02	01	H0628_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												
H0628	001	0	1	02	01	H0628_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												
H0628	001	0	1	02	01	H0628_001_0	4			Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											900.59	33						514.97	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0628	003	0	1	02	01	H0628_003_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	003	0	1	02	01	H0628_003_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	003	0	1	02	01	H0628_003_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	003	0	1	02	01	H0628_003_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	003	0	1	02	01	H0628_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												
H0628	003	0	1	02	01	H0628_003_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	003	0	1	02	01	H0628_003_0	4			Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1232.43	33						744.51	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0628	005	0	1	02	01	H0628_005_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	005	0	1	02	01	H0628_005_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	005	0	1	02	01	H0628_005_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	005	0	1	02	01	H0628_005_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	005	0	1	02	01	H0628_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												
H0628	005	0	1	02	01	H0628_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												
H0628	005	0	1	02	01	H0628_005_0	4			Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											602.48	33						548.49	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0628	006	0	1	02	01	H0628_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												
H0628	006	0	1	02	01	H0628_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
H0628	006	0	1	02	01	H0628_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												
H0628	006	0	1	02	01	H0628_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
H0628	006	0	1	02	01	H0628_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												
H0628	006	0	1	02	01	H0628_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					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					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	4			Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											960.75	33						560.69	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0628	007	0	1	02	01	H0628_007_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	007	0	1	02	01	H0628_007_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	007	0	1	02	01	H0628_007_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	007	0	1	02	01	H0628_007_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	007	0	1	02	01	H0628_007_0	4			Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					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	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	007	0	1	02	01	H0628_007_0	4			Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1170.55	33						583.92	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0628	008	0	1	02	01	H0628_008_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	008	0	1	02	01	H0628_008_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	008	0	1	02	01	H0628_008_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	008	0	1	02	01	H0628_008_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	008	0	1	02	01	H0628_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												
H0628	008	0	1	02	01	H0628_008_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	008	0	1	02	01	H0628_008_0	4			Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1121.84	33						576.28	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0628	009	0	1	02	01	H0628_009_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	009	0	1	02	01	H0628_009_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	009	0	1	02	01	H0628_009_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	009	0	1	02	01	H0628_009_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	009	0	1	02	01	H0628_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												
H0628	009	0	1	02	01	H0628_009_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	009	0	1	02	01	H0628_009_0	4			Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											595.28	33						440.23	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0628	010	0	1	02	01	H0628_010_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	010	0	1	02	01	H0628_010_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	010	0	1	02	01	H0628_010_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	010	0	1	02	01	H0628_010_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	010	0	1	02	01	H0628_010_0	4			Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					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	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	010	0	1	02	01	H0628_010_0	4			Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											918.68	33						533.61	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0628	011	0	1	01	01	H0628_011_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	011	0	1	01	01	H0628_011_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	011	0	1	01	01	H0628_011_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	011	0	1	01	01	H0628_011_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	011	0	1	01	01	H0628_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												
H0628	011	0	1	01	01	H0628_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												
H0628	011	0	1	01	01	H0628_011_0	4			Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											853.01	33						556.95	33												33						33						33		33								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											1071.44	33						539.44	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					0.00	0.00	0.00																19.00				19.00			0.63	0.00	0.00			0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred 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					0.00	0.00	0.00																20.00				20.00			0.66	0.00	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					40.00	80.00	120.00																47.00				47.00			1.56	1.33	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					80.00	160.00	240.00																100.00				100.00			3.33	2.66	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								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	02	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					0.00	0.00	0.00																19.00				19.00			0.63	0.00	0.00			0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0630	015	0	1	02	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					0.00	0.00	0.00																20.00				20.00			0.66	0.00	0.00			0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0630	015	0	1	02	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					40.00	80.00	100.00																47.00				47.00			1.56	1.33	1.33			1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0630	015	0	1	02	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					80.00	160.00	240.00																100.00				100.00			3.33	2.66	2.66			3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0630	015	0	1	02	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								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0630	015	0	1	02	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	02	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					0.00	0.00	0.00																19.00				19.00			0.63	0.00	0.00			0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0630	016	0	1	02	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					0.00	0.00	0.00																20.00				20.00			0.66	0.00	0.00			0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0630	016	0	1	02	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					40.00	80.00	100.00																47.00				47.00			1.56	1.33	1.33			1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0630	016	0	1	02	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					80.00	160.00	240.00																100.00				100.00			3.33	2.66	2.66			3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0630	016	0	1	02	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								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0630	016	0	1	02	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					0.00	0.00	0.00																19.00				19.00			0.63	0.00	0.00			0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred 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					0.00	0.00	0.00																20.00				20.00			0.66	0.16	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					40.00	80.00	120.00																47.00				47.00			1.56	1.33	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					80.00	160.00	240.00																100.00				100.00			3.33	2.66	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								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					0.00	0.00	0.00																19.00				19.00			0.63	0.00	0.00			0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred 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					0.00	0.00	0.00																20.00				20.00			0.66	0.00	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					40.00	80.00	120.00																47.00				47.00			1.56	1.33	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					80.00	160.00	240.00																100.00				100.00			3.33	2.66	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								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	02	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					0.00	0.00	0.00																19.00				19.00			0.63	0.00	0.00			0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0630	021	0	1	02	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					0.00	0.00	0.00																20.00				20.00			0.66	0.00	0.00			0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0630	021	0	1	02	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					40.00	80.00	100.00																47.00				47.00			1.56	1.33	1.33			1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0630	021	0	1	02	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					80.00	160.00	240.00																100.00				100.00			3.33	2.66	2.66			3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0630	021	0	1	02	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								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0630	021	0	1	02	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	02	01	H0630_023_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					0.00	0.00	0.00																19.00				19.00			0.63	0.00	0.00			0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0630	023	0	1	02	01	H0630_023_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					0.00	0.00	0.00																20.00				20.00			0.66	0.00	0.00			0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0630	023	0	1	02	01	H0630_023_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					40.00	80.00	100.00																47.00				47.00			1.56	1.33	1.33			1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0630	023	0	1	02	01	H0630_023_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					80.00	160.00	240.00																100.00				100.00			3.33	2.66	2.66			3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0630	023	0	1	02	01	H0630_023_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								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0630	023	0	1	02	01	H0630_023_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	025	0	1	02	01	H0630_025_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					0.00	0.00	0.00																19.00				19.00			0.63	0.00	0.00			0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0630	025	0	1	02	01	H0630_025_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					0.00	0.00	0.00																20.00				20.00			0.66	0.00	0.00			0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0630	025	0	1	02	01	H0630_025_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					40.00	80.00	120.00																47.00				47.00			1.56	1.33	1.33			1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0630	025	0	1	02	01	H0630_025_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					80.00	160.00	240.00																100.00				100.00			3.33	2.66	2.66			3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0630	025	0	1	02	01	H0630_025_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								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0630	025	0	1	02	01	H0630_025_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	026	0	1	02	01	H0630_026_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					0.00	0.00	0.00																19.00				19.00			0.63	0.00	0.00			0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0630	026	0	1	02	01	H0630_026_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					0.00	0.00	0.00																20.00				20.00			0.66	0.00	0.00			0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0630	026	0	1	02	01	H0630_026_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					40.00	80.00	120.00																47.00				47.00			1.56	1.33	1.33			1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0630	026	0	1	02	01	H0630_026_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					80.00	160.00	240.00																100.00				100.00			3.33	2.66	2.66			3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0630	026	0	1	02	01	H0630_026_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								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0630	026	0	1	02	01	H0630_026_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												
H0672	001	0	1	01	01	H0672_001_0	6		Y	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												
H0672	001	0	1	01	01	H0672_001_0	6		Y	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
H0672	001	0	1	01	01	H0672_001_0	6		Y	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								15.00	30.00	45.00					4.00	8.00	10.00											15.00	30.00	45.00				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		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0672	001	0	1	01	01	H0672_001_0	6		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								100.00	200.00	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												
H0672	001	0	1	01	01	H0672_001_0	6		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											816.81	33						814.48	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		Y	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												
H0672	003	0	1	01	01	H0672_003_0	6		Y	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
H0672	003	0	1	01	01	H0672_003_0	6		Y	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								15.00	30.00	45.00					4.00	8.00	10.00											15.00	30.00	45.00				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		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0672	003	0	1	01	01	H0672_003_0	6		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								100.00	200.00	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												
H0672	003	0	1	01	01	H0672_003_0	6		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											782.05	33						791.85	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		Y	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												
H0672	004	0	1	01	01	H0672_004_0	6		Y	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
H0672	004	0	1	01	01	H0672_004_0	6		Y	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								15.00	30.00	45.00					4.00	8.00	10.00											15.00	30.00	45.00				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		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0672	004	0	1	01	01	H0672_004_0	6		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								100.00	200.00	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												
H0672	004	0	1	01	01	H0672_004_0	6		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											480.71	33						821.19	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		Y	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												
H0672	005	0	1	01	01	H0672_005_0	6		Y	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
H0672	005	0	1	01	01	H0672_005_0	6		Y	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					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		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0672	005	0	1	01	01	H0672_005_0	6		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0672	005	0	1	01	01	H0672_005_0	6		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											624.50	33						851.53	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0672	006	0	1	01	01	H0672_006_0	6		Y	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												
H0672	006	0	1	01	01	H0672_006_0	6		Y	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
H0672	006	0	1	01	01	H0672_006_0	6		Y	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00				20.00				20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0672	006	0	1	01	01	H0672_006_0	6		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0672	006	0	1	01	01	H0672_006_0	6		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0672	006	0	1	01	01	H0672_006_0	6		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											846.61	33						682.25	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		Y	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												
H0672	007	0	1	01	01	H0672_007_0	6		Y	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
H0672	007	0	1	01	01	H0672_007_0	6		Y	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								15.00	30.00	45.00					4.00	8.00	10.00											15.00	30.00	45.00				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		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0672	007	0	1	01	01	H0672_007_0	6		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								100.00	200.00	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												
H0672	007	0	1	01	01	H0672_007_0	6		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											768.25	33						847.51	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		Y	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												
H0672	008	0	1	01	01	H0672_008_0	6		Y	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
H0672	008	0	1	01	01	H0672_008_0	6		Y	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								15.00	30.00	45.00					4.00	8.00	10.00											15.00	30.00	45.00				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		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0672	008	0	1	01	01	H0672_008_0	6		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								100.00	200.00	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												
H0672	008	0	1	01	01	H0672_008_0	6		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											768.25	33						847.51	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0672	011	0	1	01	01	H0672_011_0	5		Y	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												
H0672	011	0	1	01	01	H0672_011_0	5		Y	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
H0672	011	0	1	01	01	H0672_011_0	5		Y	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00				20.00				20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0672	011	0	1	01	01	H0672_011_0	5		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0672	011	0	1	01	01	H0672_011_0	5		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0672	011	0	1	01	01	H0672_011_0	5		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											897.34	33						788.82	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0672	013	0	1	01	01	H0672_013_0	6		Y	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												
H0672	013	0	1	01	01	H0672_013_0	6		Y	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
H0672	013	0	1	01	01	H0672_013_0	6		Y	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00				20.00				20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0672	013	0	1	01	01	H0672_013_0	6		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0672	013	0	1	01	01	H0672_013_0	6		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0672	013	0	1	01	01	H0672_013_0	6		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											897.34	33						788.82	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0672	014	0	1	01	01	H0672_014_0	5		Y	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												
H0672	014	0	1	01	01	H0672_014_0	5		Y	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
H0672	014	0	1	01	01	H0672_014_0	5		Y	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00				20.00				20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0672	014	0	1	01	01	H0672_014_0	5		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0672	014	0	1	01	01	H0672_014_0	5		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0672	014	0	1	01	01	H0672_014_0	5		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											897.34	33						788.82	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0672	016	0	1	01	01	H0672_016_0	6		Y	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												
H0672	016	0	1	01	01	H0672_016_0	6		Y	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
H0672	016	0	1	01	01	H0672_016_0	6		Y	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00				20.00				20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0672	016	0	1	01	01	H0672_016_0	6		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0672	016	0	1	01	01	H0672_016_0	6		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0672	016	0	1	01	01	H0672_016_0	6		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											897.34	33						788.82	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0672	017	0	1	01	01	H0672_017_0	6		Y	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												
H0672	017	0	1	01	01	H0672_017_0	6		Y	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
H0672	017	0	1	01	01	H0672_017_0	6		Y	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00				20.00				20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0672	017	0	1	01	01	H0672_017_0	6		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0672	017	0	1	01	01	H0672_017_0	6		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0672	017	0	1	01	01	H0672_017_0	6		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											897.34	33						788.82	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0710	008	0	1	04	01	H0710_008_0	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		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		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0710	008	0	1	04	01	H0710_008_0	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H0710	008	0	1	04	01	H0710_008_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0710	008	0	1	04	01	H0710_008_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		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		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				342.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0710	009	0	1	04	01	H0710_009_0	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0710	009	0	1	04	01	H0710_009_0	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0710	009	0	1	04	01	H0710_009_0	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H0710	009	0	1	04	01	H0710_009_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0710	009	0	1	04	01	H0710_009_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		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	009	0	1	04	01	H0710_009_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				526.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0710	012	0	1	04	01	H0710_012_0	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		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	012	0	1	04	01	H0710_012_0	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0710	012	0	1	04	01	H0710_012_0	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H0710	012	0	1	04	01	H0710_012_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0710	012	0	1	04	01	H0710_012_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		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	012	0	1	04	01	H0710_012_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				458.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0710	030	0	1	04	01	H0710_030_0	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		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		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0710	030	0	1	04	01	H0710_030_0	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H0710	030	0	1	04	01	H0710_030_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0710	030	0	1	04	01	H0710_030_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		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		Y	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												
H0710	037	0	1	04	01	H0710_037_0	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0710	037	0	1	04	01	H0710_037_0	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0710	037	0	1	04	01	H0710_037_0	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H0710	037	0	1	04	01	H0710_037_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0710	037	0	1	04	01	H0710_037_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		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	3		Y	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												
H0710	047	0	1	04	01	H0710_047_0	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0710	047	0	1	04	01	H0710_047_0	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0710	047	0	1	04	01	H0710_047_0	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H0710	047	0	1	04	01	H0710_047_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0710	047	0	1	04	01	H0710_047_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0710	047	0	1	04	01	H0710_047_0	3		Y	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												
H0710	050	0	1	04	01	H0710_050_0	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0710	050	0	1	04	01	H0710_050_0	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0710	050	0	1	04	01	H0710_050_0	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H0710	050	0	1	04	01	H0710_050_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0710	050	0	1	04	01	H0710_050_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0710	050	0	1	04	01	H0710_050_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				444.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0710	054	0	1	04	01	H0710_054_0	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0710	054	0	1	04	01	H0710_054_0	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0710	054	0	1	04	01	H0710_054_0	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H0710	054	0	1	04	01	H0710_054_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0710	054	0	1	04	01	H0710_054_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0710	054	0	1	04	01	H0710_054_0	3		Y	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												
H0710	055	0	1	04	01	H0710_055_0	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0710	055	0	1	04	01	H0710_055_0	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0710	055	0	1	04	01	H0710_055_0	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H0710	055	0	1	04	01	H0710_055_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0710	055	0	1	04	01	H0710_055_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0710	055	0	1	04	01	H0710_055_0	3		Y	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												
H0710	056	0	1	04	01	H0710_056_0	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0710	056	0	1	04	01	H0710_056_0	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0710	056	0	1	04	01	H0710_056_0	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H0710	056	0	1	04	01	H0710_056_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0710	056	0	1	04	01	H0710_056_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0710	056	0	1	04	01	H0710_056_0	3		Y	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												
H0710	057	0	1	04	01	H0710_057_0	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0710	057	0	1	04	01	H0710_057_0	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0710	057	0	1	04	01	H0710_057_0	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H0710	057	0	1	04	01	H0710_057_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0710	057	0	1	04	01	H0710_057_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0710	057	0	1	04	01	H0710_057_0	3		Y	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												
H0710	058	0	1	04	01	H0710_058_0	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0710	058	0	1	04	01	H0710_058_0	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0710	058	0	1	04	01	H0710_058_0	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H0710	058	0	1	04	01	H0710_058_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0710	058	0	1	04	01	H0710_058_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0710	058	0	1	04	01	H0710_058_0	3		Y	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												
H0710	059	0	1	04	01	H0710_059_0	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0710	059	0	1	04	01	H0710_059_0	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0710	059	0	1	04	01	H0710_059_0	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H0710	059	0	1	04	01	H0710_059_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0710	059	0	1	04	01	H0710_059_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0710	059	0	1	04	01	H0710_059_0	3		Y	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												
H0710	060	0	1	04	01	H0710_060_0	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0710	060	0	1	04	01	H0710_060_0	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0710	060	0	1	04	01	H0710_060_0	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H0710	060	0	1	04	01	H0710_060_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0710	060	0	1	04	01	H0710_060_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0710	060	0	1	04	01	H0710_060_0	3		Y	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												
H0710	061	0	1	04	01	H0710_061_0	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0710	061	0	1	04	01	H0710_061_0	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0710	061	0	1	04	01	H0710_061_0	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H0710	061	0	1	04	01	H0710_061_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0710	061	0	1	04	01	H0710_061_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0710	061	0	1	04	01	H0710_061_0	3		Y	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												
H0710	062	0	1	04	01	H0710_062_0	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0710	062	0	1	04	01	H0710_062_0	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0710	062	0	1	04	01	H0710_062_0	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H0710	062	0	1	04	01	H0710_062_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0710	062	0	1	04	01	H0710_062_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0710	062	0	1	04	01	H0710_062_0	3		Y	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												
H0710	065	0	1	04	01	H0710_065_0	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0710	065	0	1	04	01	H0710_065_0	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0710	065	0	1	04	01	H0710_065_0	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H0710	065	0	1	04	01	H0710_065_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0710	065	0	1	04	01	H0710_065_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0710	065	0	1	04	01	H0710_065_0	3		Y	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												
H0710	066	0	1	04	01	H0710_066_0	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0710	066	0	1	04	01	H0710_066_0	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0710	066	0	1	04	01	H0710_066_0	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H0710	066	0	1	04	01	H0710_066_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0710	066	0	1	04	01	H0710_066_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0710	066	0	1	04	01	H0710_066_0	3		Y	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												
H0710	067	0	1	04	01	H0710_067_0	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0710	067	0	1	04	01	H0710_067_0	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0710	067	0	1	04	01	H0710_067_0	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H0710	067	0	1	04	01	H0710_067_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0710	067	0	1	04	01	H0710_067_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0710	067	0	1	04	01	H0710_067_0	3		Y	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												
H0710	068	0	1	04	01	H0710_068_0	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0710	068	0	1	04	01	H0710_068_0	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0710	068	0	1	04	01	H0710_068_0	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H0710	068	0	1	04	01	H0710_068_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0710	068	0	1	04	01	H0710_068_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0710	068	0	1	04	01	H0710_068_0	3		Y	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												
H0710	069	0	1	04	01	H0710_069_0	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0710	069	0	1	04	01	H0710_069_0	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0710	069	0	1	04	01	H0710_069_0	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H0710	069	0	1	04	01	H0710_069_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0710	069	0	1	04	01	H0710_069_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0710	069	0	1	04	01	H0710_069_0	3		Y	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												
H0710	070	0	1	04	01	H0710_070_0	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0710	070	0	1	04	01	H0710_070_0	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0710	070	0	1	04	01	H0710_070_0	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H0710	070	0	1	04	01	H0710_070_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0710	070	0	1	04	01	H0710_070_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0710	070	0	1	04	01	H0710_070_0	3		Y	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												
H0712	019	0	1	01	01	H0712_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								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00				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												
H0712	019	0	1	01	01	H0712_019_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					1.00	2.00	3.00											10.00	20.00	30.00				1.00	2.00	0.00				10.00				10.00			0.33	0.03		0.33	0.03	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0712	019	0	1	01	01	H0712_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												
H0712	019	0	1	01	01	H0712_019_0	4			Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											89.89	45	45	45				85.90	43	43	43										45	45	45				43	43	43			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0712	019	0	1	01	01	H0712_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												
H0712	019	0	1	01	01	H0712_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												
H0712	019	0	1	01	01	H0712_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	
H0712	020	0	1	01	01	H0712_020_0	4			Preferred Generic	4	11	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								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												
H0712	020	0	1	01	01	H0712_020_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	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												
H0712	020	0	1	01	01	H0712_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	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, Select Care Drugs												
H0712	020	0	1	01	01	H0712_020_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											99.57	44	44	44				99.57	44	44	44										44	44	44				44	44	44			44			44								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0712	020	0	1	01	01	H0712_020_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												
H0712	020	0	1	01	01	H0712_020_0	4			Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			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	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												
H0712	023	0	1	01	01	H0712_023_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												
H0712	023	0	1	01	01	H0712_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								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	4			Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											88.69	48	48	48				85.00	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	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												
H0712	023	0	1	01	01	H0712_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	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	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												
H0724	001	0	1	01	01	H0724_001_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					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	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												
H0724	001	0	1	01	01	H0724_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												
H0724	001	0	1	01	01	H0724_001_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												
H0724	001	0	1	01	01	H0724_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												
H0724	001	0	1	01	01	H0724_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	
H0724	006	0	1	01	01	H0724_006_0	6			Preferred Generic	4	11	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								19.00	38.00	57.00					0.00	0.00	0.00											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												
H0724	006	0	1	01	01	H0724_006_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	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												
H0724	006	0	1	01	01	H0724_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	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, Select Care Drugs												
H0724	006	0	1	01	01	H0724_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											97.83	48	48	48				97.83	48	48	48										48	48	48				48	48	48			48			48								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0724	006	0	1	01	01	H0724_006_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												
H0724	006	0	1	01	01	H0724_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												
H0724	007	0	1	01	01	H0724_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								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00				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	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					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	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												
H0724	007	0	1	01	01	H0724_007_0	6			Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	300.00					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	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												
H0724	007	0	1	01	01	H0724_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												
H0724	007	0	1	01	01	H0724_007_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	
H0738	001	0	1	01	01	H0738_001_0	6		N	Generic	2	01	1	2	1	1	111		01	100		1	30	60	100				1	2			100				30		31	6.75	13.50	20.25																					20.25																6.75				6.75		0.23						0.22	Generic, Brand												
H0738	001	0	1	01	01	H0738_001_0	6		N	Brand	2	11	1	1	2	1	111		01	100		1	30	60	100				1	2			100				30		31				92.28	25	25	25																				25															25			25								Generic, Brand												
H0755	030	0	1	02	01	H0755_030_0	2		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0755	030	0	1	02	01	H0755_030_0	2		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H0755	030	0	1	02	01	H0755_030_0	2		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	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												
H0755	030	0	1	02	01	H0755_030_0	2		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	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
H0755	030	0	1	02	01	H0755_030_0	2		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0755	030	0	1	02	01	H0755_030_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0755	030	0	1	02	01	H0755_030_0	2		Y	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												
H0755	031	0	1	02	01	H0755_031_0	2		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0755	031	0	1	02	01	H0755_031_0	2		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H0755	031	0	1	02	01	H0755_031_0	2		Y	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												
H0755	031	0	1	02	01	H0755_031_0	2		Y	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
H0755	031	0	1	02	01	H0755_031_0	2		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0755	031	0	1	02	01	H0755_031_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0755	031	0	1	02	01	H0755_031_0	2		Y	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												
H0755	033	0	1	02	01	H0755_033_0	2		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0755	033	0	1	02	01	H0755_033_0	2		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H0755	033	0	1	02	01	H0755_033_0	2		Y	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												
H0755	033	0	1	02	01	H0755_033_0	2		Y	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
H0755	033	0	1	02	01	H0755_033_0	2		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0755	033	0	1	02	01	H0755_033_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0755	033	0	1	02	01	H0755_033_0	2		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				353.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0755	038	0	1	02	01	H0755_038_0	2		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0755	038	0	1	02	01	H0755_038_0	2		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H0755	038	0	1	02	01	H0755_038_0	2		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0755	038	0	1	02	01	H0755_038_0	2		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H0755	038	0	1	02	01	H0755_038_0	2		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0755	038	0	1	02	01	H0755_038_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0755	038	0	1	02	01	H0755_038_0	2		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				435.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0755	044	0	1	02	01	H0755_044_0	2		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0755	044	0	1	02	01	H0755_044_0	2		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H0755	044	0	1	02	01	H0755_044_0	2		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0755	044	0	1	02	01	H0755_044_0	2		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H0755	044	0	1	02	01	H0755_044_0	2		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0755	044	0	1	02	01	H0755_044_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0755	044	0	1	02	01	H0755_044_0	2		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				440.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0755	045	0	1	02	01	H0755_045_0	2		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0755	045	0	1	02	01	H0755_045_0	2		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H0755	045	0	1	02	01	H0755_045_0	2		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0755	045	0	1	02	01	H0755_045_0	2		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H0755	045	0	1	02	01	H0755_045_0	2		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0755	045	0	1	02	01	H0755_045_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0755	045	0	1	02	01	H0755_045_0	2		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				543.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0783	002	0	1	01	01	H0783_002_0	3		Y	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									15.00		45.00				0.00		0.00				0.00				0.00		0				0.50	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0783	002	0	1	01	01	H0783_002_0	3		Y	Generic	4	11	3	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	10.00		30.00																									20.00		60.00				10.00		0.00				10.00				10.00		0.33				0.67	0.33	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0783	002	0	1	01	01	H0783_002_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		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	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		290.00				100.00				100.00		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	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0783	003	0	1	01	01	H0783_003_0	3		Y	Preferred Generic	4	11	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0783	003	0	1	01	01	H0783_003_0	3		Y	Preferred Generic	4	11	1	2	1	3	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H0783	003	0	1	01	01	H0783_003_0	3		Y	Generic	4	11	1	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	5.00		15.00																									20.00		60.00				5.00		0.00				5.00				5.00		0.17				0.67	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0783	003	0	1	01	01	H0783_003_0	3		Y	Generic	4	11	1	2	2	3	110		01		110	1	30		90				2	2				30		90	30		31	5.00		15.00																									20.00		60.00				5.00		0.00				5.00				5.00		0.17				0.67	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H0783	003	0	1	01	01	H0783_003_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	45.00		135.00																									47.00		141.00				45.00		90.00				45.00				45.00		1.50				1.57	1.50	1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0783	003	0	1	01	01	H0783_003_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	99.00		297.00																									100.00		300.00				99.00		198.00				99.00				99.00		3.30				3.33	3.30	3.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0783	003	0	1	01	01	H0783_003_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0798	001	0	1	01	01	H0798_001_0	6		Y	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	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		Y	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					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		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	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		Y	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											96.90	42	42	42				96.66	42	42	42										42	42	42				42	42	42			42			42								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0798	001	0	1	01	01	H0798_001_0	6		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												29							29												29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0826	001	0	1	01	01	H0826_001_0	4		Y	Preferred Generic	4	01	1	2	1	1	110		01	110		1	30		90				1	2	30		90				30		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0826	001	0	1	01	01	H0826_001_0	4		Y	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		Y	Generic	4	01	1	2	2	1	110		01	110		1	30		90				1	2	30		90				30		31	10.00		30.00																			10.00		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		Y	Preferred Brand	4	10	1	2	3	1	110		01	110		1	30		90				1	2	30		90				30		31	47.00		141.00																			47.00		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		Y	Non-Preferred Drug	4	10	1	2	4	1	110		01	110		1	30		90				1	2	30		90				30		31	100.00		300.00																			100.00		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		Y	Specialty Tier	4	10	1	1	5	1	010		01			1	30														30		31				891.00	31																																					31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0826	002	0	1	01	01	H0826_002_0	4		N	Preferred Generic	4	01	1	2	1	1	110		01	110		1	30		90				1	2	30		90				30		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0826	002	0	1	01	01	H0826_002_0	4		N	Preferred Generic	4	01	1	2	1	3	110		01	110		1	30		90				1	2	30		90				30		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H0826	002	0	1	01	01	H0826_002_0	4		N	Generic	4	01	1	1	2	1	110		01	110		1	30		90				1	2	30		90				30		31				8.00	25		25																		25		25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0826	002	0	1	01	01	H0826_002_0	4		N	Preferred Brand	4	10	1	1	3	1	110		01	110		1	30		90				1	2	30		90				30		31				78.00	25		25																		25		25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0826	002	0	1	01	01	H0826_002_0	4		N	Non-Preferred Drug	4	10	1	1	4	1	110		01	110		1	30		90				1	2	30		90				30		31				62.00	25		25																		25		25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0826	002	0	1	01	01	H0826_002_0	4		N	Specialty Tier	4	10	1	1	5	1	010		01			1	30														30		31				788.00	25																																					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0838	024	0	1	01	01	H0838_024_0	6		N	Preferred Generic	4	11	1	2	1	1	110		01	100		1	30		90				1	2			90				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	6		N	Preferred Generic	4	11	1	2	1	3	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H0838	024	0	1	01	01	H0838_024_0	6		N	Generic	4	11	1	1	2	1	110		01	100		1	30		90				2	2			90				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	6		N	Preferred Brand	4	11	1	1	3	1	110		01	100		1	30		90				2	2			90				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	6		N	Non-Preferred Drug	4	11	1	1	4	1	110		01	100		1	30		90				2	2			90				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	6		N	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	6		N	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	6		N	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	6		N	Preferred Generic	4	11	1	2	1	1	110		01	100		1	30		90				1	2			90				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	6		N	Preferred Generic	4	11	1	2	1	3	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H0838	028	0	1	01	01	H0838_028_0	6		N	Generic	4	11	1	2	2	1	110		01	100		1	30		90				2	2			90				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	6		N	Preferred Brand	4	11	1	2	3	1	110		01	100		1	30		90				2	2			90				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	6		N	Non-Preferred Drug	4	11	1	2	4	1	110		01	100		1	30		90				2	2			90				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	6		N	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	6		N	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	6		N	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	6		N	Preferred Generic	4	11	1	2	1	1	110		01	100		1	30		90				1	2			90				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	6		N	Preferred Generic	4	11	1	2	1	3	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H0838	029	0	1	01	01	H0838_029_0	6		N	Generic	4	11	1	1	2	1	110		01	100		1	30		90				2	2			90				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	6		N	Preferred Brand	4	11	1	1	3	1	110		01	100		1	30		90				2	2			90				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	6		N	Non-Preferred Drug	4	11	1	1	4	1	110		01	100		1	30		90				2	2			90				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	6		N	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	6		N	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	6		N	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	6		Y	Preferred Generic	4	11	1	2	1	1	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0838	039	1	1	01	01	H0838_039_1	6		Y	Preferred Generic	4	11	1	2	1	3	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H0838	039	1	1	01	01	H0838_039_1	6		Y	Generic	4	11	1	2	2	1	110		01	100		1	30		90				2	2			90				30		31	9.00		27.00																					18.00																9.00				9.00		0.30						0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0838	039	1	1	01	01	H0838_039_1	6		Y	Preferred Brand	4	11	1	2	3	1	110		01	100		1	30		90				2	2			90				30		31	47.00		141.00																					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	6		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01	100		1	30		90				2	2			90				30		31	90.00		270.00																					180.00																90.00				90.00		3.00						2.90	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0838	039	1	1	01	01	H0838_039_1	6		Y	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	6		Y	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	6		Y	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	6		Y	Preferred Generic	4	11	1	2	1	1	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0838	039	2	1	01	01	H0838_039_2	6		Y	Preferred Generic	4	11	1	2	1	3	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H0838	039	2	1	01	01	H0838_039_2	6		Y	Generic	4	11	1	2	2	1	110		01	100		1	30		90				2	2			90				30		31	9.00		27.00																					18.00																9.00				9.00		0.30						0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0838	039	2	1	01	01	H0838_039_2	6		Y	Preferred Brand	4	11	1	2	3	1	110		01	100		1	30		90				2	2			90				30		31	47.00		141.00																					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	6		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01	100		1	30		90				2	2			90				30		31	90.00		270.00																					180.00																90.00				90.00		3.00						2.90	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0838	039	2	1	01	01	H0838_039_2	6		Y	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	6		Y	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	6		Y	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	4		N	Preferred Generic	4	11	1	2	1	1	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0838	040	1	1	01	01	H0838_040_1	4		N	Preferred Generic	4	11	1	2	1	3	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H0838	040	1	1	01	01	H0838_040_1	4		N	Generic	4	11	1	1	2	1	110		01	100		1	30		90				2	2			90				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	4		N	Preferred Brand	4	11	1	1	3	1	110		01	100		1	30		90				2	2			90				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	4		N	Non-Preferred Drug	4	11	1	1	4	1	110		01	100		1	30		90				2	2			90				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	4		N	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	4		N	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	4		N	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	4		N	Preferred Generic	4	11	1	2	1	1	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0838	040	2	1	01	01	H0838_040_2	4		N	Preferred Generic	4	11	1	2	1	3	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H0838	040	2	1	01	01	H0838_040_2	4		N	Generic	4	11	1	1	2	1	110		01	100		1	30		90				2	2			90				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	4		N	Preferred Brand	4	11	1	1	3	1	110		01	100		1	30		90				2	2			90				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	4		N	Non-Preferred Drug	4	11	1	1	4	1	110		01	100		1	30		90				2	2			90				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	4		N	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	4		N	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	4		N	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	6		N	Preferred Generic	4	11	1	2	1	1	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0838	042	0	1	01	01	H0838_042_0	6		N	Preferred Generic	4	11	1	2	1	3	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H0838	042	0	1	01	01	H0838_042_0	6		N	Generic	4	11	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												
H0838	042	0	1	01	01	H0838_042_0	6		N	Preferred Brand	4	11	1	2	3	1	110		01	100		1	30		90				2	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0838	042	0	1	01	01	H0838_042_0	6		N	Non-Preferred Drug	4	11	1	2	4	1	110		01	100		1	30		90				2	2			90				30		31	50.00		150.00																					100.00																50.00				50.00		1.67						1.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0838	042	0	1	01	01	H0838_042_0	6		N	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	6		N	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	6		N	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		N	Preferred Generic	4	11	1	2	1	1	110		01	100		1	30		90				1	2			90				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		N	Preferred Generic	4	11	1	2	1	3	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H0838	043	0	1	01	01	H0838_043_0	6		N	Generic	4	11	1	2	2	1	110		01	100		1	30		90				2	2			90				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		N	Preferred Brand	4	11	1	2	3	1	110		01	100		1	30		90				2	2			90				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		N	Non-Preferred Drug	4	11	1	2	4	1	110		01	100		1	30		90				2	2			90				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		N	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		N	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		N	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		N	Preferred Generic	4	11	1	2	1	1	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0838	044	0	1	01	01	H0838_044_0	6		N	Preferred Generic	4	11	1	2	1	3	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H0838	044	0	1	01	01	H0838_044_0	6		N	Generic	4	11	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												
H0838	044	0	1	01	01	H0838_044_0	6		N	Preferred Brand	4	11	1	1	3	1	110		01	100		1	30		90				2	2			90				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		N	Non-Preferred Drug	4	11	1	1	4	1	110		01	100		1	30		90				2	2			90				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		N	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		N	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	044	0	1	01	01	H0838_044_0	6		N	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		N	Preferred Generic	4	11	1	2	1	1	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0																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		N	Preferred Generic	4	11	1	2	1	3	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H0838	045	0	1	01	01	H0838_045_0	6		N	Generic	4	11	1	1	2	1	110		01	100		1	30		90				2	2			90				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		N	Preferred Brand	4	11	1	1	3	1	110		01	100		1	30		90				2	2			90				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		N	Non-Preferred Drug	4	11	1	1	4	1	110		01	100		1	30		90				2	2			90				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		N	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		N	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												
H0838	045	0	1	01	01	H0838_045_0	6		N	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		N	Preferred Generic	4	11	1	2	1	1	110		01	100		1	30		90				1	2			90				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		N	Preferred Generic	4	11	1	2	1	3	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H0838	046	0	1	01	01	H0838_046_0	6		N	Generic	4	11	1	2	2	1	110		01	100		1	30		90				2	2			90				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		N	Preferred Brand	4	11	1	2	3	1	110		01	100		1	30		90				2	2			90				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		N	Non-Preferred Drug	4	11	1	2	4	1	110		01	100		1	30		90				2	2			90				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		N	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		N	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		N	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		Y	Preferred Generic	4	11	1	2	1	1	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0838	047	0	1	01	01	H0838_047_0	6		Y	Preferred Generic	4	11	1	2	1	3	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H0838	047	0	1	01	01	H0838_047_0	6		Y	Generic	4	11	1	2	2	1	110		01	100		1	30		90				2	2			90				30		31	12.00		36.00																					24.00																12.00				12.00		0.40						0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0838	047	0	1	01	01	H0838_047_0	6		Y	Preferred Brand	4	11	1	2	3	1	110		01	100		1	30		90				2	2			90				30		31	47.00		141.00																					94.00																47.00				47.00		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		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01	100		1	30		90				2	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 Care Drugs												
H0838	047	0	1	01	01	H0838_047_0	6		Y	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				414.32	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0838	047	0	1	01	01	H0838_047_0	6		Y	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	047	0	1	01	01	H0838_047_0	6		Y	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	7		N	Preferred Generic	4	11	1	2	1	1	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0838	049	0	1	01	01	H0838_049_0	7		N	Preferred Generic	4	11	1	2	1	3	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H0838	049	0	1	01	01	H0838_049_0	7		N	Generic	4	11	1	2	2	1	110		01	100		1	30		90				2	2			90				30		31	12.00		36.00																					24.00																12.00				12.00		0.40						0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0838	049	0	1	01	01	H0838_049_0	7		N	Preferred Brand	4	11	1	2	3	1	110		01	100		1	30		90				2	2			90				30		31	47.00		141.00																					94.00																47.00				47.00		1.57						1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0838	049	0	1	01	01	H0838_049_0	7		N	Non-Preferred Drug	4	11	1	2	4	1	110		01	100		1	30		90				2	2			90				30		31	100.00		300.00																					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	7		N	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	7		N	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	7		N	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	050	1	1	01	01	H0838_050_1	6		N	Preferred Generic	4	11	1	2	1	1	110		01	100		1	30		90				1	2			90				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	050	1	1	01	01	H0838_050_1	6		N	Preferred Generic	4	11	1	2	1	3	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H0838	050	1	1	01	01	H0838_050_1	6		N	Generic	4	11	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												
H0838	050	1	1	01	01	H0838_050_1	6		N	Preferred Brand	4	11	1	2	3	1	110		01	100		1	30		90				2	2			90				30		31	47.00		141.00																					94.00																47.00				47.00		1.57						1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0838	050	1	1	01	01	H0838_050_1	6		N	Non-Preferred Drug	4	11	1	2	4	1	110		01	100		1	30		90				2	2			90				30		31	100.00		300.00																					200																100.00				100.00		3.33						3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0838	050	1	1	01	01	H0838_050_1	6		N	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	050	1	1	01	01	H0838_050_1	6		N	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	050	1	1	01	01	H0838_050_1	6		N	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	050	2	1	01	01	H0838_050_2	6		N	Preferred Generic	4	11	1	2	1	1	110		01	100		1	30		90				1	2			90				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	050	2	1	01	01	H0838_050_2	6		N	Preferred Generic	4	11	1	2	1	3	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H0838	050	2	1	01	01	H0838_050_2	6		N	Generic	4	11	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												
H0838	050	2	1	01	01	H0838_050_2	6		N	Preferred Brand	4	11	1	2	3	1	110		01	100		1	30		90				2	2			90				30		31	47.00		141.00																					94.00																47.00				47.00		1.57						1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0838	050	2	1	01	01	H0838_050_2	6		N	Non-Preferred Drug	4	11	1	2	4	1	110		01	100		1	30		90				2	2			90				30		31	100.00		300.00																					200																100.00				100.00		3.33						3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0838	050	2	1	01	01	H0838_050_2	6		N	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	050	2	1	01	01	H0838_050_2	6		N	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	050	2	1	01	01	H0838_050_2	6		N	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	051	1	1	01	01	H0838_051_1	6		N	Preferred Generic	4	11	1	2	1	1	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0838	051	1	1	01	01	H0838_051_1	6		N	Preferred Generic	4	11	1	2	1	3	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H0838	051	1	1	01	01	H0838_051_1	6		N	Generic	4	11	1	2	2	1	110		01	100		1	30		90				2	2			90				30		31	12.00		36.00																					24.00																12.00				12.00		0.40						0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0838	051	1	1	01	01	H0838_051_1	6		N	Preferred Brand	4	11	1	2	3	1	110		01	100		1	30		90				2	2			90				30		31	47.00		141.00																					94.00																47.00				47.00		1.57						1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0838	051	1	1	01	01	H0838_051_1	6		N	Non-Preferred Drug	4	11	1	2	4	1	110		01	100		1	30		90				2	2			90				30		31	100.00		300.00																					200.00																100.00				100.00		3.33						3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0838	051	1	1	01	01	H0838_051_1	6		N	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	051	1	1	01	01	H0838_051_1	6		N	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	051	1	1	01	01	H0838_051_1	6		N	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	051	2	1	01	01	H0838_051_2	7		N	Preferred Generic	4	11	1	2	1	1	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0838	051	2	1	01	01	H0838_051_2	7		N	Preferred Generic	4	11	1	2	1	3	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H0838	051	2	1	01	01	H0838_051_2	7		N	Generic	4	11	1	2	2	1	110		01	100		1	30		90				2	2			90				30		31	12.00		36.00																					24.00																12.00				12.00		0.40						0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0838	051	2	1	01	01	H0838_051_2	7		N	Preferred Brand	4	11	1	2	3	1	110		01	100		1	30		90				2	2			90				30		31	47.00		141.00																					94.00																47.00				47.00		1.57						1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0838	051	2	1	01	01	H0838_051_2	7		N	Non-Preferred Drug	4	11	1	2	4	1	110		01	100		1	30		90				2	2			90				30		31	100.00		300.00																					200.00																100.00				100.00		3.33						3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0838	051	2	1	01	01	H0838_051_2	7		N	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	051	2	1	01	01	H0838_051_2	7		N	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	051	2	1	01	01	H0838_051_2	7		N	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	5		N	Preferred Generic	4	01	1	1	1	1	111		01	111		1	31	60	100				1	2	31	60	100				31		31				2.89	20	20	20																		20	20	20															20			20								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0876	001	0	1	01	01	H0876_001_0	5		N	Generic	4	01	1	1	2	1	111		01	111		1	31	60	100				1	2	31	60	100				31		31				11.50	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	5		N	Preferred Brand	4	10	1	1	3	1	111		01	111		1	31	60	100				1	2	31	60	100				31		31				117.30	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	5		N	Non-Preferred Brand	4	10	1	1	4	1	111		01	111		1	31	60	100				1	2	31	60	100				31		31				74.20	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	5		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	31								31						31		31				1032.44	25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0885	001	0	1	04	01	H0885_001_0	8		Y	Preferred Generic	4	11	1	2	1	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				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	8		Y	Generic	4	01	1	2	2	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	8.00	16.00	24.00																									8.00	16.00	24.00				4.00	8.00	12.00				8.00				8.00		0.27				0.27	0.13	0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0885	001	0	1	04	01	H0885_001_0	8		Y	Preferred Brand	4	11	1	2	3	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	47.00	94.00	141.00																									47.00	94.00	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, Select Care Drugs												
H0885	001	0	1	04	01	H0885_001_0	8		Y	Non-Preferred Drug	4	11	1	2	4	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	100.00	200.00	300.00																									100.00	200.00	300.00				100.00	200.00	300.00				100.00				100.00		3.33				3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0885	001	0	1	04	01	H0885_001_0	8		Y	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31				758.00	30																																					30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0885	001	0	1	04	01	H0885_001_0	8		Y	Select Care Drugs	4	01	1	2	6	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0885	002	0	1	04	01	H0885_002_0	8		Y	Preferred Generic	4	11	1	2	1	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				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	8		Y	Generic	4	01	1	2	2	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	5.00	10.00	15.00																									5.00	10.00	15.00				2.50	5.00	7.50				5.00				5.00		0.17				0.17	0.08	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0885	002	0	1	04	01	H0885_002_0	8		Y	Preferred Brand	4	11	1	2	3	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	47.00	94.00	141.00																									47.00	94.00	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, Select Care Drugs												
H0885	002	0	1	04	01	H0885_002_0	8		Y	Non-Preferred Drug	4	11	1	2	4	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	100.00	200.00	300.00																									100.00	200.00	300.00				100.00	200.00	300.00				100.00				100.00		3.33				3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0885	002	0	1	04	01	H0885_002_0	8		Y	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31				752.00	30																																					30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0885	002	0	1	04	01	H0885_002_0	8		Y	Select Care Drugs	4	01	1	2	6	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0885	003	0	1	04	01	H0885_003_0	8		Y	Preferred Generic	4	11	1	2	1	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0885	003	0	1	04	01	H0885_003_0	8		Y	Generic	4	01	1	2	2	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	8.00	16.00	24.00																									8.00	16.00	24.00				4.00	8.00	12.00				8.00				8.00		.27				0.27	0.13	0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0885	003	0	1	04	01	H0885_003_0	8		Y	Preferred Brand	4	11	1	2	3	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	47.00	94.00	141.00																									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, Select Care Drugs												
H0885	003	0	1	04	01	H0885_003_0	8		Y	Non-Preferred Drug	4	11	1	2	4	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	100.00	200.00	300.00																									100.00	200.00	300.00				100.00	200.00	300.00				100.00				100.00		3.33				3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0885	003	0	1	04	01	H0885_003_0	8		Y	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31				758.00	30																																					30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0885	003	0	1	04	01	H0885_003_0	8		Y	Select Care Drugs	4	01	1	2	6	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0885	004	0	1	04	01	H0885_004_0	8		Y	Preferred Generic	4	11	1	2	1	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0885	004	0	1	04	01	H0885_004_0	8		Y	Generic	4	01	1	2	2	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	8.00	16.00	24.00																									8.00	16.00	24.00				4.00	8.00	12.00				8.00				8.00		0.27				0.27	0.13	0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0885	004	0	1	04	01	H0885_004_0	8		Y	Preferred Brand	4	11	1	2	3	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	47.00	94.00	141.00																									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, Select Care Drugs												
H0885	004	0	1	04	01	H0885_004_0	8		Y	Non-Preferred Drug	4	11	1	2	4	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	100.00	200.00	300.00																									100.00	200.00	300.00				100.00	200.00	300.00				100.00				100.00		3.33				3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0885	004	0	1	04	01	H0885_004_0	8		Y	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31				758.00	30																																					30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0885	004	0	1	04	01	H0885_004_0	8		Y	Select Care Drugs	4	01	1	2	6	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0885	005	0	1	04	01	H0885_005_0	8		Y	Preferred Generic	4	11	1	2	1	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0885	005	0	1	04	01	H0885_005_0	8		Y	Generic	4	01	1	2	2	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	8.00	16.00	24.00																									8.00	16.00	24.00				4.00	8.00	12.00				8.00				8.00		0.27				0.27	0.13	0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0885	005	0	1	04	01	H0885_005_0	8		Y	Preferred Brand	4	11	1	2	3	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	47.00	94.00	141.00																									47.00	94.00	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, Select Care Drugs												
H0885	005	0	1	04	01	H0885_005_0	8		Y	Non-Preferred Drug	4	11	1	2	4	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	100.00	200.00	300.00																									100.00	200.00	300.00				100.00	200.00	300.00				100.00				100.00		3.33				3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0885	005	0	1	04	01	H0885_005_0	8		Y	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31				758.00	30																																					30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0885	005	0	1	04	01	H0885_005_0	8		Y	Select Care Drugs	4	01	1	2	6	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0885	006	0	1	04	01	H0885_006_0	8		Y	Preferred Generic	4	11	1	2	1	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0885	006	0	1	04	01	H0885_006_0	8		Y	Generic	4	01	1	2	2	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	8.00	16.00	24.00																									8.00	16.00	24.00				4.00	8.00	12.00				8.00				8.00		0.27				0.27	0.13	0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0885	006	0	1	04	01	H0885_006_0	8		Y	Preferred Brand	4	11	1	2	3	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	47.00	94.00	141.00																									47.00	94.00	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, Select Care Drugs												
H0885	006	0	1	04	01	H0885_006_0	8		Y	Non-Preferred Drug	4	11	1	2	4	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	100.00	200.00	300.00																									100.00	200.00	300.00				100.00	200.00	300.00				100.00				100.00		3.33				3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0885	006	0	1	04	01	H0885_006_0	8		Y	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31				758.00	30																																					30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0885	006	0	1	04	01	H0885_006_0	8		Y	Select Care Drugs	4	01	1	2	6	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0907	001	0	1	01	01	H0907_001_0	6		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								5.00	10.00	15.00					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	6		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								15.00	30.00	45.00					15.00	30.00	45.00					15.00	45.00	45.00																15.00				15.00			0.50	0.50	0.50			0.44	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0907	001	0	1	01	01	H0907_001_0	6		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								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	6		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	285.00	285.00																100.00				100.00			3.33	3.17	3.17			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0907	001	0	1	01	01	H0907_001_0	6		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												25							25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0907	001	0	1	01	01	H0907_001_0	6		N	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								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	003	0	1	01	01	H0908_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												
H0908	003	0	1	01	01	H0908_003_0	6			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
H0908	003	0	1	01	01	H0908_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					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	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												
H0908	003	0	1	01	01	H0908_003_0	6			Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	300.00					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	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												
H0908	003	0	1	01	01	H0908_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												
H0908	003	0	1	01	01	H0908_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	
H0908	004	0	1	01	01	H0908_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								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												
H0908	004	0	1	01	01	H0908_004_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	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												
H0908	004	0	1	01	01	H0908_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	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, Select Care Drugs												
H0908	004	0	1	01	01	H0908_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											99.30	45	45	45				99.30	45	45	45										45	45	45				45	45	45			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0908	004	0	1	01	01	H0908_004_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												
H0908	004	0	1	01	01	H0908_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												
H0908	005	0	1	01	01	H0908_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								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00				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	005	0	1	01	01	H0908_005_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					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	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												
H0908	005	0	1	01	01	H0908_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											92.76	50	50	50				89.05	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	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												
H0908	005	0	1	01	01	H0908_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	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0913	002	0	1	02	01	H0913_002_0	4			Preferred Generic	4	11	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	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					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00				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												
H0913	002	0	1	02	01	H0913_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												
H0913	002	0	1	02	01	H0913_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											87.27	50	50	50				83.78	48	48	48										50	50	50				48	48	48			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0913	002	0	1	02	01	H0913_002_0	4			Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												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	4			Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			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	5		N	Preferred Generic	3	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	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												
H0913	013	0	1	01	01	H0913_013_0	5		N	Generic	3	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	5		N	Preferred Brand	3	11	1	2	3	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	45.00	90.00	135.00																									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	5		N	Non-Preferred Drug	3	11	1	1	4	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31				98.46	41	41	41																								41	41	41				41	41	41			41			41								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0913	013	0	1	01	01	H0913_013_0	5		N	Specialty Tier	3	11	1	1	5	1	010		01		010	1	30											30			30		31					25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0913	013	0	1	01	01	H0913_013_0	5		N	Select Care Drugs	3	11	1	2	6	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0913	015	0	1	01	01	H0913_015_0	4			Preferred Generic	3	11	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								19.00	38.00	57.00					0.00	0.00	0.00											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												
H0913	015	0	1	01	01	H0913_015_0	4			Generic	3	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					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												
H0913	015	0	1	01	01	H0913_015_0	4			Preferred Brand	3	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	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, Select Care Drugs												
H0913	015	0	1	01	01	H0913_015_0	4			Non-Preferred Drug	3	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											99.70	45	45	45				99.70	45	45	45										45	45	45				45	45	45			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0913	015	0	1	01	01	H0913_015_0	4			Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0913	015	0	1	01	01	H0913_015_0	4			Select Care Drugs	3	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0913	017	0	1	01	01	H0913_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								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00				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	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					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00				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												
H0913	017	0	1	01	01	H0913_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												
H0913	017	0	1	01	01	H0913_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											93.97	45	45	45				89.79	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	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												
H0913	017	0	1	01	01	H0913_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												
H0913	021	0	1	01	01	H0913_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								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00				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	021	0	1	01	01	H0913_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					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												
H0913	021	0	1	01	01	H0913_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					37.00	74.00	111.00											47.00	94.00	141.00				37.00	74.00	74.00				47.00				47.00			1.57	1.23		1.57	1.23	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0913	021	0	1	01	01	H0913_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					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, Select Care Drugs												
H0913	021	0	1	01	01	H0913_021_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												
H0913	021	0	1	01	01	H0913_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	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	5			Generic Drugs	4	11			1	1	111		01	111		1	30	60	90				1	2	30	60	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	5			Brand Drugs	4	11			2	1	111		01	111		1	30	60	90				1	2	30	60	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	5			Non-Medicare 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 OTC Drugs	2	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H0969	001	0	1	04	01	H0969_001_0	4			Preferred Generic	4	11	3	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			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	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												
H0969	001	0	1	04	01	H0969_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												
H0969	001	0	1	04	01	H0969_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											80.54	45	45	45				76.96	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	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												
H0969	001	0	1	04	01	H0969_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												
H0969	003	0	1	04	01	H0969_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												
H0969	003	0	1	04	01	H0969_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					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	4			Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											47.00	94.00	141.00				37.00	74.00	74.00				47.00				47.00			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	4			Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											89.22	50	50	50				85.65	48	48	48										50	50	50				48	48	48			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0969	003	0	1	04	01	H0969_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												
H0969	003	0	1	04	01	H0969_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												
H0969	003	0	1	04	01	H0969_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	
H0969	005	0	1	04	01	H0969_005_0	4			Preferred Generic	3	11	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								19.00	38.00	57.00					0.00	0.00	0.00											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												
H0969	005	0	1	04	01	H0969_005_0	4			Generic	3	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					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												
H0969	005	0	1	04	01	H0969_005_0	4			Preferred Brand	3	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	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, Select Care Drugs												
H0969	005	0	1	04	01	H0969_005_0	4			Non-Preferred Drug	3	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											99.65	45	45	45				99.65	45	45	45										45	45	45				45	45	45			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0969	005	0	1	04	01	H0969_005_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, Select Care Drugs												
H0969	005	0	1	04	01	H0969_005_0	4			Select Care Drugs	3	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0978	001	0	1	01	01	H0978_001_0	8		Y	Preferred Generic	4	11	3	2	1	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								5.00	10.00	10.00					0.00	0.00	0.00											5.00	10.00	10.00				0.00	0.00	0.00				5.00				5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0978	001	0	1	01	01	H0978_001_0	8		Y	Preferred Generic	4	11	3	2	1	3		111	01		111	1				30	60	100	1	2				30	60	100	30		31								5.00	10.00	10.00					0.00	0.00	0.00											5.00	10.00	10.00				0.00	0.00	0.00				5.00				5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H0978	001	0	1	01	01	H0978_001_0	8		Y	Generic	4	11	1	2	2	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								9.00	18.00	18.00					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	8		Y	Generic	4	11	1	2	2	3		111	01		111	1				30	60	100	1	2				30	60	100	30		31								9.00	18.00	18.00					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	8		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								47.00	94.00	121.00					37.00	74.00	91.00											47.00	94.00	121.00				37.00	74.00	91.00				47.00				47.00			1.57	1.23		1.57	1.23	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0978	001	0	1	01	01	H0978_001_0	8		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								100.00	200.00	280.00					95.00	190.00	265.00											100.00	200.00	280.00				95.00	190.00	265.00				100.00				100.00			3.33	3.17		3.33	3.17	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0978	001	0	1	01	01	H0978_001_0	8		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0978	002	0	1	01	01	H0978_002_0	8		Y	Preferred Generic	4	11	1	2	1	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								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	8		Y	Preferred Generic	4	11	1	2	1	3		111	01		111	1				30	60	100	1	2				30	60	100	30		31								5.00	10.00	10.00					0.00	0.00	0.00											5.00	10.00	10.00				0.00	0.00	0.00				5.00				5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H0978	002	0	1	01	01	H0978_002_0	8		Y	Generic	4	11	1	2	2	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								9.00	18.00	18.00					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	8		Y	Generic	4	11	1	2	2	3		111	01		111	1				30	60	100	1	2				30	60	100	30		31								9.00	18.00	18.00					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	8		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								47.00	94.00	121.00					37.00	74.00	91.00											47.00	94.00	121.00				37.00	74.00	91.00				47.00				47.00			1.57	1.23		1.57	1.23	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0978	002	0	1	01	01	H0978_002_0	8		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								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	8		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0978	003	0	1	01	01	H0978_003_0	8		Y	Preferred Generic	4	11	1	2	1	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								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	8		Y	Preferred Generic	4	11	1	2	1	3		111	01		111	1				30	60	100	1	2				30	60	100	30		31								5.00	10.00	10.00					0.00	0.00	0.00											5.00	10.00	10.00				0.00	0.00	0.00				5.00				5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H0978	003	0	1	01	01	H0978_003_0	8		Y	Generic	4	11	1	2	2	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								9.00	18.00	18.00					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	8		Y	Generic	4	11	1	2	2	3		111	01		111	1				30	60	100	1	2				30	60	100	30		31								9.00	18.00	18.00					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	8		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								47.00	94.00	121.00					37.00	74.00	91.00											47.00	94.00	121.00				37.00	74.00	91.00				47.00				47.00			1.57	1.23		1.57	1.23	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0978	003	0	1	01	01	H0978_003_0	8		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								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	8		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0978	004	0	1	01	01	H0978_004_0	9		Y	Preferred Generic	4	11	3	2	1	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								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	9		Y	Preferred Generic	4	11	3	2	1	3		111	01		111	1				30	60	100	1	2				30	60	100	30		31								10.00	20.00	20.00					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	9		Y	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	9		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								47.00	94.00	121.00					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	9		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								100.00	200.00	280.00					95.00	190.00	265.00											100.00	200.00	280.00				95.00	190.00	265.00				100.00				100.00			3.33	3.17		3.33	3.17	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0978	004	0	1	01	01	H0978_004_0	9		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0978	005	0	1	01	01	H0978_005_0	7		Y	Preferred Generic	4	11	3	2	1	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								5.00	10.00	10.00					0.00	0.00	0.00											5.00	10.00	10.00				0.00	0.00	0.00				5.00				5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0978	005	0	1	01	01	H0978_005_0	7		Y	Preferred Generic	4	11	3	2	1	3		111	01		111	1				30	60	100	1	2				30	60	100	30		31								5.00	10.00	10.00					0.00	0.00	0.00											5.00	10.00	10.00				0.00	0.00	0.00				5.00				5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H0978	005	0	1	01	01	H0978_005_0	7		Y	Generic	4	11	1	2	2	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								9.00	18.00	18.00					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	005	0	1	01	01	H0978_005_0	7		Y	Generic	4	11	1	2	2	3		111	01		111	1				30	60	100	1	2				30	60	100	30		31								9.00	18.00	18.00					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	005	0	1	01	01	H0978_005_0	7		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								47.00	94.00	121.00					37.00	74.00	91.00											47.00	94.00	121.00				37.00	74.00	91.00				47.00				47.00			1.57	1.23		1.57	1.23	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0978	005	0	1	01	01	H0978_005_0	7		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								100.00	200.00	280.00					95.00	190.00	265.00											100.00	200.00	280.00				95.00	190.00	265.00				100.00				100.00			3.33	3.17		3.33	3.17	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0978	005	0	1	01	01	H0978_005_0	7		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0978	006	0	1	01	01	H0978_006_0	7		Y	Preferred Generic	4	11	1	2	1	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								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	006	0	1	01	01	H0978_006_0	7		Y	Preferred Generic	4	11	1	2	1	3		111	01		111	1				30	60	100	1	2				30	60	100	30		31								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	006	0	1	01	01	H0978_006_0	7		Y	Generic	4	11	1	2	2	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								9.00	18.00	18.00					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	006	0	1	01	01	H0978_006_0	7		Y	Generic	4	11	1	2	2	3		111	01		111	1				30	60	100	1	2				30	60	100	30		31								9.00	18.00	18.00					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	006	0	1	01	01	H0978_006_0	7		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								47.00	94.00	121.00					37.00	74.00	91.00											47.00	94.00	121.00				37.00	74.00	91.00				47.00				47.00			1.57	1.23		1.57	1.23	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0978	006	0	1	01	01	H0978_006_0	7		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								100.00	200.00	280.00					95.00	190.00	265.00											100.00	200.00	280.00				95.00	190.00	265.00				100.00				100.00			3.33	3.17		3.33	3.17	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0978	006	0	1	01	01	H0978_006_0	7		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0978	007	0	1	01	01	H0978_007_0	7		Y	Preferred Generic	4	11	1	2	1	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								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	007	0	1	01	01	H0978_007_0	7		Y	Preferred Generic	4	11	1	2	1	3		111	01		111	1				30	60	100	1	2				30	60	100	30		31								5.00	10.00	10.00					0.00	0.00	0.00											5.00	10.00	10.00				0.00	0.00	0.00				5.00				5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H0978	007	0	1	01	01	H0978_007_0	7		Y	Generic	4	11	1	2	2	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								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	007	0	1	01	01	H0978_007_0	7		Y	Generic	4	11	1	2	2	3		111	01		111	1				30	60	100	1	2				30	60	100	30		31								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	007	0	1	01	01	H0978_007_0	7		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								47.00	94.00	121.00					37.00	74.00	91.00											47.00	94.00	121.00				37.00	74.00	91.00				47.00				47.00			1.57	1.23		1.57	1.23	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0978	007	0	1	01	01	H0978_007_0	7		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								100.00	200.00	280.00					95.00	190.00	265.00											100.00	200.00	280.00				95.00	190.00	265.00				100.00				100.00			3.33	3.17		3.33	3.17	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0978	007	0	1	01	01	H0978_007_0	7		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0978	008	0	1	01	01	H0978_008_0	8		Y	Preferred Generic	4	11	3	2	1	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								10.00	20.00	20.00					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	008	0	1	01	01	H0978_008_0	8		Y	Preferred Generic	4	11	3	2	1	3		111	01		111	1				30	60	100	1	2				30	60	100	30		31								10.00	20.00	20.00					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	008	0	1	01	01	H0978_008_0	8		Y	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	008	0	1	01	01	H0978_008_0	8		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								47.00	94.00	121.00					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	008	0	1	01	01	H0978_008_0	8		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								100.00	200.00	280.00					95.00	190.00	265.00											100.00	200.00	280.00				95.00	190.00	265.00				100.00				100.00			3.33	3.17		3.33	3.17	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0978	008	0	1	01	01	H0978_008_0	8		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0978	009	0	1	01	01	H0978_009_0	8		Y	Preferred Generic	4	11	3	2	1	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								5.00	10.00	10.00					0.00	0.00	0.00											5.00	10.00	10.00				0.00	0.00	0.00				5.00				5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0978	009	0	1	01	01	H0978_009_0	8		Y	Preferred Generic	4	11	3	2	1	3		111	01		111	1				30	60	100	1	2				30	60	100	30		31								5.00	10.00	10.00					0.00	0.00	0.00											5.00	10.00	10.00				0.00	0.00	0.00				5.00				5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H0978	009	0	1	01	01	H0978_009_0	8		Y	Generic	4	11	1	2	2	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								9.00	18.00	18.00					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	009	0	1	01	01	H0978_009_0	8		Y	Generic	4	11	1	2	2	3		111	01		111	1				30	60	100	1	2				30	60	100	30		31								9.00	18.00	18.00					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	009	0	1	01	01	H0978_009_0	8		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								47.00	94.00	121.00					37.00	74.00	91.00											47.00	94.00	121.00				37.00	74.00	91.00				47.00				47.00			1.57	1.23		1.57	1.23	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0978	009	0	1	01	01	H0978_009_0	8		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								100.00	200.00	280.00					95.00	190.00	265.00											100.00	200.00	280.00				95.00	190.00	265.00				100.00				100.00			3.33	3.17		3.33	3.17	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0978	009	0	1	01	01	H0978_009_0	8		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0982	001	0	1	01	01	H0982_001_0	7			Preferred Generic	4	01	1	2	1	1	110		01	100		1	30		90				2	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs												
H0982	001	0	1	01	01	H0982_001_0	7			Preferred Generic	4	01	1	2	1	3	110		01	100		1	30		90				2	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs										1		
H0982	001	0	1	01	01	H0982_001_0	7			Generic	4	01	1	2	2	1	110		01	100		1	30		90				2	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs												
H0982	001	0	1	01	01	H0982_001_0	7			Generic	4	01	1	2	2	3	110		01	100		1	30		90				2	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs										1		
H0982	001	0	1	01	01	H0982_001_0	7			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	7			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	7			Specialty Tier	4	10	1	1	5	1	010		01			1	30														30		31				115.59	33																																					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs												
H0982	001	0	1	01	01	H0982_001_0	7			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		N	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		N	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		N	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		N	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		N	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		N	Supplemental Drugs	4	11	2	2	6	1	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs												
H0982	007	0	1	01	01	H0982_007_0	7			Preferred Generic	4	01	1	2	1	1	110		01	100		1	30		90				2	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs												
H0982	007	0	1	01	01	H0982_007_0	7			Preferred Generic	4	01	1	2	1	3	110		01	100		1	30		90				2	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs										1		
H0982	007	0	1	01	01	H0982_007_0	7			Generic	4	01	1	2	2	1	110		01	100		1	30		90				2	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs												
H0982	007	0	1	01	01	H0982_007_0	7			Generic	4	01	1	2	2	3	110		01	100		1	30		90				2	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs										1		
H0982	007	0	1	01	01	H0982_007_0	7			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	7			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	7			Specialty Tier	4	10	1	1	5	1	010		01			1	30														30		31				134.54	33																																					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs												
H0982	007	0	1	01	01	H0982_007_0	7			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	7			Preferred Generic	4	01	1	2	1	1	110		01	100		1	30		90				2	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs												
H0982	008	0	1	01	01	H0982_008_0	7			Preferred Generic	4	01	1	2	1	3	110		01	100		1	30		90				2	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs										1		
H0982	008	0	1	01	01	H0982_008_0	7			Generic	4	01	1	2	2	1	110		01	100		1	30		90				2	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs												
H0982	008	0	1	01	01	H0982_008_0	7			Generic	4	01	1	2	2	3	110		01	100		1	30		90				2	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs										1		
H0982	008	0	1	01	01	H0982_008_0	7			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	7			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	7			Specialty Tier	4	10	1	1	5	1	010		01			1	30														30		31				137.32	33																																					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs												
H0982	008	0	1	01	01	H0982_008_0	7			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	7			Preferred Generic	4	01	1	2	1	1	110		01	100		1	30		90				2	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs												
H0982	009	0	1	01	01	H0982_009_0	7			Preferred Generic	4	01	1	2	1	3	110		01	100		1	30		90				2	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs										1		
H0982	009	0	1	01	01	H0982_009_0	7			Generic	4	01	1	2	2	1	110		01	100		1	30		90				2	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs												
H0982	009	0	1	01	01	H0982_009_0	7			Generic	4	01	1	2	2	3	110		01	100		1	30		90				2	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs										1		
H0982	009	0	1	01	01	H0982_009_0	7			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	7			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	7			Specialty Tier	4	10	1	1	5	1	010		01			1	30														30		31				133.30	33																																					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs												
H0982	009	0	1	01	01	H0982_009_0	7			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		N	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		N	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		N	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		N	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		N	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		N	Supplemental Drugs	4	11	2	2	6	1	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs												
H0982	011	0	1	01	01	H0982_011_0	7			Preferred Generic	4	01	1	1	1	1	110		01	100		1	30		90				2	2			90				30		31				0.00	0		0																				0															0			0								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs												
H0982	011	0	1	01	01	H0982_011_0	7			Preferred Generic	4	01	1	1	1	3	110		01	100		1	30		90				2	2			90				30		31				0.00	0		0																				0															0			0								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs										1		
H0982	011	0	1	01	01	H0982_011_0	7			Generic	4	01	1	1	2	1	110		01	100		1	30		90				2	2			90				30		31				0.00	0		0																				0															0			0								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs												
H0982	011	0	1	01	01	H0982_011_0	7			Generic	4	01	1	1	2	3	110		01	100		1	30		90				2	2			90				30		31				0.00	0		0																				0															0			0								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs										1		
H0982	011	0	1	01	01	H0982_011_0	7			Preferred Brand	4	10	1	1	3	1	110		01			1	30		90				2	2							30		31				0.00	0		0																																			0			0								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs												
H0982	011	0	1	01	01	H0982_011_0	7			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	7			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	7			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		N	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		N	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		N	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		N	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		N	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		N	Supplemental Drugs	4	11	2	2	6	1	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs												
H0982	013	0	1	01	01	H0982_013_0	8		N	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		N	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		N	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		N	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		N	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		N	Supplemental Drugs	4	11	2	2	6	1	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs												
H0982	014	0	1	01	01	H0982_014_0	7			Preferred Generic	4	01	1	2	1	1	110		01	100		1	30		90				2	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs												
H0982	014	0	1	01	01	H0982_014_0	7			Preferred Generic	4	01	1	2	1	3	110		01	100		1	30		90				2	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs										1		
H0982	014	0	1	01	01	H0982_014_0	7			Generic	4	01	1	2	2	1	110		01	100		1	30		90				2	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs												
H0982	014	0	1	01	01	H0982_014_0	7			Generic	4	01	1	2	2	3	110		01	100		1	30		90				2	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs										1		
H0982	014	0	1	01	01	H0982_014_0	7			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	014	0	1	01	01	H0982_014_0	7			Non-Preferred Brand	4	10	1	2	4	1	110		01			1	30		90				2	2							30		31	5.00		12.50																																					5.00				5.00		0.17						0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs												
H0982	014	0	1	01	01	H0982_014_0	7			Specialty Tier	4	10	1	1	5	1	010		01			1	30														30		31				182.17	33																																					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs												
H0982	014	0	1	01	01	H0982_014_0	7			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	015	0	1	01	01	H0982_015_0	8		N	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	015	0	1	01	01	H0982_015_0	8		N	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	015	0	1	01	01	H0982_015_0	8		N	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	015	0	1	01	01	H0982_015_0	8		N	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	015	0	1	01	01	H0982_015_0	8		N	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	015	0	1	01	01	H0982_015_0	8		N	Supplemental Drugs	4	11	2	2	6	1	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs												
H1016	001	0	1	01	01	H1016_001_0	5		Y	Preferred Generic	4	11	3	2	1	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1016	001	0	1	01	01	H1016_001_0	5		Y	Preferred Generic	4	11	3	2	1	3		111	01		111	1				30	60	100	1	2				30	60	100	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H1016	001	0	1	01	01	H1016_001_0	5		Y	Generic	4	11	3	2	2	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								10.00	20.00	25.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00				10.00				0.00			0.33	0.00		0.33	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1016	001	0	1	01	01	H1016_001_0	5		Y	Generic	4	11	3	2	2	3		111	01		111	1				30	60	100	1	2				30	60	100	30		31								10.00	20.00	25.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00				0.00				0.00			0.33	0.00		0.33	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H1016	001	0	1	01	01	H1016_001_0	5		Y	Preferred Brand	4	11	3	2	3	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								35.00	70.00	87.50					25.00	50.00	62.50											35.00	70.00	105.00				25.00	50.00	62.50				35.00				25.00			1.17	0.83		1.17	0.83	0.81	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1016	001	0	1	01	01	H1016_001_0	5		Y	Non-Preferred Drug	4	11	3	2	4	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								85.00	170.00	212.50					35.00	70.00	87.50											85.00	170.00	255.00				35.00	70.00	87.50				85.00				35.00			2.83	1.17		2.83	1.17	1.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1016	001	0	1	01	01	H1016_001_0	5		Y	Specialty Tier	4	11	1	1	5	1		010	01			1				30											30		31											696.39	33						696.39	33																							33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1016	021	0	1	01	01	H1016_021_0	4		Y	Preferred Generic	4	11	3	2	1	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1016	021	0	1	01	01	H1016_021_0	4		Y	Preferred Generic	4	11	3	2	1	3		111	01		111	1				30	60	100	1	2				30	60	100	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H1016	021	0	1	01	01	H1016_021_0	4		Y	Generic	4	11	3	2	2	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								10.00	20.00	25.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00				10.00				0.00			0.33	0.00		0.33	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1016	021	0	1	01	01	H1016_021_0	4		Y	Generic	4	11	3	2	2	3		111	01		111	1				30	60	100	1	2				30	60	100	30		31								10.00	20.00	25.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00				10.00				0.00			0.33	0.00		0.33	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H1016	021	0	1	01	01	H1016_021_0	4		Y	Preferred Brand	4	11	3	2	3	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								40.00	80.00	100.00					30.00	60.00	75.00											40.00	80.00	120.00				30.00	60.00	75.00				40.00				30.00			1.33	1.00		1.33	1.00	0.97	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1016	021	0	1	01	01	H1016_021_0	4		Y	Non-Preferred Drug	4	11	3	2	4	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								100.00	200.00	250.00					65.00	130.00	162.50											100.00	200.00	300.00				65.00	130.00	162.50				100.00				65.00			3.33	2.17		3.33	2.17	2.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1016	021	0	1	01	01	H1016_021_0	4		Y	Specialty Tier	4	11	1	1	5	1		010	01			1				30											30		31											696.39	33						696.39	33																							33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1016	023	0	1	01	01	H1016_023_0	4		Y	Preferred Generic	4	11	3	2	1	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1016	023	0	1	01	01	H1016_023_0	4		Y	Preferred Generic	4	11	3	2	1	3		111	01		111	1				30	60	100	1	2				30	60	100	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H1016	023	0	1	01	01	H1016_023_0	4		Y	Generic	4	11	3	2	2	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								10.00	20.00	25.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00				10.00				0.00			0.33	0.00		0.33	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1016	023	0	1	01	01	H1016_023_0	4		Y	Generic	4	11	3	2	2	3		111	01		111	1				30	60	100	1	2				30	60	100	30		31								10.00	20.00	25.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00				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	4		Y	Preferred Brand	4	11	3	2	3	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								25.00	50.00	62.50					0.00	0.00	0.00											25.00	50.00	75.00				0.00	0.00	0.00				25.00				0.00			0.83	0.00		0.83	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1016	023	0	1	01	01	H1016_023_0	4		Y	Non-Preferred Drug	4	11	3	2	4	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								85.00	170.00	212.50					35.00	70.00	87.50											85.00	170.00	255.00				35.00	70.00	87.50				85.00				35.00			2.83	1.17		2.83	1.17	1.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1016	023	0	1	01	01	H1016_023_0	4		Y	Specialty Tier	4	11	1	1	5	1		010	01			1				30											30		31											696.39	33						696.39	33																							33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1016	024	0	1	01	01	H1016_024_0	4		Y	Preferred Generic	4	11	3	2	1	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1016	024	0	1	01	01	H1016_024_0	4		Y	Preferred Generic	4	11	3	2	1	3		111	01		111	1				30	60	100	1	2				30	60	100	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H1016	024	0	1	01	01	H1016_024_0	4		Y	Generic	4	11	3	2	2	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								10.00	20.00	25.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00				10.00				0.00			0.33	0.00		0.33	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1016	024	0	1	01	01	H1016_024_0	4		Y	Generic	4	11	3	2	2	3		111	01		111	1				30	60	100	1	2				30	60	100	30		31								10.00	20.00	25.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00				10.00				0.00			0.33	0.00		0.33	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H1016	024	0	1	01	01	H1016_024_0	4		Y	Preferred Brand	4	11	3	2	3	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								30.00	60.00	75.00					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	4		Y	Non-Preferred Drug	4	11	3	2	4	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								100.00	200.00	250.00					65.00	130.00	162.50											100.00	200.00	300.00				65.00	130.00	162.50				100.00				65.00			3.33	2.17		3.33	2.17	2.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1016	024	0	1	01	01	H1016_024_0	4		Y	Specialty Tier	4	11	1	1	5	1		010	01			1				30											30		31											696.39	33						696.39	33																							33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1016	025	0	1	02	01	H1016_025_0	5		Y	Preferred Generic	4	11	3	2	1	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1016	025	0	1	02	01	H1016_025_0	5		Y	Preferred Generic	4	11	3	2	1	3		111	01		111	1				30	60	100	1	2				30	60	100	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H1016	025	0	1	02	01	H1016_025_0	5		Y	Generic	4	11	3	2	2	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								10.00	20.00	25.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00				10.00				0.00			0.33	0.00		0.33	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1016	025	0	1	02	01	H1016_025_0	5		Y	Generic	4	11	3	2	2	3		111	01		111	1				30	60	100	1	2				30	60	100	30		31								10.00	20.00	25.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00				0.00				0.00			0.33	0.00		0.33	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H1016	025	0	1	02	01	H1016_025_0	5		Y	Preferred Brand	4	11	3	2	3	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								40.00	80.00	100.00					30.00	60.00	75.00											40.00	80.00	120.00				30.00	60.00	75.00				40.00				30.00			1.33	1.00		1.33	1.00	0.97	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1016	025	0	1	02	01	H1016_025_0	5		Y	Non-Preferred Drug	4	11	3	2	4	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								100.00	200.00	250.00					75.00	150.00	187.50											100.00	200.00	300.00				75.00	150.00	187.50				100.00				75.00			3.33	2.50		3.33	2.50	2.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1016	025	0	1	02	01	H1016_025_0	5		Y	Specialty Tier	4	11	1	1	5	1		010	01			1				30											30		31											696.39	33						696.39	33																							33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1016	026	0	1	02	01	H1016_026_0	4		Y	Preferred Generic	4	11	3	2	1	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1016	026	0	1	02	01	H1016_026_0	4		Y	Preferred Generic	4	11	3	2	1	3		111	01		111	1				30	60	100	1	2				30	60	100	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H1016	026	0	1	02	01	H1016_026_0	4		Y	Generic	4	11	3	2	2	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								10.00	20.00	25.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00				10.00				0.00			0.33	0.00		0.33	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1016	026	0	1	02	01	H1016_026_0	4		Y	Generic	4	11	3	2	2	3		111	01		111	1				30	60	100	1	2				30	60	100	30		31								10.00	20.00	25.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00				0.00				0.00			0.33	0.00		0.33	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H1016	026	0	1	02	01	H1016_026_0	4		Y	Preferred Brand	4	11	3	2	3	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								40.00	80.00	100.00					30.00	60.00	75.00											40.00	80.00	120.00				30.00	60.00	75.00				40.00				30.00			1.33	1.00		1.33	1.00	0.97	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1016	026	0	1	02	01	H1016_026_0	4		Y	Non-Preferred Drug	4	11	3	2	4	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								100.00	200.00	250.00					75.00	150.00	187.50											100.00	200.00	300.00				75.00	150.00	187.50				100.00				75.00			3.33	2.50		3.33	2.50	2.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1016	026	0	1	02	01	H1016_026_0	4		Y	Specialty Tier	4	11	1	1	5	1		010	01			1				30											30		31											696.39	33						696.39	33																							33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1016	028	0	1	01	01	H1016_028_0	4			Preferred Generic	4	11	3	2	1	1		111	01		100	1				30	60	100	1	2						100	30		31								5.00	10.00	12.50					0.00	0.00	0.00													15.00						0.00				5.00				0.00			0.17	0.00				0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1016	028	0	1	01	01	H1016_028_0	4			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			0.17	0.00				0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H1016	028	0	1	01	01	H1016_028_0	4			Generic	4	11	3	2	2	1		111	01		100	1				30	60	100	1	2						100	30		31								20.00	40.00	50.00					0.00	0.00	0.00													60.00						0.00				20.00				0.00			0.67	0.00				0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1016	028	0	1	01	01	H1016_028_0	4			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			0.67	0.00				0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H1016	028	0	1	01	01	H1016_028_0	4			Preferred Brand	4	11	3	2	3	1		111	01		100	1				30	60	100	1	2						100	30		31								47.00	94.00	118.00					40.00	80.00	100.00													141.00						100.00				47.00				40.00			1.57	1.33				1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1016	028	0	1	01	01	H1016_028_0	4			Non-Preferred Drug	4	11	3	2	4	1		111	01		100	1				30	60	100	1	2						100	30		31								100.00	200.00	250.00					80.00	160.00	200.00													300.00						200.00				100.00				80.00			3.33	2.67				2.58	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1016	028	0	1	01	01	H1016_028_0	4			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	029	0	1	01	01	H1016_029_0	4		Y	Preferred Generic	4	11	3	2	1	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1016	029	0	1	01	01	H1016_029_0	4		Y	Preferred Generic	4	11	3	2	1	3		111	01		111	1				30	60	100	1	2				30	60	100	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H1016	029	0	1	01	01	H1016_029_0	4		Y	Generic	4	11	3	2	2	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								10.00	20.00	25.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00				10.00				0.00			0.33	0.00		0.33	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1016	029	0	1	01	01	H1016_029_0	4		Y	Generic	4	11	3	2	2	3		111	01		111	1				30	60	100	1	2				30	60	100	30		31								10.00	20.00	25.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00				10.00				0.00			0.33	0.00		0.33	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H1016	029	0	1	01	01	H1016_029_0	4		Y	Preferred Brand	4	11	3	2	3	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								40.00	80.00	100.00					30.00	60.00	75.00											40.00	80.00	120.00				30.00	60.00	75.00				40.00				30.00			1.33	1.00		1.33	1.00	0.97	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1016	029	0	1	01	01	H1016_029_0	4		Y	Non-Preferred Drug	4	11	3	2	4	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								100.00	200.00	250.00					75.00	150.00	187.50											100.00	200.00	300.00				75.00	150.00	187.50				100.00				75.00			3.33	2.50		3.33	2.50	2.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1016	029	0	1	01	01	H1016_029_0	4		Y	Specialty Tier	4	11	1	1	5	1		010	01			1				30											30		31											696.39	33						696.39	33																							33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1016	030	0	1	01	01	H1016_030_0	4		Y	Preferred Generic	4	11	3	2	1	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								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	030	0	1	01	01	H1016_030_0	4		Y	Preferred Generic	4	11	3	2	1	3		111	01		111	1				30	60	100	1	2				30	60	100	30		31								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	030	0	1	01	01	H1016_030_0	4		Y	Generic	4	11	3	2	2	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								20.00	40.00	50.00					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												
H1016	030	0	1	01	01	H1016_030_0	4		Y	Generic	4	11	3	2	2	3		111	01		111	1				30	60	100	1	2				30	60	100	30		31								20.00	40.00	50.00					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										1		3
H1016	030	0	1	01	01	H1016_030_0	4		Y	Preferred Brand	4	11	3	2	3	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								47.00	94.00	117.50					30.00	60.00	75.00											47.00	94.00	141.00				30.00	60.00	75.00				47.00				30.00			1.57	1.00		1.57	1.00	0.97	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1016	030	0	1	01	01	H1016_030_0	4		Y	Non-Preferred Drug	4	11	3	2	4	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								100.00	200.00	250.00					85.00	170.00	212.50											100.00	200.00	300.00				85.00	170.00	212.50				100.00				85.00			3.33	2.83		3.33	2.83	2.74	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1016	030	0	1	01	01	H1016_030_0	4		Y	Specialty Tier	4	11	1	1	5	1		010	01			1				30											30		31											696.39	33						696.39	33																							33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	001	0	1	01	01	H1019_001_0	4		Y	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									5.00		15.00				0.00		0.00				0.00				0.00		0				0.17	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	001	0	1	01	01	H1019_001_0	4		Y	Preferred Generic	4	11	3	2	1	3	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									5.00		15.00				0.00		0.00				0.00				0.00		0				0.17	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H1019	001	0	1	01	01	H1019_001_0	4		Y	Generic	4	11	1	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	001	0	1	01	01	H1019_001_0	4		Y	Generic	4	11	1	2	2	3	110		01		110	1	30		90				2	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1019	001	0	1	01	01	H1019_001_0	4		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	0.00		0.00																									47.00		141.00				0.00		0.00				0.00				0.00		0				1.57	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	001	0	1	01	01	H1019_001_0	4		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	75.00		225.00																									100.00		300.00				75.00		215.00				75.00				75.00		2.50				3.33	2.50	2.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	001	0	1	01	01	H1019_001_0	4		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	006	0	1	01	01	H1019_006_0	3		Y	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0				0	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	006	0	1	01	01	H1019_006_0	3		Y	Preferred Generic	4	11	3	2	1	3	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0				0	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H1019	006	0	1	01	01	H1019_006_0	3		Y	Generic	4	11	1	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0				0	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	006	0	1	01	01	H1019_006_0	3		Y	Generic	4	11	1	2	2	3	110		01		110	1	30		90				2	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0				0	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1019	006	0	1	01	01	H1019_006_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0				0	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	006	0	1	01	01	H1019_006_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	25.00		75.00																									36.00		108.00				25.00		65.00				25.00				25.00		0.83				1.20	0.83	0.81	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	006	0	1	01	01	H1019_006_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	023	0	1	01	01	H1019_023_0	4		N	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	2.00		6.00																									2.00		6.00				2.00		0.00				2.00				2.00		0.07				0.07	0.07	0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	023	0	1	01	01	H1019_023_0	4		N	Generic	4	11	1	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	15.00		45.00																									16.00		48.00				15.00		0.00				15.00				15.00		0.50				0.53	0.50	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	023	0	1	01	01	H1019_023_0	4		N	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		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	4		N	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		290.00				100.00				100.00		3.33				3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	023	0	1	01	01	H1019_023_0	4		N	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	026	0	1	01	01	H1019_026_0	3		N	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	3.00		9.00																									10.00		30.00				3.00		0.00				3.00				3.00		0.10				0.33	0.10	0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	026	0	1	01	01	H1019_026_0	3		N	Generic	4	11	1	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	15.00		45.00																									20.00		60.00				15.00		0.00				15.00				15.00		0.50				0.67	0.50	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	026	0	1	01	01	H1019_026_0	3		N	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	026	0	1	01	01	H1019_026_0	3		N	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		290.00				100.00				100.00		3.33				3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	026	0	1	01	01	H1019_026_0	3		N	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	043	0	1	01	01	H1019_043_0	3		Y	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	043	0	1	01	01	H1019_043_0	3		Y	Preferred Generic	4	11	3	2	1	3	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H1019	043	0	1	01	01	H1019_043_0	3		Y	Generic	4	11	1	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	5.00		15.00																									20.00		60.00				5.00		0.00				5.00				5.00		0.17				0.67	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	043	0	1	01	01	H1019_043_0	3		Y	Generic	4	11	1	2	2	3	110		01		110	1	30		90				2	2				30		90	30		31	5.00		15.00																									20.00		60.00				5.00		0.00				5.00				5.00		0.17				0.67	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1019	043	0	1	01	01	H1019_043_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	25.00		75.00																									47.00		141.00				25.00		65.00				25.00				25.00		0.83				1.57	0.83	0.81	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	043	0	1	01	01	H1019_043_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	75.00		225.00																									100.00		300.00				75.00		215.00				75.00				75.00		2.50				3.33	2.50	2.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	043	0	1	01	01	H1019_043_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	057	0	1	02	01	H1019_057_0	3		Y	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	057	0	1	02	01	H1019_057_0	3		Y	Preferred Generic	4	11	3	2	1	3	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H1019	057	0	1	02	01	H1019_057_0	3		Y	Generic	4	11	1	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	0.00		0.00																									20.00		60.00				0.00		0.00				0.00				0.00		0				0.67	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	057	0	1	02	01	H1019_057_0	3		Y	Generic	4	11	1	2	2	3	110		01		110	1	30		90				2	2				30		90	30		31	0.00		0.00																									20.00		60.00				0.00		0.00				0.00				0.00		0				0.67	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1019	057	0	1	02	01	H1019_057_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	25.00		75.00																									47.00		141.00				25.00		65.00				25.00				25.00		0.83				1.57	0.83	0.81	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	057	0	1	02	01	H1019_057_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	85.00		255.00																									100.00		300.00				85.00		245.00				85.00				85.00		2.83				3.33	2.83	2.74	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	057	0	1	02	01	H1019_057_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	065	0	1	01	01	H1019_065_0	3		Y	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0				0	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	065	0	1	01	01	H1019_065_0	3		Y	Preferred Generic	4	11	3	2	1	3	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0				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		Y	Generic	4	11	1	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	0.00		0.00																									12.00		36.00				0.00		0.00				0.00				0.00		0				0.40	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	065	0	1	01	01	H1019_065_0	3		Y	Generic	4	11	1	2	2	3	110		01		110	1	30		90				2	2				30		90	30		31	0.00		0.00																									12.00		36.00				0.00		0.00				0.00				0.00		0				0.40	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1019	065	0	1	01	01	H1019_065_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		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		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	97.00		291.00																									100.00		300.00				97.00		281.00				97.00				97.00		3.23				3.33	3.23	3.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	065	0	1	01	01	H1019_065_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	069	0	1	01	01	H1019_069_0	3		Y	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	069	0	1	01	01	H1019_069_0	3		Y	Preferred Generic	4	11	3	2	1	3	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H1019	069	0	1	01	01	H1019_069_0	3		Y	Generic	4	11	1	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	0.00		0.00																									20.00		60.00				0.00		0.00				0.00				0.00		0				0.67	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	069	0	1	01	01	H1019_069_0	3		Y	Generic	4	11	1	2	2	3	110		01		110	1	30		90				2	2				30		90	30		31	0.00		0.00																									20.00		60.00				0.00		0.00				0.00				0.00		0				0.67	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1019	069	0	1	01	01	H1019_069_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	45.00		135.00																									47.00		141.00				45.00		125.00				45.00				45.00		1.50				1.57	1.50	1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	069	0	1	01	01	H1019_069_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	95.00		285.00																									100.00		300.00				95.00		275.00				95.00				95.00		3.17				3.33	3.17	3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	069	0	1	01	01	H1019_069_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	073	0	1	01	01	H1019_073_0	4		N	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	7.00		21.00																									8.00		24.00				7.00		0.00				7.00				7.00		0.23				0.27	0.23	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	073	0	1	01	01	H1019_073_0	4		N	Generic	4	11	1	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	15.00		45.00																									20.00		60.00				15.00		0.00				15.00				15.00		0.50				0.67	0.50	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	073	0	1	01	01	H1019_073_0	4		N	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		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	4		N	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		290.00				100.00				100.00		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	4		N	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	076	0	1	01	01	H1019_076_0	3		Y	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0				0	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	076	0	1	01	01	H1019_076_0	3		Y	Preferred Generic	4	11	3	2	1	3	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0				0	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H1019	076	0	1	01	01	H1019_076_0	3		Y	Generic	4	11	1	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	076	0	1	01	01	H1019_076_0	3		Y	Generic	4	11	1	2	2	3	110		01		110	1	30		90				2	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1019	076	0	1	01	01	H1019_076_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		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		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	97.00		291.00																									100.00		300.00				97.00		281.00				97.00				97.00		3.23				3.33	3.23	3.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	076	0	1	01	01	H1019_076_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	094	0	1	01	01	H1019_094_0	3		Y	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	094	0	1	01	01	H1019_094_0	3		Y	Preferred Generic	4	11	3	2	1	3	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H1019	094	0	1	01	01	H1019_094_0	3		Y	Generic	4	11	1	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	5.00		15.00																									20.00		60.00				5.00		0.00				5.00				5.00		0.17				0.67	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	094	0	1	01	01	H1019_094_0	3		Y	Generic	4	11	1	2	2	3	110		01		110	1	30		90				2	2				30		90	30		31	5.00		15.00																									20.00		60.00				5.00		0.00				5.00				5.00		0.17				0.67	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1019	094	0	1	01	01	H1019_094_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	45.00		135.00																									47.00		141.00				45.00		125.00				45.00				45.00		1.50				1.57	1.50	1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	094	0	1	01	01	H1019_094_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	95.00		285.00																									100.00		300.00				95.00		275.00				95.00				95.00		3.17				3.33	3.17	3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	094	0	1	01	01	H1019_094_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					31																										31						31					31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	098	0	1	01	01	H1019_098_0	3		Y	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	098	0	1	01	01	H1019_098_0	3		Y	Preferred Generic	4	11	3	2	1	3	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H1019	098	0	1	01	01	H1019_098_0	3		Y	Generic	4	11	1	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	0.00		0.00																									20.00		60.00				0.00		0.00				0.00				0.00		0				0.67	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	098	0	1	01	01	H1019_098_0	3		Y	Generic	4	11	1	2	2	3	110		01		110	1	30		90				2	2				30		90	30		31	0.00		0.00																									20.00		60.00				0.00		0.00				0.00				0.00		0				0.67	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1019	098	0	1	01	01	H1019_098_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	35.00		105.00																									47.00		141.00				35.00		95.00				35.00				35.00		1.17				1.57	1.17	1.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	098	0	1	01	01	H1019_098_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	80.00		240.00																									100.00		300.00				80.00		230.00				80.00				80.00		2.67				3.33	2.67	2.58	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	098	0	1	01	01	H1019_098_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	099	0	1	01	01	H1019_099_0	3		Y	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	099	0	1	01	01	H1019_099_0	3		Y	Preferred Generic	4	11	3	2	1	3	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H1019	099	0	1	01	01	H1019_099_0	3		Y	Generic	4	11	1	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	5.00		15.00																									20.00		60.00				5.00		0.00				5.00				5.00		0.17				0.67	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	099	0	1	01	01	H1019_099_0	3		Y	Generic	4	11	1	2	2	3	110		01		110	1	30		90				2	2				30		90	30		31	5.00		15.00																									20.00		60.00				5.00		0.00				5.00				5.00		0.17				0.67	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1019	099	0	1	01	01	H1019_099_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	45.00		135.00																									47.00		141.00				45.00		125.00				45.00				45.00		1.50				1.57	1.50	1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	099	0	1	01	01	H1019_099_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	85.00		255.00																									100.00		300.00				85.00		245.00				85.00				85.00		2.83				3.33	2.83	2.74	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	099	0	1	01	01	H1019_099_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	102	0	1	01	01	H1019_102_0	3		Y	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									5.00		15.00				0.00		0.00				0.00				0.00		0				0.17	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	102	0	1	01	01	H1019_102_0	3		Y	Preferred Generic	4	11	3	2	1	3	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									5.00		15.00				0.00		0.00				0.00				0.00		0				0.17	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H1019	102	0	1	01	01	H1019_102_0	3		Y	Generic	4	11	1	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	102	0	1	01	01	H1019_102_0	3		Y	Generic	4	11	1	2	2	3	110		01		110	1	30		90				2	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1019	102	0	1	01	01	H1019_102_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	15.00		45.00																									47.00		141.00				15.00		35.00				15.00				15.00		0.50				1.57	0.50	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	102	0	1	01	01	H1019_102_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	75.00		225.00																									100.00		300.00				75.00		215.00				75.00				75.00		2.50				3.33	2.50	2.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	102	0	1	01	01	H1019_102_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	103	1	1	01	01	H1019_103_1	3		Y	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	103	1	1	01	01	H1019_103_1	3		Y	Preferred Generic	4	11	3	2	1	3	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H1019	103	1	1	01	01	H1019_103_1	3		Y	Generic	4	11	1	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	0.00		0.00																									20.00		60.00				0.00		0.00				0.00				0.00		0				0.67	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	103	1	1	01	01	H1019_103_1	3		Y	Generic	4	11	1	2	2	3	110		01		110	1	30		90				2	2				30		90	30		31	0.00		0.00																									20.00		60.00				0.00		0.00				0.00				0.00		0				0.67	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1019	103	1	1	01	01	H1019_103_1	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	5.00		15.00																									47.00		141.00				5.00		5.00				5.00				5.00		0.17				1.57	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	103	1	1	01	01	H1019_103_1	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	45.00		135.00																									100.00		300.00				45.00		125.00				45.00				45.00		1.50				3.33	1.50	1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	103	1	1	01	01	H1019_103_1	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	103	2	1	01	01	H1019_103_2	3		Y	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	103	2	1	01	01	H1019_103_2	3		Y	Preferred Generic	4	11	3	2	1	3	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H1019	103	2	1	01	01	H1019_103_2	3		Y	Generic	4	11	1	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	0.00		0.00																									20.00		60.00				0.00		0.00				0.00				0.00		0				0.67	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	103	2	1	01	01	H1019_103_2	3		Y	Generic	4	11	1	2	2	3	110		01		110	1	30		90				2	2				30		90	30		31	0.00		0.00																									20.00		60.00				0.00		0.00				0.00				0.00		0				0.67	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1019	103	2	1	01	01	H1019_103_2	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	5.00		15.00																									47.00		141.00				5.00		5.00				5.00				5.00		0.17				1.57	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	103	2	1	01	01	H1019_103_2	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	45.00		135.00																									100.00		300.00				45.00		125.00				45.00				45.00		1.50				3.33	1.50	1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	103	2	1	01	01	H1019_103_2	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	104	1	1	01	01	H1019_104_1	3		Y	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	104	1	1	01	01	H1019_104_1	3		Y	Preferred Generic	4	11	3	2	1	3	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H1019	104	1	1	01	01	H1019_104_1	3		Y	Generic	4	11	1	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	0.00		0.00																									20.00		60.00				0.00		0.00				0.00				0.00		0				0.67	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	104	1	1	01	01	H1019_104_1	3		Y	Generic	4	11	1	2	2	3	110		01		110	1	30		90				2	2				30		90	30		31	0.00		0.00																									20.00		60.00				0.00		0.00				0.00				0.00		0				0.67	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1019	104	1	1	01	01	H1019_104_1	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	35.00		105.00																									47.00		141.00				35.00		95.00				35.00				35.00		1.17				1.57	1.17	1.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	104	1	1	01	01	H1019_104_1	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	60.00		180.00																									100.00		300.00				60.00		170.00				60.00				60.00		2				3.33	2	1.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	104	1	1	01	01	H1019_104_1	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	104	2	1	01	01	H1019_104_2	3		Y	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	104	2	1	01	01	H1019_104_2	3		Y	Preferred Generic	4	11	3	2	1	3	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H1019	104	2	1	01	01	H1019_104_2	3		Y	Generic	4	11	1	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	0.00		0.00																									20.00		60.00				0.00		0.00				0.00				0.00		0				0.67	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	104	2	1	01	01	H1019_104_2	3		Y	Generic	4	11	1	2	2	3	110		01		110	1	30		90				2	2				30		90	30		31	0.00		0.00																									20.00		60.00				0.00		0.00				0.00				0.00		0				0.67	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1019	104	2	1	01	01	H1019_104_2	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	35.00		105.00																									47.00		141.00				35.00		95.00				35.00				35.00		1.17				1.57	1.17	1.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	104	2	1	01	01	H1019_104_2	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	60.00		180.00																									100.00		300.00				60.00		170.00				60.00				60.00		2				3.33	2	1.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	104	2	1	01	01	H1019_104_2	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	105	0	1	01	01	H1019_105_0	4		Y	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0				0	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	105	0	1	01	01	H1019_105_0	4		Y	Preferred Generic	4	11	3	2	1	3	110		01		110	1	30		90				1	2				30		90	30		31	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										1		3
H1019	105	0	1	01	01	H1019_105_0	4		Y	Generic	4	11	1	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0				0	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	105	0	1	01	01	H1019_105_0	4		Y	Generic	4	11	1	2	2	3	110		01		110	1	30		90				2	2				30		90	30		31	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										1		
H1019	105	0	1	01	01	H1019_105_0	4		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0				0	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	105	0	1	01	01	H1019_105_0	4		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	25.00		75.00																									36.00		108.00				25.00		65.00				25.00				25.00		0.83				1.20	0.83	0.81	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	105	0	1	01	01	H1019_105_0	4		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	106	0	1	01	01	H1019_106_0	4		Y	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0				0	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	106	0	1	01	01	H1019_106_0	4		Y	Preferred Generic	4	11	3	2	1	3	110		01		110	1	30		90				1	2				30		90	30		31	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										1		3
H1019	106	0	1	01	01	H1019_106_0	4		Y	Generic	4	11	1	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	0.00		0.00																									12.00		36.00				0.00		0.00				0.00				0.00		0				0.40	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	106	0	1	01	01	H1019_106_0	4		Y	Generic	4	11	1	2	2	3	110		01		110	1	30		90				2	2				30		90	30		31	0.00		0.00																									12.00		36.00				0.00		0.00				0.00				0.00		0				0.40	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1019	106	0	1	01	01	H1019_106_0	4		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	40.00		120.00																									47.00		141.00				40.00		110.00				40.00				40.00		1.33				1.57	1.33	1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	106	0	1	01	01	H1019_106_0	4		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	97.00		291.00																									100.00		300.00				97.00		281.00				97.00				97.00		3.23				3.33	3.23	3.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	106	0	1	01	01	H1019_106_0	4		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	107	0	1	01	01	H1019_107_0	4		Y	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	107	0	1	01	01	H1019_107_0	4		Y	Preferred Generic	4	11	3	2	1	3	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H1019	107	0	1	01	01	H1019_107_0	4		Y	Generic	4	11	1	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	5.00		15.00																									20.00		60.00				5.00		0.00				5.00				5.00		0.17				0.67	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	107	0	1	01	01	H1019_107_0	4		Y	Generic	4	11	1	2	2	3	110		01		110	1	30		90				2	2				30		90	30		31	5.00		15.00																									20.00		60.00				5.00		0.00				5.00				5.00		0.17				0.67	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1019	107	0	1	01	01	H1019_107_0	4		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	35.00		105.00																									47.00		141.00				35.00		95.00				35.00				35.00		1.17				1.57	1.17	1.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	107	0	1	01	01	H1019_107_0	4		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	85.00		255.00																									100.00		300.00				85.00		245.00				85.00				85.00		2.83				3.33	2.83	2.74	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	107	0	1	01	01	H1019_107_0	4		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	108	0	1	01	01	H1019_108_0	3		Y	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	108	0	1	01	01	H1019_108_0	3		Y	Preferred Generic	4	11	3	2	1	3	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H1019	108	0	1	01	01	H1019_108_0	3		Y	Generic	4	11	1	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	5.00		15.00																									20.00		60.00				5.00		0.00				5.00				5.00		0.17				0.67	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	108	0	1	01	01	H1019_108_0	3		Y	Generic	4	11	1	2	2	3	110		01		110	1	30		90				2	2				30		90	30		31	5.00		15.00																									20.00		60.00				5.00		0.00				5.00				5.00		0.17				0.67	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1019	108	0	1	01	01	H1019_108_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	45.00		135.00																									47.00		141.00				45.00		125.00				45.00				45.00		1.50				1.57	1.50	1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	108	0	1	01	01	H1019_108_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	85.00		255.00																									100.00		300.00				85.00		245.00				85.00				85.00		2.83				3.33	2.83	2.74	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	108	0	1	01	01	H1019_108_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	109	0	1	01	01	H1019_109_0	4		Y	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	109	0	1	01	01	H1019_109_0	4		Y	Preferred Generic	4	11	3	2	1	3	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H1019	109	0	1	01	01	H1019_109_0	4		Y	Generic	4	11	1	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	5.00		15.00																									20.00		60.00				5.00		0.00				5.00				5.00		0.17				0.67	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	109	0	1	01	01	H1019_109_0	4		Y	Generic	4	11	1	2	2	3	110		01		110	1	30		90				2	2				30		90	30		31	5.00		15.00																									20.00		60.00				5.00		0.00				5.00				5.00		0.17				0.67	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1019	109	0	1	01	01	H1019_109_0	4		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	45.00		135.00																									47.00		141.00				45.00		125.00				45.00				45.00		1.50				1.57	1.50	1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	109	0	1	01	01	H1019_109_0	4		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	95.00		285.00																									100.00		300.00				95.00		275.00				95.00				95.00		3.17				3.33	3.17	3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	109	0	1	01	01	H1019_109_0	4		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	110	0	1	02	01	H1019_110_0	3		Y	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	110	0	1	02	01	H1019_110_0	3		Y	Preferred Generic	4	11	3	2	1	3	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H1019	110	0	1	02	01	H1019_110_0	3		Y	Generic	4	11	1	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	5.00		15.00																									20.00		60.00				5.00		0.00				5.00				5.00		0.17				0.67	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	110	0	1	02	01	H1019_110_0	3		Y	Generic	4	11	1	2	2	3	110		01		110	1	30		90				2	2				30		90	30		31	5.00		15.00																									20.00		60.00				5.00		0.00				5.00				5.00		0.17				0.67	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1019	110	0	1	02	01	H1019_110_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	30.00		90.00																									47.00		141.00				30.00		80.00				30.00				30.00		1				1.57	1	0.97	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	110	0	1	02	01	H1019_110_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	95.00		285.00																									100.00		300.00				95.00		275.00				95.00				95.00		3.17				3.33	3.17	3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	110	0	1	02	01	H1019_110_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	111	0	1	01	01	H1019_111_0	3		Y	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	111	0	1	01	01	H1019_111_0	3		Y	Preferred Generic	4	11	3	2	1	3	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H1019	111	0	1	01	01	H1019_111_0	3		Y	Generic	4	11	1	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	0.00		0.00																									20.00		60.00				0.00		0.00				0.00				0.00		0				0.67	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	111	0	1	01	01	H1019_111_0	3		Y	Generic	4	11	1	2	2	3	110		01		110	1	30		90				2	2				30		90	30		31	0.00		0.00																									20.00		60.00				0.00		0.00				0.00				0.00		0				0.67	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1019	111	0	1	01	01	H1019_111_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	10.00		30.00																									47.00		141.00				10.00		20.00				10.00				10.00		0.33				1.57	0.33	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	111	0	1	01	01	H1019_111_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	55.00		165.00																									100.00		300.00				55.00		155.00				55.00				55.00		1.83				3.33	1.83	1.77	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	111	0	1	01	01	H1019_111_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	112	0	1	01	01	H1019_112_0	3		Y	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0				0	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	112	0	1	01	01	H1019_112_0	3		Y	Preferred Generic	4	11	3	2	1	3	110		01		110	1	30		90				1	2				30		90	30		31	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										1		3
H1019	112	0	1	01	01	H1019_112_0	3		Y	Generic	4	11	1	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0				0	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	112	0	1	01	01	H1019_112_0	3		Y	Generic	4	11	1	2	2	3	110		01		110	1	30		90				2	2				30		90	30		31	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										1		
H1019	112	0	1	01	01	H1019_112_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	30.00		90.00																									30.00		90.00				30.00		80.00				30.00				30.00		1				1	1	0.97	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	112	0	1	01	01	H1019_112_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	85.00		255.00																									100.00		300.00				85.00		245.00				85.00				85.00		2.83				3.33	2.83	2.74	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	112	0	1	01	01	H1019_112_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	113	0	1	01	01	H1019_113_0	3		Y	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	113	0	1	01	01	H1019_113_0	3		Y	Preferred Generic	4	11	3	2	1	3	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H1019	113	0	1	01	01	H1019_113_0	3		Y	Generic	4	11	1	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	0.00		0.00																									20.00		60.00				0.00		0.00				0.00				0.00		0				0.67	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	113	0	1	01	01	H1019_113_0	3		Y	Generic	4	11	1	2	2	3	110		01		110	1	30		90				2	2				30		90	30		31	0.00		0.00																									20.00		60.00				0.00		0.00				0.00				0.00		0				0.67	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1019	113	0	1	01	01	H1019_113_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	45.00		135.00																									47.00		141.00				45.00		125.00				45.00				45.00		1.50				1.57	1.50	1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	113	0	1	01	01	H1019_113_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	95.00		285.00																									100.00		300.00				95.00		275.00				95.00				95.00		3.17				3.33	3.17	3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	113	0	1	01	01	H1019_113_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	114	0	1	01	01	H1019_114_0	4		Y	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0				0	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	114	0	1	01	01	H1019_114_0	4		Y	Preferred Generic	4	11	3	2	1	3	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0				0	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H1019	114	0	1	01	01	H1019_114_0	4		Y	Generic	4	11	1	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0				0	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	114	0	1	01	01	H1019_114_0	4		Y	Generic	4	11	1	2	2	3	110		01		110	1	30		90				2	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0				0	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1019	114	0	1	01	01	H1019_114_0	4		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0				0	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	114	0	1	01	01	H1019_114_0	4		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	25.00		75.00																									36.00		108.00				25.00		65.00				25.00				25.00		0.83				1.20	0.83	0.81	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	114	0	1	01	01	H1019_114_0	4		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	115	0	1	01	01	H1019_115_0	4		Y	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0				0	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	115	0	1	01	01	H1019_115_0	4		Y	Preferred Generic	4	11	3	2	1	3	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0				0	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H1019	115	0	1	01	01	H1019_115_0	4		Y	Generic	4	11	1	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	0.00		0.00																									12.00		36.00				0.00		0.00				0.00				0.00		0				0.40	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	115	0	1	01	01	H1019_115_0	4		Y	Generic	4	11	1	2	2	3	110		01		110	1	30		90				2	2				30		90	30		31	0.00		0.00																									12.00		36.00				0.00		0.00				0.00				0.00		0				0.40	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1019	115	0	1	01	01	H1019_115_0	4		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	40.00		120.00																									47.00		141.00				40.00		110.00				40.00				40.00		1.33				1.57	1.33	1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	115	0	1	01	01	H1019_115_0	4		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	97.00		291.00																									100.00		300.00				97.00		281.00				97.00				97.00		3.23				3.33	3.23	3.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	115	0	1	01	01	H1019_115_0	4		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	116	0	1	01	01	H1019_116_0	4		Y	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	116	0	1	01	01	H1019_116_0	4		Y	Preferred Generic	4	11	3	2	1	3	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H1019	116	0	1	01	01	H1019_116_0	4		Y	Generic	4	11	1	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	5.00		15.00																									20.00		60.00				5.00		0.00				5.00				5.00		0.17				0.67	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	116	0	1	01	01	H1019_116_0	4		Y	Generic	4	11	1	2	2	3	110		01		110	1	30		90				2	2				30		90	30		31	5.00		15.00																									20.00		60.00				5.00		0.00				5.00				5.00		0.17				0.67	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1019	116	0	1	01	01	H1019_116_0	4		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	35.00		105.00																									47.00		141.00				35.00		95.00				35.00				35.00		1.17				1.57	1.17	1.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	116	0	1	01	01	H1019_116_0	4		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	85.00		255.00																									100.00		300.00				85.00		245.00				85.00				85.00		2.83				3.33	2.83	2.74	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	116	0	1	01	01	H1019_116_0	4		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	117	0	1	01	01	H1019_117_0	3		Y	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	117	0	1	01	01	H1019_117_0	3		Y	Preferred Generic	4	11	3	2	1	3	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H1019	117	0	1	01	01	H1019_117_0	3		Y	Generic	4	11	1	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	5.00		15.00																									20.00		60.00				5.00		0.00				5.00				5.00		0.17				0.67	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	117	0	1	01	01	H1019_117_0	3		Y	Generic	4	11	1	2	2	3	110		01		110	1	30		90				2	2				30		90	30		31	5.00		15.00																									20.00		60.00				5.00		0.00				5.00				5.00		0.17				0.67	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1019	117	0	1	01	01	H1019_117_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	45.00		135.00																									47.00		141.00				45.00		125.00				45.00				45.00		1.50				1.57	1.50	1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	117	0	1	01	01	H1019_117_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	85.00		255.00																									100.00		300.00				85.00		245.00				85.00				85.00		2.83				3.33	2.83	2.74	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	117	0	1	01	01	H1019_117_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	118	0	1	01	01	H1019_118_0	3		Y	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	118	0	1	01	01	H1019_118_0	3		Y	Preferred Generic	4	11	3	2	1	3	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H1019	118	0	1	01	01	H1019_118_0	3		Y	Generic	4	11	1	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	5.00		15.00																									20.00		60.00				5.00		0.00				5.00				5.00		0.17				0.67	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	118	0	1	01	01	H1019_118_0	3		Y	Generic	4	11	1	2	2	3	110		01		110	1	30		90				2	2				30		90	30		31	5.00		15.00																									20.00		60.00				5.00		0.00				5.00				5.00		0.17				0.67	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1019	118	0	1	01	01	H1019_118_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	45.00		135.00																									47.00		141.00				45.00		125.00				45.00				45.00		1.50				1.57	1.50	1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	118	0	1	01	01	H1019_118_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	95.00		285.00																									100.00		300.00				95.00		275.00				95.00				95.00		3.17				3.33	3.17	3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	118	0	1	01	01	H1019_118_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	120	1	1	01	01	H1019_120_1	3		Y	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	120	1	1	01	01	H1019_120_1	3		Y	Preferred Generic	4	11	3	2	1	3	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H1019	120	1	1	01	01	H1019_120_1	3		Y	Generic	4	11	1	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	5.00		15.00																									20.00		60.00				5.00		0.00				5.00				5.00		0.17				0.67	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	120	1	1	01	01	H1019_120_1	3		Y	Generic	4	11	1	2	2	3	110		01		110	1	30		90				2	2				30		90	30		31	5.00		15.00																									20.00		60.00				5.00		0.00				5.00				5.00		0.17				0.67	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1019	120	1	1	01	01	H1019_120_1	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	35.00		105.00																									47.00		141.00				35.00		95.00				35.00				35.00		1.17				1.57	1.17	1.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	120	1	1	01	01	H1019_120_1	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	85.00		255.00																									100.00		300.00				85.00		245.00				85.00				85.00		2.83				3.33	2.83	2.74	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	120	1	1	01	01	H1019_120_1	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	120	2	1	01	01	H1019_120_2	3		Y	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	120	2	1	01	01	H1019_120_2	3		Y	Preferred Generic	4	11	3	2	1	3	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H1019	120	2	1	01	01	H1019_120_2	3		Y	Generic	4	11	1	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	5.00		15.00																									20.00		60.00				5.00		0.00				5.00				5.00		0.17				0.67	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	120	2	1	01	01	H1019_120_2	3		Y	Generic	4	11	1	2	2	3	110		01		110	1	30		90				2	2				30		90	30		31	5.00		15.00																									20.00		60.00				5.00		0.00				5.00				5.00		0.17				0.67	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1019	120	2	1	01	01	H1019_120_2	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	35.00		105.00																									47.00		141.00				35.00		95.00				35.00				35.00		1.17				1.57	1.17	1.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	120	2	1	01	01	H1019_120_2	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	85.00		255.00																									100.00		300.00				85.00		245.00				85.00				85.00		2.83				3.33	2.83	2.74	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	120	2	1	01	01	H1019_120_2	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	121	0	1	01	01	H1019_121_0	3		Y	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									1.00		3.00				0.00		0.00				0.00				0.00		0				0.03	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	121	0	1	01	01	H1019_121_0	3		Y	Preferred Generic	4	11	3	2	1	3	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									1.00		3.00				0.00		0.00				0.00				0.00		0				0.03	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H1019	121	0	1	01	01	H1019_121_0	3		Y	Generic	4	11	1	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	5.00		15.00																									6.00		18.00				5.00		0.00				5.00				5.00		0.17				0.20	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	121	0	1	01	01	H1019_121_0	3		Y	Generic	4	11	1	2	2	3	110		01		110	1	30		90				2	2				30		90	30		31	5.00		15.00																									6.00		18.00				5.00		0.00				5.00				5.00		0.17				0.20	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1019	121	0	1	01	01	H1019_121_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	25.00		75.00																									26.00		78.00				25.00		65.00				25.00				25.00		0.83				0.87	0.83	0.81	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	121	0	1	01	01	H1019_121_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	85.00		255.00																									86.00		258.00				85.00		245.00				85.00				85.00		2.83				2.87	2.83	2.74	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	121	0	1	01	01	H1019_121_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	122	0	1	01	01	H1019_122_0	3		Y	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	122	0	1	01	01	H1019_122_0	3		Y	Preferred Generic	4	11	3	2	1	3	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H1019	122	0	1	01	01	H1019_122_0	3		Y	Generic	4	11	1	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	5.00		15.00																									20.00		60.00				5.00		0.00				5.00				5.00		0.17				0.67	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	122	0	1	01	01	H1019_122_0	3		Y	Generic	4	11	1	2	2	3	110		01		110	1	30		90				2	2				30		90	30		31	5.00		15.00																									20.00		60.00				5.00		0.00				5.00				5.00		0.17				0.67	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1019	122	0	1	01	01	H1019_122_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	40.00		120.00																									47.00		141.00				40.00		110.00				40.00				40.00		1.33				1.57	1.33	1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	122	0	1	01	01	H1019_122_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	70.00		210.00																									100.00		300.00				70.00		200.00				70.00				70.00		2.33				3.33	2.33	2.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	122	0	1	01	01	H1019_122_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	123	0	1	01	01	H1019_123_0	3		Y	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									1.00		3.00				0.00		0.00				0.00				0.00		0				0.03	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	123	0	1	01	01	H1019_123_0	3		Y	Preferred Generic	4	11	3	2	1	3	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									1.00		3.00				0.00		0.00				0.00				0.00		0				0.03	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H1019	123	0	1	01	01	H1019_123_0	3		Y	Generic	4	11	1	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	5.00		15.00																									6.00		18.00				5.00		0.00				5.00				5.00		0.17				0.20	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	123	0	1	01	01	H1019_123_0	3		Y	Generic	4	11	1	2	2	3	110		01		110	1	30		90				2	2				30		90	30		31	5.00		15.00																									6.00		18.00				5.00		0.00				5.00				5.00		0.17				0.20	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1019	123	0	1	01	01	H1019_123_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	25.00		75.00																									26.00		78.00				25.00		65.00				25.00				25.00		0.83				0.87	0.83	0.81	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	123	0	1	01	01	H1019_123_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	85.00		255.00																									86.00		258.00				85.00		245.00				85.00				85.00		2.83				2.87	2.83	2.74	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	123	0	1	01	01	H1019_123_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	124	0	1	01	01	H1019_124_0	3		Y	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0				0	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	124	0	1	01	01	H1019_124_0	3		Y	Preferred Generic	4	11	3	2	1	3	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0				0	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H1019	124	0	1	01	01	H1019_124_0	3		Y	Generic	4	11	1	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	5.00		15.00																									12.00		36.00				5.00		0.00				5.00				5.00		0.17				0.40	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	124	0	1	01	01	H1019_124_0	3		Y	Generic	4	11	1	2	2	3	110		01		110	1	30		90				2	2				30		90	30		31	5.00		15.00																									12.00		36.00				5.00		0.00				5.00				5.00		0.17				0.40	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1019	124	0	1	01	01	H1019_124_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	45.00		135.00																									47.00		141.00				45.00		125.00				45.00				45.00		1.50				1.57	1.50	1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	124	0	1	01	01	H1019_124_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	85.00		255.00																									100.00		300.00				85.00		245.00				85.00				85.00		2.83				3.33	2.83	2.74	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	124	0	1	01	01	H1019_124_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	125	0	1	01	01	H1019_125_0	3		Y	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	125	0	1	01	01	H1019_125_0	3		Y	Preferred Generic	4	11	3	2	1	3	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H1019	125	0	1	01	01	H1019_125_0	3		Y	Generic	4	11	1	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	5.00		15.00																									20.00		60.00				5.00		0.00				5.00				5.00		0.17				0.67	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	125	0	1	01	01	H1019_125_0	3		Y	Generic	4	11	1	2	2	3	110		01		110	1	30		90				2	2				30		90	30		31	5.00		15.00																									20.00		60.00				5.00		0.00				5.00				5.00		0.17				0.67	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1019	125	0	1	01	01	H1019_125_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	40.00		120.00																									47.00		141.00				40.00		110.00				40.00				40.00		1.33				1.57	1.33	1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	125	0	1	01	01	H1019_125_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	70.00		210.00																									100.00		300.00				70.00		200.00				70.00				70.00		2.33				3.33	2.33	2.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	125	0	1	01	01	H1019_125_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	126	0	1	01	01	H1019_126_0	4		Y	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	126	0	1	01	01	H1019_126_0	4		Y	Preferred Generic	4	11	3	2	1	3	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H1019	126	0	1	01	01	H1019_126_0	4		Y	Generic	4	11	1	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	5.00		15.00																									20.00		60.00				5.00		0.00				5.00				5.00		0.17				0.67	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	126	0	1	01	01	H1019_126_0	4		Y	Generic	4	11	1	2	2	3	110		01		110	1	30		90				2	2				30		90	30		31	5.00		15.00																									20.00		60.00				5.00		0.00				5.00				5.00		0.17				0.67	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1019	126	0	1	01	01	H1019_126_0	4		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	45.00		135.00																									47.00		141.00				45.00		125.00				45.00				45.00		1.50				1.57	1.50	1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	126	0	1	01	01	H1019_126_0	4		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	85.00		255.00																									100.00		300.00				85.00		245.00				85.00				85.00		2.83				3.33	2.83	2.74	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	126	0	1	01	01	H1019_126_0	4		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	127	0	1	01	01	H1019_127_0	4		Y	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	127	0	1	01	01	H1019_127_0	4		Y	Preferred Generic	4	11	3	2	1	3	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H1019	127	0	1	01	01	H1019_127_0	4		Y	Generic	4	11	1	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	0.00		0.00																									20.00		60.00				0.00		0.00				0.00				0.00		0				0.67	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	127	0	1	01	01	H1019_127_0	4		Y	Generic	4	11	1	2	2	3	110		01		110	1	30		90				2	2				30		90	30		31	0.00		0.00																									20.00		60.00				0.00		0.00				0.00				0.00		0				0.67	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1019	127	0	1	01	01	H1019_127_0	4		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	0.00		0.00																									47.00		141.00				0.00		0.00				0.00				0.00		0				1.57	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	127	0	1	01	01	H1019_127_0	4		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	60.00		180.00																									100.00		300.00				60.00		170.00				60.00				60.00		2				3.33	2	1.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	127	0	1	01	01	H1019_127_0	4		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	128	0	1	01	01	H1019_128_0	4		Y	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	128	0	1	01	01	H1019_128_0	4		Y	Preferred Generic	4	11	3	2	1	3	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H1019	128	0	1	01	01	H1019_128_0	4		Y	Generic	4	11	1	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	0.00		0.00																									20.00		60.00				0.00		0.00				0.00				0.00		0				0.67	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	128	0	1	01	01	H1019_128_0	4		Y	Generic	4	11	1	2	2	3	110		01		110	1	30		90				2	2				30		90	30		31	0.00		0.00																									20.00		60.00				0.00		0.00				0.00				0.00		0				0.67	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1019	128	0	1	01	01	H1019_128_0	4		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	0.00		0.00																									47.00		141.00				0.00		0.00				0.00				0.00		0				1.57	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	128	0	1	01	01	H1019_128_0	4		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	60.00		180.00																									100.00		300.00				60.00		170.00				60.00				60.00		2				3.33	2	1.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	128	0	1	01	01	H1019_128_0	4		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	129	0	1	01	01	H1019_129_0	4		Y	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	129	0	1	01	01	H1019_129_0	4		Y	Preferred Generic	4	11	3	2	1	3	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H1019	129	0	1	01	01	H1019_129_0	4		Y	Generic	4	11	1	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	5.00		15.00																									20.00		60.00				5.00		0.00				5.00				5.00		0.17				0.67	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	129	0	1	01	01	H1019_129_0	4		Y	Generic	4	11	1	2	2	3	110		01		110	1	30		90				2	2				30		90	30		31	5.00		15.00																									20.00		60.00				5.00		0.00				5.00				5.00		0.17				0.67	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1019	129	0	1	01	01	H1019_129_0	4		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	45.00		135.00																									47.00		141.00				45.00		125.00				45.00				45.00		1.50				1.57	1.50	1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	129	0	1	01	01	H1019_129_0	4		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	85.00		255.00																									100.00		300.00				85.00		245.00				85.00				85.00		2.83				3.33	2.83	2.74	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	129	0	1	01	01	H1019_129_0	4		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	130	0	1	01	01	H1019_130_0	3		Y	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0				0	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	130	0	1	01	01	H1019_130_0	3		Y	Preferred Generic	4	11	3	2	1	3	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0				0	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H1019	130	0	1	01	01	H1019_130_0	3		Y	Generic	4	11	1	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	5.00		15.00																									12.00		36.00				5.00		0.00				5.00				5.00		0.17				0.40	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	130	0	1	01	01	H1019_130_0	3		Y	Generic	4	11	1	2	2	3	110		01		110	1	30		90				2	2				30		90	30		31	5.00		15.00																									12.00		36.00				5.00		0.00				5.00				5.00		0.17				0.40	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1019	130	0	1	01	01	H1019_130_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	45.00		135.00																									47.00		141.00				45.00		125.00				45.00				45.00		1.50				1.57	1.50	1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	130	0	1	01	01	H1019_130_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	85.00		255.00																									100.00		300.00				85.00		245.00				85.00				85.00		2.83				3.33	2.83	2.74	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	130	0	1	01	01	H1019_130_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	134	0	1	01	01	H1019_134_0	3		Y	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	134	0	1	01	01	H1019_134_0	3		Y	Preferred Generic	4	11	3	2	1	3	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H1019	134	0	1	01	01	H1019_134_0	3		Y	Generic	4	11	1	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	0.00		0.00																									20.00		60.00				0.00		0.00				0.00				0.00		0				0.67	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	134	0	1	01	01	H1019_134_0	3		Y	Generic	4	11	1	2	2	3	110		01		110	1	30		90				2	2				30		90	30		31	0.00		0.00																									20.00		60.00				0.00		0.00				0.00				0.00		0				0.67	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1019	134	0	1	01	01	H1019_134_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	25.00		75.00																									47.00		141.00				25.00		65.00				25.00				25.00		0.83				1.57	0.83	0.81	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	134	0	1	01	01	H1019_134_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	55.00		165.00																									100.00		300.00				55.00		155.00				55.00				55.00		1.83				3.33	1.83	1.77	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	134	0	1	01	01	H1019_134_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	135	0	1	01	01	H1019_135_0	3		Y	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0				0	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	135	0	1	01	01	H1019_135_0	3		Y	Preferred Generic	4	11	3	2	1	3	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0				0	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H1019	135	0	1	01	01	H1019_135_0	3		Y	Generic	4	11	1	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	5.00		15.00																									12.00		36.00				5.00		0.00				5.00				5.00		0.17				0.40	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	135	0	1	01	01	H1019_135_0	3		Y	Generic	4	11	1	2	2	3	110		01		110	1	30		90				2	2				30		90	30		31	5.00		15.00																									12.00		36.00				5.00		0.00				5.00				5.00		0.17				0.40	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1019	135	0	1	01	01	H1019_135_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	135	0	1	01	01	H1019_135_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	85.00		255.00																									100.00		300.00				85.00		245.00				85.00				85.00		2.83				3.33	2.83	2.74	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	135	0	1	01	01	H1019_135_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	136	0	1	01	01	H1019_136_0	3		Y	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0				0	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	136	0	1	01	01	H1019_136_0	3		Y	Preferred Generic	4	11	3	2	1	3	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0				0	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H1019	136	0	1	01	01	H1019_136_0	3		Y	Generic	4	11	1	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	136	0	1	01	01	H1019_136_0	3		Y	Generic	4	11	1	2	2	3	110		01		110	1	30		90				2	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1019	136	0	1	01	01	H1019_136_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	136	0	1	01	01	H1019_136_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	85.00		255.00																									100.00		300.00				85.00		245.00				85.00				85.00		2.83				3.33	2.83	2.74	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	136	0	1	01	01	H1019_136_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	137	0	1	01	01	H1019_137_0	3		Y	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	137	0	1	01	01	H1019_137_0	3		Y	Preferred Generic	4	11	3	2	1	3	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H1019	137	0	1	01	01	H1019_137_0	3		Y	Generic	4	11	1	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	5.00		15.00																									20.00		60.00				5.00		0.00				5.00				5.00		0.17				0.67	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	137	0	1	01	01	H1019_137_0	3		Y	Generic	4	11	1	2	2	3	110		01		110	1	30		90				2	2				30		90	30		31	5.00		15.00																									20.00		60.00				5.00		0.00				5.00				5.00		0.17				0.67	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1019	137	0	1	01	01	H1019_137_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	45.00		135.00																									47.00		141.00				45.00		125.00				45.00				45.00		1.50				1.57	1.50	1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	137	0	1	01	01	H1019_137_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	85.00		255.00																									100.00		300.00				85.00		245.00				85.00				85.00		2.83				3.33	2.83	2.74	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	137	0	1	01	01	H1019_137_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	138	0	1	01	01	H1019_138_0	3		Y	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	138	0	1	01	01	H1019_138_0	3		Y	Preferred Generic	4	11	3	2	1	3	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H1019	138	0	1	01	01	H1019_138_0	3		Y	Generic	4	11	1	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	5.00		15.00																									20.00		60.00				5.00		0.00				5.00				5.00		0.17				0.67	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	138	0	1	01	01	H1019_138_0	3		Y	Generic	4	11	1	2	2	3	110		01		110	1	30		90				2	2				30		90	30		31	5.00		15.00																									20.00		60.00				5.00		0.00				5.00				5.00		0.17				0.67	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1019	138	0	1	01	01	H1019_138_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	45.00		135.00																									47.00		141.00				45.00		125.00				45.00				45.00		1.50				1.57	1.50	1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	138	0	1	01	01	H1019_138_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	85.00		255.00																									100.00		300.00				85.00		245.00				85.00				85.00		2.83				3.33	2.83	2.74	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	138	0	1	01	01	H1019_138_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	139	0	1	01	01	H1019_139_0	3		Y	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	139	0	1	01	01	H1019_139_0	3		Y	Preferred Generic	4	11	3	2	1	3	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H1019	139	0	1	01	01	H1019_139_0	3		Y	Generic	4	11	1	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	5.00		15.00																									20.00		60.00				5.00		0.00				5.00				5.00		0.17				0.67	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	139	0	1	01	01	H1019_139_0	3		Y	Generic	4	11	1	2	2	3	110		01		110	1	30		90				2	2				30		90	30		31	5.00		15.00																									20.00		60.00				5.00		0.00				5.00				5.00		0.17				0.67	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1019	139	0	1	01	01	H1019_139_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	45.00		135.00																									47.00		141.00				45.00		125.00				45.00				45.00		1.50				1.57	1.50	1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	139	0	1	01	01	H1019_139_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	85.00		255.00																									100.00		300.00				85.00		245.00				85.00				85.00		2.83				3.33	2.83	2.74	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	139	0	1	01	01	H1019_139_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	140	0	1	01	01	H1019_140_0	3		Y	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	140	0	1	01	01	H1019_140_0	3		Y	Preferred Generic	4	11	3	2	1	3	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H1019	140	0	1	01	01	H1019_140_0	3		Y	Generic	4	11	1	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	5.00		15.00																									20.00		60.00				5.00		0.00				5.00				5.00		0.17				0.67	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	140	0	1	01	01	H1019_140_0	3		Y	Generic	4	11	1	2	2	3	110		01		110	1	30		90				2	2				30		90	30		31	5.00		15.00																									20.00		60.00				5.00		0.00				5.00				5.00		0.17				0.67	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1019	140	0	1	01	01	H1019_140_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	45.00		135.00																									47.00		141.00				45.00		125.00				45.00				45.00		1.50				1.57	1.50	1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	140	0	1	01	01	H1019_140_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	85.00		255.00																									100.00		300.00				85.00		245.00				85.00				85.00		2.83				3.33	2.83	2.74	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	140	0	1	01	01	H1019_140_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	141	0	1	02	01	H1019_141_0	3		Y	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	141	0	1	02	01	H1019_141_0	3		Y	Preferred Generic	4	11	3	2	1	3	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H1019	141	0	1	02	01	H1019_141_0	3		Y	Generic	4	11	1	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	5.00		15.00																									20.00		60.00				5.00		0.00				5.00				5.00		0.17				0.67	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	141	0	1	02	01	H1019_141_0	3		Y	Generic	4	11	1	2	2	3	110		01		110	1	30		90				2	2				30		90	30		31	5.00		15.00																									20.00		60.00				5.00		0.00				5.00				5.00		0.17				0.67	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1019	141	0	1	02	01	H1019_141_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	45.00		135.00																									47.00		141.00				45.00		125.00				45.00				45.00		1.50				1.57	1.50	1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	141	0	1	02	01	H1019_141_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	85.00		255.00																									100.00		300.00				85.00		245.00				85.00				85.00		2.83				3.33	2.83	2.74	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	141	0	1	02	01	H1019_141_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	142	0	1	02	01	H1019_142_0	3		Y	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	142	0	1	02	01	H1019_142_0	3		Y	Preferred Generic	4	11	3	2	1	3	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H1019	142	0	1	02	01	H1019_142_0	3		Y	Generic	4	11	1	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	5.00		15.00																									20.00		60.00				5.00		0.00				5.00				5.00		0.17				0.67	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	142	0	1	02	01	H1019_142_0	3		Y	Generic	4	11	1	2	2	3	110		01		110	1	30		90				2	2				30		90	30		31	5.00		15.00																									20.00		60.00				5.00		0.00				5.00				5.00		0.17				0.67	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1019	142	0	1	02	01	H1019_142_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	45.00		135.00																									47.00		141.00				45.00		125.00				45.00				45.00		1.50				1.57	1.50	1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	142	0	1	02	01	H1019_142_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	85.00		255.00																									100.00		300.00				85.00		245.00				85.00				85.00		2.83				3.33	2.83	2.74	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	142	0	1	02	01	H1019_142_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1032	040	0	1	01	01	H1032_040_0	5		N	Preferred Generic	4	11	3	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			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		N	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		N	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		N	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		N	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		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1032	040	0	1	01	01	H1032_040_0	5		N	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	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		N	Select Care Drugs	4	11	1	2	6	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	2	
H1032	184	0	1	01	01	H1032_184_0	5		Y	Preferred Generic	4	11	3	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				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		Y	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		Y	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		Y	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		Y	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		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								75.00	150.00	225.00					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		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs												
H1032	184	0	1	01	01	H1032_184_0	5		Y	Select Diabetic Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				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		Y	Select Diabetic 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 Diabetic Drugs										2	1	
H1032	186	0	1	01	01	H1032_186_0	5		Y	Preferred Generic	4	11	3	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				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		Y	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		Y	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		Y	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		Y	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		Y	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		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs												
H1032	186	0	1	01	01	H1032_186_0	5		Y	Select Diabetic Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				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		Y	Select Diabetic 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 Diabetic Drugs										2	1	
H1032	189	0	1	01	01	H1032_189_0	5		N	Preferred Generic	4	11	3	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			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		N	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		N	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					5.00	10.00	15.00											10.00	20.00	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		N	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											47.00	94.00	141.00				37.00	74.00	74.00				47.00				47.00			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		N	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	300.00					90.00	180.00	270.00											100.00	200.00	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		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1032	189	0	1	01	01	H1032_189_0	5		N	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	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		N	Select Care Drugs	4	11	1	2	6	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	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		N	Preferred Generic	4	11	3	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			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		N	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		N	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00				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		N	Preferred Brand	4	11	1	2	3	1		111	01		111	1				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	84.00				47.00				47.00			1.57	1.4		1.57	1.4	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1032	190	0	1	01	01	H1032_190_0	5		N	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	300.00					90.00	180.00	270.00											100.00	200.00	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		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1032	190	0	1	01	01	H1032_190_0	5		N	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	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		N	Select Care Drugs	4	11	1	2	6	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	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		N	Preferred Generic	4	11	3	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			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		N	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		N	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					5.00	10.00	15.00											10.00	20.00	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		N	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											47.00	94.00	141.00				37.00	74.00	74.00				47.00				47.00			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		N	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	300.00					90.00	180.00	270.00											100.00	200.00	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		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1032	191	0	1	01	01	H1032_191_0	5		N	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	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		N	Select Care Drugs	4	11	1	2	6	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	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		N	Preferred Generic	4	11	3	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			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		N	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		N	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00				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		N	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								45.00	90.00	135.00					35.00	70.00	105.00											45.00	90.00	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		N	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											70.53	46	46	46				67.47	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		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1032	192	0	1	01	01	H1032_192_0	5		N	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	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		N	Select Care Drugs	4	11	1	2	6	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	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		N	Preferred Generic	4	11	3	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			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		N	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		N	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00				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		N	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								40.00	80.00	120.00					30.00	60.00	90.00											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		N	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								90.00	180.00	270.00					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		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1032	193	0	1	01	01	H1032_193_0	5		N	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	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		N	Select Care Drugs	4	11	1	2	6	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	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	5		N	Preferred Generic	4	11	3	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			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	5		N	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	5		N	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	5		N	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	5		N	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								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	5		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1032	194	0	1	01	01	H1032_194_0	5		N	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	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	5		N	Select Care Drugs	4	11	1	2	6	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	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	5		N	Preferred Generic	4	11	3	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			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	5		N	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	5		N	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00				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	5		N	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								40.00	80.00	120.00					30.00	60.00	90.00											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	5		N	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								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	5		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1032	195	0	1	01	01	H1032_195_0	5		N	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	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	5		N	Select Care Drugs	4	11	1	2	6	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	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		N	Preferred Generic	4	11	3	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			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		N	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		N	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		N	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		N	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		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1032	196	0	1	01	01	H1032_196_0	5		N	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	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		N	Select Care Drugs	4	11	1	2	6	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	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		N	Preferred Generic	4	11	3	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			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		N	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		N	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		N	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		N	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								90.00	180.00	270.00					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		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1032	198	0	1	01	01	H1032_198_0	5		N	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	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		N	Select Care Drugs	4	11	1	2	6	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	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		N	Preferred Generic	4	11	3	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			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		N	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		N	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		N	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		N	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		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1032	199	0	1	01	01	H1032_199_0	5		N	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	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		N	Select Care Drugs	4	11	1	2	6	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	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		N	Preferred Generic	4	11	3	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			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		N	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		N	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00				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		N	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		N	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								80.00	160.00	240.00					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		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1032	200	0	1	01	01	H1032_200_0	5		N	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	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		N	Select Care Drugs	4	11	1	2	6	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	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		N	Preferred Generic	4	11	3	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			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		N	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		N	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		N	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		N	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		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1032	201	0	1	01	01	H1032_201_0	5		N	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	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		N	Select Care Drugs	4	11	1	2	6	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	2	
H1032	203	0	1	01	01	H1032_203_0	5		Y	Preferred Generic	4	11	3	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				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		Y	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		Y	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00				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		Y	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		Y	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		Y	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		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs												
H1032	203	0	1	01	01	H1032_203_0	5		Y	Select Diabetic Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				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		Y	Select Diabetic 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 Diabetic Drugs										2	1	
H1032	204	0	1	01	01	H1032_204_0	5		N	Preferred Generic	4	11	3	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			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		N	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		N	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00				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		N	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								45.00	90.00	135.00					35.00	70.00	105.00											45.00	90.00	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		N	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											76.75	50	50	50				73.68	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	204	0	1	01	01	H1032_204_0	5		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1032	204	0	1	01	01	H1032_204_0	5		N	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	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		N	Select Care Drugs	4	11	1	2	6	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	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		N	Preferred Generic	4	11	3	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			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		N	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		N	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		N	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		N	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											74.22	50	50	50				71.25	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		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1032	205	0	1	01	01	H1032_205_0	5		N	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	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		N	Select Care Drugs	4	11	1	2	6	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	2	
H1032	209	0	1	01	01	H1032_209_0	5		N	Preferred Generic	4	11	3	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			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		N	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		N	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00				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		N	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								45.00	90.00	135.00					35.00	70.00	105.00											45.00	90.00	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		N	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											88.11	50	50	50				84.58	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	209	0	1	01	01	H1032_209_0	5		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1032	209	0	1	01	01	H1032_209_0	5		N	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	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		N	Select Care Drugs	4	11	1	2	6	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	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		N	Preferred Generic	4	11	3	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			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		N	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		N	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		N	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								40.00	80.00	120.00					30.00	60.00	90.00											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		N	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								90.00	180.00	270.00					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		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1032	210	0	1	01	01	H1032_210_0	5		N	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	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		N	Select Care Drugs	4	11	1	2	6	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	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		N	Preferred Generic	4	11	3	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			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		N	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		N	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		N	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		N	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		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1032	211	0	1	01	01	H1032_211_0	5		N	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	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		N	Select Care Drugs	4	11	1	2	6	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	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		N	Preferred Generic	4	11	3	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			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		N	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		N	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00				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		N	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		N	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								95.00	190.00	285.00					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		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1032	212	0	1	01	01	H1032_212_0	5		N	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	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		N	Select Care Drugs	4	11	1	2	6	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	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		N	Preferred Generic	4	11	3	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			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		N	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		N	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		N	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		N	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		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1032	213	0	1	01	01	H1032_213_0	5		N	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	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		N	Select Care Drugs	4	11	1	2	6	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	2	
H1032	218	0	1	01	01	H1032_218_0	5		N	Preferred Generic	4	11	3	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			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		N	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		N	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					5.00	10.00	15.00											10.00	20.00	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		N	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								45.00	90.00	135.00					35.00	70.00	105.00											45.00	90.00	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		N	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		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1032	218	0	1	01	01	H1032_218_0	5		N	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	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		N	Select Care Drugs	4	11	1	2	6	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	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		Y	Preferred Generic	4	11	3	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				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		Y	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		Y	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		Y	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		Y	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		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								75.00	150.00	225.00					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		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs												
H1032	224	0	1	01	01	H1032_224_0	5		Y	Select Diabetic Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					10.00	20.00	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		Y	Select Diabetic Drugs	4	11	1	2	6	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					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	1	
H1032	227	0	1	01	01	H1032_227_0	5		Y	Preferred Generic	4	11	3	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				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		Y	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		Y	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00				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		Y	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		Y	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		Y	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		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs												
H1032	227	0	1	01	01	H1032_227_0	5		Y	Select Diabetic Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					10.00	20.00	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		Y	Select Diabetic Drugs	4	11	1	2	6	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					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	1	
H1035	002	0	1	02	01	H1035_002_0	10			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	10			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	10			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					0.00	0.00	0.00						0.00	0.00																20.00				20.00			0.65	0.00				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1035	002	0	1	02	01	H1035_002_0	10			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					0.00	0.00	0.00						0.00	0.00																20.00				20.00			0.65	0.00				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H1035	002	0	1	02	01	H1035_002_0	10			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	10			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	10			Specialty Tier	4	11	1	1	5	1		010	01			1				31											31		31											1347.97	33						511.95	33																							33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1035	006	0	1	01	01	H1035_006_0	9			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	9			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	006	0	1	01	01	H1035_006_0	9			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	9			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					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										1		
H1035	006	0	1	01	01	H1035_006_0	9			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	9			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	9			Specialty Tier	4	11	1	1	5	1		010	01			1				31											31		31											1030.82	26						367.60	26																							26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1035	011	0	1	01	01	H1035_011_0	9			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	9			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	9			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	9			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	9			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	9			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	9			Specialty Tier	4	11	1	1	5	1		010	01			1				31											31		31											1339.96	33						511.63	33																							33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1035	014	0	1	01	01	H1035_014_0	9			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	014	0	1	01	01	H1035_014_0	9			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	9			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	9			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	9			Specialty Tier	4	11	1	1	5	1		010	01			1				31											31		31											1405.60	25						441.33	25																							25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1035	016	0	1	01	01	H1035_016_0	9			Preferred Generic	4	01	1	2	1	1		111	01	101		1				31	62	93	2	1		62	93				31		31								10.00	20.00	30.00					0.00	0.00	0.00						0.00	0.00																10.00				10.00			0.32	0.00				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1035	016	0	1	01	01	H1035_016_0	9			Preferred Generic	4	01	1	2	1	3		111	01	101		1				31	62	93	2	1		62	93				31		31								10.00	20.00	30.00					0.00	0.00	0.00						0.00	0.00																10.00				10.00			0.32	0.00				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H1035	016	0	1	01	01	H1035_016_0	9			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	9			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	9			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	9			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	9			Specialty Tier	4	11	1	1	5	1		010	01			1				31											31		31											1699.48	33						527.13	33																							33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1035	017	0	1	01	01	H1035_017_0	6		Y	Preferred Generic	4	01	1	2	1	1	110		01	110		1	31		100				1	2	31		100				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	017	0	1	01	01	H1035_017_0	6		Y	Preferred Generic	4	01	1	2	1	3	110		01	110		1	31		100				1	2	31		100				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	017	0	1	01	01	H1035_017_0	6		Y	Generic	4	01	1	2	2	1	110		01	110		1	31		100				1	2	31		100				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	017	0	1	01	01	H1035_017_0	6		Y	Generic	4	01	1	2	2	3	110		01	110		1	31		100				1	2	31		100				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	017	0	1	01	01	H1035_017_0	6		Y	Preferred Brand	4	11	1	2	3	1	110		01	110		1	31		90				1	2	31		90				31		31	35.00		105.00																			35.00		105.00																35.00				35.00		1.13			1.13			1.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1035	017	0	1	01	01	H1035_017_0	6		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01	110		1	31		90				1	2	31		90				31		31	93.00		279.00																			93.00		279.00																93.00				93.00		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	6		Y	Specialty Tier	4	11	1	1	5	1	010		01	010		1	31								31						31		31				1206.80	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1035	018	0	1	01	01	H1035_018_0	6		Y	Preferred Generic	4	01	1	2	1	1	110		01	110		1	31		100				1	2	31		100				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	018	0	1	01	01	H1035_018_0	6		Y	Preferred Generic	4	01	1	2	1	3	110		01	110		1	31		100				1	2	31		100				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	018	0	1	01	01	H1035_018_0	6		Y	Generic	4	01	1	2	2	1	110		01	110		1	31		100				1	2	31		100				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	018	0	1	01	01	H1035_018_0	6		Y	Generic	4	01	1	2	2	3	110		01	110		1	31		100				1	2	31		100				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	018	0	1	01	01	H1035_018_0	6		Y	Preferred Brand	4	11	1	2	3	1	110		01	110		1	31		90				1	2	31		90				31		31	35.00		105.00																			35.00		105.00																35.00				35.00		1.13			1.13			1.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1035	018	0	1	01	01	H1035_018_0	6		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01	110		1	31		90				1	2	31		90				31		31	93.00		279.00																			93.00		279.00																93.00				93.00		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	6		Y	Specialty Tier	4	11	1	1	5	1	010		01	010		1	31								31						31		31				1297.04	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	6		Y	Select Care Drugs	4	01	1	2	6	1	110		01	110		1	31		100				1	2	31		100				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	018	0	1	01	01	H1035_018_0	6		Y	Select Care Drugs	4	01	1	2	6	3	110		01	110		1	31		100				1	2	31		100				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	019	0	1	01	01	H1035_019_0	7		Y	Preferred Generic	4	01	1	2	1	1	110		01	110		1	31		100				1	2	31		100				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	019	0	1	01	01	H1035_019_0	7		Y	Preferred Generic	4	01	1	2	1	3	110		01	110		1	31		100				1	2	31		100				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	019	0	1	01	01	H1035_019_0	7		Y	Generic	4	01	1	2	2	1	110		01	110		1	31		100				1	2	31		100				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												
H1035	019	0	1	01	01	H1035_019_0	7		Y	Preferred Brand	4	11	1	2	3	1	110		01	110		1	31		90				1	2	31		90				31		31	40.00		120.00																			40.00		120.00																40.00				40.00		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		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01	110		1	31		90				1	2	31		90				31		31	93.00		279.00																			93.00		279.00																93.00				93.00		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		Y	Specialty Tier	4	11	1	1	5	1	010		01	010		1	31								31						31		31				1216.99	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		Y	Select Care Drugs	4	01	1	2	6	1	110		01	110		1	31		100				1	2	31		100				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	019	0	1	01	01	H1035_019_0	7		Y	Select Care Drugs	4	01	1	2	6	3	110		01	110		1	31		100				1	2	31		100				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	020	0	1	01	01	H1035_020_0	6		Y	Preferred Generic	4	01	1	2	1	1	110		01	110		1	31		100				1	2	31		100				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	020	0	1	01	01	H1035_020_0	6		Y	Preferred Generic	4	01	1	2	1	3	110		01	110		1	31		100				1	2	31		100				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	020	0	1	01	01	H1035_020_0	6		Y	Generic	4	01	1	2	2	1	110		01	110		1	31		100				1	2	31		100				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												
H1035	020	0	1	01	01	H1035_020_0	6		Y	Generic	4	01	1	2	2	3	110		01	110		1	31		100				1	2	31		100				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										1		
H1035	020	0	1	01	01	H1035_020_0	6		Y	Preferred Brand	4	11	1	2	3	1	110		01	110		1	31		90				1	2	31		90				31		31	40.00		120.00																			40.00		120.00																40.00				40.00		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	6		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01	110		1	31		90				1	2	31		90				31		31	93.00		279.00																			93.00		279.00																93.00				93.00		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	6		Y	Specialty Tier	4	11	1	1	5	1	010		01	010		1	31								31						31		31				1445.87	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	6		Y	Select Care Drugs	4	01	1	2	6	1	110		01	110		1	31		100				1	2	31		100				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	020	0	1	01	01	H1035_020_0	6		Y	Select Care Drugs	4	01	1	2	6	3	110		01	110		1	31		100				1	2	31		100				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	021	0	1	01	01	H1035_021_0	6		Y	Preferred Generic	4	01	1	2	1	1	110		01	110		1	31		100				1	2	31		100				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	021	0	1	01	01	H1035_021_0	6		Y	Preferred Generic	4	01	1	2	1	3	110		01	110		1	31		100				1	2	31		100				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	021	0	1	01	01	H1035_021_0	6		Y	Generic	4	01	1	2	2	1	110		01	110		1	31		100				1	2	31		100				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												
H1035	021	0	1	01	01	H1035_021_0	6		Y	Generic	4	01	1	2	2	3	110		01	110		1	31		100				1	2	31		100				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										1		
H1035	021	0	1	01	01	H1035_021_0	6		Y	Preferred Brand	4	11	1	2	3	1	110		01	110		1	31		90				1	2	31		90				31		31	40.00		120.00																			40.00		120.00																40.00				40.00		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	6		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01	110		1	31		90				1	2	31		90				31		31	93.00		279.00																			93.00		279.00																93.00				93.00		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	6		Y	Specialty Tier	4	11	1	1	5	1	010		01	010		1	31								31						31		31				1441.78	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	6		Y	Select Care Drugs	4	01	1	2	6	1	110		01	110		1	31		100				1	2	31		100				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	021	0	1	01	01	H1035_021_0	6		Y	Select Care Drugs	4	01	1	2	6	3	110		01	110		1	31		100				1	2	31		100				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	022	0	1	01	01	H1035_022_0	8		Y	Preferred Generic	4	01	3	2	1	1	110		01	110		1	31		100				1	2	31		100				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	022	0	1	01	01	H1035_022_0	8		Y	Preferred Generic	4	01	3	2	1	3	110		01	110		1	31		100				1	2	31		100				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		3
H1035	022	0	1	01	01	H1035_022_0	8		Y	Generic	4	01	1	2	2	1	110		01	110		1	31		100				1	2	31		100				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	022	0	1	01	01	H1035_022_0	8		Y	Generic	4	01	1	2	2	3	110		01	110		1	31		100				1	2	31		100				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	022	0	1	01	01	H1035_022_0	8		Y	Preferred Brand	4	11	1	2	3	1	110		01	110		1	31		90				1	2	31		90				31		31	35.00		105.00																			35.00		105.00																35.00				35.00		1.13			1.13			1.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1035	022	0	1	01	01	H1035_022_0	8		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01	110		1	31		90				1	2	31		90				31		31	93.00		279.00																			93.00		279.00																93.00				93.00		3.00			3.00			3.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1035	022	0	1	01	01	H1035_022_0	8		Y	Specialty Tier	4	11	1	1	5	1	010		01	010		1	31								31						31		31				1159.11	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1035	023	0	1	01	01	H1035_023_0	7		Y	Preferred Generic	4	01	3	2	1	1	110		01	110		1	31		100				1	2	31		100				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	023	0	1	01	01	H1035_023_0	7		Y	Preferred Generic	4	01	3	2	1	3	110		01	110		1	31		100				1	2	31		100				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		3
H1035	023	0	1	01	01	H1035_023_0	7		Y	Generic	4	01	1	2	2	1	110		01	110		1	31		100				1	2	31		100				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	023	0	1	01	01	H1035_023_0	7		Y	Generic	4	01	1	2	2	3	110		01	110		1	31		100				1	2	31		100				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	023	0	1	01	01	H1035_023_0	7		Y	Preferred Brand	4	11	1	2	3	1	110		01	110		1	31		90				1	2	31		90				31		31	25.00		75.00																			25.00		75.00																25.00				25.00		0.81			0.81			0.81	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1035	023	0	1	01	01	H1035_023_0	7		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01	110		1	31		90				1	2	31		90				31		31	80.00		240.00																			80.00		240.00																80.00				80.00		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	7		Y	Specialty Tier	4	11	1	1	5	1	010		01	010		1	31								31						31		31				1304.34	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1035	024	0	1	01	01	H1035_024_0	10		Y	Preferred Generic	4	01	3	2	1	1	110		01	110		1	31		100				1	2	31		100				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	024	0	1	01	01	H1035_024_0	10		Y	Preferred Generic	4	01	3	2	1	3	110		01	110		1	31		100				1	2	31		100				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		3
H1035	024	0	1	01	01	H1035_024_0	10		Y	Generic	4	01	1	2	2	1	110		01	110		1	31		100				1	2	31		100				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	024	0	1	01	01	H1035_024_0	10		Y	Generic	4	01	1	2	2	3	110		01	110		1	31		100				1	2	31		100				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	024	0	1	01	01	H1035_024_0	10		Y	Preferred Brand	4	11	1	2	3	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	024	0	1	01	01	H1035_024_0	10		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01	110		1	31		90				1	2	31		90				31		31	50.00		150.00																			50.00		150.00																50.00				50.00		1.61			1.61			1.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1035	024	0	1	01	01	H1035_024_0	10		Y	Specialty Tier	4	11	1	1	5	1	010		01	010		1	31								31						31		31				931.79	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1035	025	0	1	01	01	H1035_025_0	7		Y	Preferred Generic	4	01	3	2	1	1	110		01	110		1	31		100				1	2	31		100				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	025	0	1	01	01	H1035_025_0	7		Y	Preferred Generic	4	01	3	2	1	3	110		01	110		1	31		100				1	2	31		100				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		3
H1035	025	0	1	01	01	H1035_025_0	7		Y	Generic	4	01	1	2	2	1	110		01	110		1	31		100				1	2	31		100				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	025	0	1	01	01	H1035_025_0	7		Y	Generic	4	01	1	2	2	3	110		01	110		1	31		100				1	2	31		100				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	025	0	1	01	01	H1035_025_0	7		Y	Preferred Brand	4	11	1	2	3	1	110		01	110		1	31		90				1	2	31		90				31		31	20.00		60.00																			20.00		60.00																20.00				20.00		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	7		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01	110		1	31		90				1	2	31		90				31		31	93.00		279.00																			93.00		279.00																93.00				93.00		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	7		Y	Specialty Tier	4	11	1	1	5	1	010		01	010		1	31								31						31		31				1395.79	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1035	026	0	1	01	01	H1035_026_0	7		Y	Preferred Generic	4	01	3	2	1	1	110		01	110		1	31		100				1	2	31		100				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	026	0	1	01	01	H1035_026_0	7		Y	Preferred Generic	4	01	3	2	1	3	110		01	110		1	31		100				1	2	31		100				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		3
H1035	026	0	1	01	01	H1035_026_0	7		Y	Generic	4	01	1	2	2	1	110		01	110		1	31		100				1	2	31		100				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	026	0	1	01	01	H1035_026_0	7		Y	Generic	4	01	1	2	2	3	110		01	110		1	31		100				1	2	31		100				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	026	0	1	01	01	H1035_026_0	7		Y	Preferred Brand	4	11	1	2	3	1	110		01	110		1	31		90				1	2	31		90				31		31	30.00		90.00																			30.00		90.00																30.00				30.00		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	7		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01	110		1	31		90				1	2	31		90				31		31	93.00		279.00																			93.00		279.00																93.00				93.00		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	7		Y	Specialty Tier	4	11	1	1	5	1	010		01	010		1	31								31						31		31				1216.57	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1035	027	0	1	01	01	H1035_027_0	6		N	Preferred Generic	4	01	3	1	1	1	110		01	110		1	31		100				1	2	31		100				31		31				1.60	25		25																		25		25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1035	027	0	1	01	01	H1035_027_0	6		N	Generic	4	01	1	1	2	1	110		01	110		1	31		100				1	2	31		100				31		31				7.81	25		25																		25		25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1035	027	0	1	01	01	H1035_027_0	6		N	Preferred Brand	4	11	1	1	3	1	110		01	110		1	31		90				1	2	31		90				31		31				71.03	25		25																		25		25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1035	027	0	1	01	01	H1035_027_0	6		N	Non-Preferred Drug	4	11	1	1	4	1	110		01	110		1	31		90				1	2	31		90				31		31				95.77	25		25																		25		25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1035	027	0	1	01	01	H1035_027_0	6		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	31								31						31		31				735.63	25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1035	028	0	1	01	01	H1035_028_0	6		N	Preferred Generic	4	01	3	1	1	1	110		01	110		1	31		100				1	2	31		100				31		31				1.64	25		25																		25		25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1035	028	0	1	01	01	H1035_028_0	6		N	Generic	4	01	1	1	2	1	110		01	110		1	31		100				1	2	31		100				31		31				7.93	25		25																		25		25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1035	028	0	1	01	01	H1035_028_0	6		N	Preferred Brand	4	11	1	1	3	1	110		01	110		1	31		90				1	2	31		90				31		31				69.88	25		25																		25		25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1035	028	0	1	01	01	H1035_028_0	6		N	Non-Preferred Drug	4	11	1	1	4	1	110		01	110		1	31		90				1	2	31		90				31		31				99.37	25		25																		25		25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1035	028	0	1	01	01	H1035_028_0	6		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	31								31						31		31				712.70	25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1035	029	0	1	01	01	H1035_029_0	6		N	Preferred Generic	4	01	3	1	1	1	110		01	110		1	31		100				1	2	31		100				31		31				1.60	25		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		N	Generic	4	01	1	1	2	1	110		01	110		1	31		100				1	2	31		100				31		31				7.73	25		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		N	Preferred Brand	4	11	1	1	3	1	110		01	110		1	31		90				1	2	31		90				31		31				70.15	25		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		N	Non-Preferred Drug	4	11	1	1	4	1	110		01	110		1	31		90				1	2	31		90				31		31				101.23	25		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		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	31								31						31		31				791.06	25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1035	030	0	1	01	01	H1035_030_0	6		N	Preferred Generic	4	01	3	1	1	1	110		01	110		1	31		100				1	2	31		100				31		31				1.55	25		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		N	Generic	4	01	1	1	2	1	110		01	110		1	31		100				1	2	31		100				31		31				7.53	25		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		N	Preferred Brand	4	11	1	1	3	1	110		01	110		1	31		90				1	2	31		90				31		31				65.87	25		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		N	Non-Preferred Drug	4	11	1	1	4	1	110		01	110		1	31		90				1	2	31		90				31		31				97.40	25		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		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	31								31						31		31				752.78	25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1035	031	0	1	01	01	H1035_031_0	6		N	Preferred Generic	4	01	3	1	1	1	110		01	110		1	31		100				1	2	31		100				31		31				1.55	25		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		N	Generic	4	01	1	1	2	1	110		01	110		1	31		100				1	2	31		100				31		31				7.51	25		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		N	Preferred Brand	4	11	1	1	3	1	110		01	110		1	31		90				1	2	31		90				31		31				69.15	25		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		N	Non-Preferred Drug	4	11	1	1	4	1	110		01	110		1	31		90				1	2	31		90				31		31				101.23	25		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		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	31								31						31		31				764.86	25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1035	032	0	1	01	01	H1035_032_0	6		N	Preferred Generic	4	01	3	1	1	1	110		01	110		1	31		100				1	2	31		100				31		31				1.50	25		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		N	Generic	4	01	1	1	2	1	110		01	110		1	31		100				1	2	31		100				31		31				7.36	25		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		N	Preferred Brand	4	11	1	1	3	1	110		01	110		1	31		90				1	2	31		90				31		31				72.61	25		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		N	Non-Preferred Drug	4	11	1	1	4	1	110		01	110		1	31		90				1	2	31		90				31		31				92.64	25		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		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	31								31						31		31				742.56	25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1035	033	0	1	01	01	H1035_033_0	6		Y	Preferred Generic	4	01	3	2	1	1	110		01	110		1	31		100				1	2	31		100				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	033	0	1	01	01	H1035_033_0	6		Y	Preferred Generic	4	01	3	2	1	3	110		01	110		1	31		100				1	2	31		100				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		3
H1035	033	0	1	01	01	H1035_033_0	6		Y	Generic	4	01	1	2	2	1	110		01	110		1	31		100				1	2	31		100				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	033	0	1	01	01	H1035_033_0	6		Y	Generic	4	01	1	2	2	3	110		01	110		1	31		100				1	2	31		100				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	033	0	1	01	01	H1035_033_0	6		Y	Preferred Brand	4	11	1	2	3	1	110		01	110		1	31		90				1	2	31		90				31		31	40.00		120.00																			40.00		120.00																40.00				40.00		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	6		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01	110		1	31		90				1	2	31		90				31		31	93.00		279.00																			93.00		279.00																93.00				93.00		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	6		Y	Specialty Tier	4	11	1	1	5	1	010		01	010		1	31								31						31		31				1062.72	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1035	034	0	1	01	01	H1035_034_0	6		Y	Preferred Generic	4	01	3	2	1	1	110		01	110		1	31		100				1	2	31		100				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	034	0	1	01	01	H1035_034_0	6		Y	Preferred Generic	4	01	3	2	1	3	110		01	110		1	31		100				1	2	31		100				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		3
H1035	034	0	1	01	01	H1035_034_0	6		Y	Generic	4	01	1	2	2	1	110		01	110		1	31		100				1	2	31		100				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	034	0	1	01	01	H1035_034_0	6		Y	Generic	4	01	1	2	2	3	110		01	110		1	31		100				1	2	31		100				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	034	0	1	01	01	H1035_034_0	6		Y	Preferred Brand	4	11	1	2	3	1	110		01	110		1	31		90				1	2	31		90				31		31	30.00		90.00																			30.00		90.00																30.00				30.00		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	6		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01	110		1	31		90				1	2	31		90				31		31	90.00		270.00																			90.00		270.00																90.00				90.00		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	6		Y	Specialty Tier	4	11	1	1	5	1	010		01	010		1	31								31						31		31				886.28	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1035	035	0	1	01	01	H1035_035_0	7		Y	Preferred Generic	4	01	1	2	1	1	110		01	110		1	31		100				1	2	31		100				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	7		Y	Generic	4	01	1	2	2	1	110		01	110		1	31		100				1	2	31		100				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	7		Y	Preferred Brand	4	11	1	2	3	1	110		01	110		1	31		90				1	2	31		90				31		31	47.00		141.00																			47.00		141.00																47.00				47.00		1.52			1.52			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1035	035	0	1	01	01	H1035_035_0	7		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01	110		1	31		90				1	2	31		90				31		31	100.00		300.00																			100.00		300.00																100.00				100.00		3.23			3.23			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1035	035	0	1	01	01	H1035_035_0	7		Y	Specialty Tier	4	11	1	1	5	1	010		01	010		1	31								31						31		31				1261.66	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	7		Y	Select Care Drugs	4	01	1	2	6	1	110		01	110		1	31		100				1	2	31		100				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	7		Y	Select Care Drugs	4	01	1	2	6	3	110		01	110		1	31		100				1	2	31		100				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	7		Y	Preferred Generic	4	01	1	2	1	1	110		01	110		1	31		100				1	2	31		100				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	7		Y	Generic	4	01	1	2	2	1	110		01	110		1	31		100				1	2	31		100				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	7		Y	Preferred Brand	4	11	1	2	3	1	110		01	110		1	31		90				1	2	31		90				31		31	47.00		141.00																			47.00		141.00																47.00				47.00		1.52			1.52			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1035	037	0	1	01	01	H1035_037_0	7		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01	110		1	31		90				1	2	31		90				31		31	100.00		300.00																			100.00		300.00																100.00				100.00		3.23			3.23			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1035	037	0	1	01	01	H1035_037_0	7		Y	Specialty Tier	4	11	1	1	5	1	010		01	010		1	31								31						31		31				1148.89	32																				32																	32			32								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1035	037	0	1	01	01	H1035_037_0	7		Y	Select Care Drugs	4	01	1	2	6	1	110		01	110		1	31		100				1	2	31		100				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	7		Y	Select Care Drugs	4	01	1	2	6	3	110		01	110		1	31		100				1	2	31		100				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	7		Y	Preferred Generic	4	01	1	2	1	1	110		01	110		1	31		100				1	2	31		100				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	7		Y	Generic	4	01	1	2	2	1	110		01	110		1	31		100				1	2	31		100				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	7		Y	Preferred Brand	4	11	1	2	3	1	110		01	110		1	31		90				1	2	31		90				31		31	47.00		141.00																			47.00		141.00																47.00				47.00		1.52			1.52			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1035	038	0	1	01	01	H1035_038_0	7		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01	110		1	31		90				1	2	31		90				31		31	100.00		300.00																			100.00		300.00																100.00				100.00		3.23			3.23			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1035	038	0	1	01	01	H1035_038_0	7		Y	Specialty Tier	4	11	1	1	5	1	010		01	010		1	31								31						31		31				1268.05	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	7		Y	Select Care Drugs	4	01	1	2	6	1	110		01	110		1	31		100				1	2	31		100				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	7		Y	Select Care Drugs	4	01	1	2	6	3	110		01	110		1	31		100				1	2	31		100				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	7		Y	Preferred Generic	4	01	1	2	1	1	110		01	110		1	31		100				1	2	31		100				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	7		Y	Preferred Generic	4	01	1	2	1	3	110		01	110		1	31		100				1	2	31		100				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	7		Y	Generic	4	01	1	2	2	1	110		01	110		1	31		100				1	2	31		100				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	7		Y	Generic	4	01	1	2	2	3	110		01	110		1	31		100				1	2	31		100				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	7		Y	Preferred Brand	4	11	1	2	3	1	110		01	110		1	31		90				1	2	31		90				31		31	25.00		75.00																			25.00		75.00																25.00				25.00		0.81			0.81			0.81	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1035	039	0	1	01	01	H1035_039_0	7		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01	110		1	31		90				1	2	31		90				31		31	50.00		150.00																			50.00		150.00																50.00				50.00		1.61			1.61			1.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1035	039	0	1	01	01	H1035_039_0	7		Y	Specialty Tier	4	11	1	1	5	1	010		01	010		1	31								31						31		31				1317.95	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1035	040	0	1	01	01	H1035_040_0	10			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	10			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	10			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	10			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	10			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	10			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	10			Specialty Tier	4	11	1	1	5	1		010	01			1				31											31		31											1311.74	33						494.60	33																							33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1035	043	0	1	01	01	H1035_043_0	8		Y	Preferred Generic	4	01	3	2	1	1	110		01	110		1	31		100				1	2	31		100				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	043	0	1	01	01	H1035_043_0	8		Y	Preferred Generic	4	01	3	2	1	3	110		01	110		1	31		100				1	2	31		100				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		3
H1035	043	0	1	01	01	H1035_043_0	8		Y	Generic	4	01	1	2	2	1	110		01	110		1	31		100				1	2	31		100				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	043	0	1	01	01	H1035_043_0	8		Y	Generic	4	01	1	2	2	3	110		01	110		1	31		100				1	2	31		100				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	043	0	1	01	01	H1035_043_0	8		Y	Preferred Brand	4	11	1	2	3	1	110		01	110		1	31		90				1	2	31		90				31		31	35.00		105.00																			35.00		105.00																35.00				35.00		1.13			1.13			1.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1035	043	0	1	01	01	H1035_043_0	8		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01	110		1	31		90				1	2	31		90				31		31	93.00		279.00																			93.00		279.00																93.00				93.00		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	8		Y	Specialty Tier	4	11	1	1	5	1	010		01	010		1	31								31						31		31				1102.31	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1035	045	0	1	01	01	H1035_045_0	7		Y	Preferred Generic	4	01	3	2	1	1	110		01	110		1	31		100				1	2	31		100				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	045	0	1	01	01	H1035_045_0	7		Y	Preferred Generic	4	01	3	2	1	3	110		01	110		1	31		100				1	2	31		100				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		3
H1035	045	0	1	01	01	H1035_045_0	7		Y	Generic	4	01	1	2	2	1	110		01	110		1	31		100				1	2	31		100				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	045	0	1	01	01	H1035_045_0	7		Y	Generic	4	01	1	2	2	3	110		01	110		1	31		100				1	2	31		100				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	045	0	1	01	01	H1035_045_0	7		Y	Preferred Brand	4	11	1	2	3	1	110		01	110		1	31		90				1	2	31		90				31		31	30.00		90.00																			30.00		90.00																30.00				30.00		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	7		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01	110		1	31		90				1	2	31		90				31		31	90.00		270.00																			90.00		270.00																90.00				90.00		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	7		Y	Specialty Tier	4	11	1	1	5	1	010		01	010		1	31								31						31		31				1097.91	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1035	046	0	1	01	01	H1035_046_0	7		Y	Preferred Generic	4	01	1	2	1	1	110		01	110		1	31		100				1	2	31		100				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	046	0	1	01	01	H1035_046_0	7		Y	Preferred Generic	4	01	1	2	1	3	110		01	110		1	31		100				1	2	31		100				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	046	0	1	01	01	H1035_046_0	7		Y	Generic	4	01	1	2	2	1	110		01	110		1	31		100				1	2	31		100				31		31	5.00		15.00																			5.00		15.00																5.00				5.00		0.16			0.16			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1035	046	0	1	01	01	H1035_046_0	7		Y	Preferred Brand	4	11	1	2	3	1	110		01	110		1	31		90				1	2	31		90				31		31	40.00		120.00																			40.00		120.00																40.00				40.00		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	7		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01	110		1	31		90				1	2	31		90				31		31	93.00		279.00																			93.00		279.00																93.00				93.00		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	7		Y	Specialty Tier	4	11	1	1	5	1	010		01	010		1	31								31						31		31				1206.45	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	7		Y	Select Care Drugs	4	01	1	2	6	1	110		01	110		1	31		100				1	2	31		100				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	046	0	1	01	01	H1035_046_0	7		Y	Select Care Drugs	4	01	1	2	6	3	110		01	110		1	31		100				1	2	31		100				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	047	0	1	01	01	H1035_047_0	6		Y	Preferred Generic	4	01	1	2	1	1	110		01	110		1	31		100				1	2	31		100				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	047	0	1	01	01	H1035_047_0	6		Y	Preferred Generic	4	01	1	2	1	3	110		01	110		1	31		100				1	2	31		100				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	047	0	1	01	01	H1035_047_0	6		Y	Generic	4	01	1	2	2	1	110		01	110		1	31		100				1	2	31		100				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	047	0	1	01	01	H1035_047_0	6		Y	Preferred Brand	4	11	1	2	3	1	110		01	110		1	31		90				1	2	31		90				31		31	40.00		120.00																			40.00		120.00																40.00				40.00		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	6		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01	110		1	31		90				1	2	31		90				31		31	93.00		279.00																			93.00		279.00																93.00				93.00		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	6		Y	Specialty Tier	4	11	1	1	5	1	010		01	010		1	31								31						31		31				1212.52	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	6		Y	Select Care Drugs	4	01	1	2	6	1	110		01	110		1	31		100				1	2	31		100				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	047	0	1	01	01	H1035_047_0	6		Y	Select Care Drugs	4	01	1	2	6	3	110		01	110		1	31		100				1	2	31		100				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	048	0	1	01	01	H1035_048_0	6		Y	Preferred Generic	4	01	3	2	1	1	110		01	110		1	31		100				1	2	31		100				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	048	0	1	01	01	H1035_048_0	6		Y	Preferred Generic	4	01	3	2	1	3	110		01	110		1	31		100				1	2	31		100				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		3
H1035	048	0	1	01	01	H1035_048_0	6		Y	Generic	4	01	1	2	2	1	110		01	110		1	31		100				1	2	31		100				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	048	0	1	01	01	H1035_048_0	6		Y	Generic	4	01	1	2	2	3	110		01	110		1	31		100				1	2	31		100				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	048	0	1	01	01	H1035_048_0	6		Y	Preferred Brand	4	11	1	2	3	1	110		01	110		1	31		90				1	2	31		90				31		31	35.00		105.00																			35.00		105.00																35.00				35.00		1.13			1.13			1.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1035	048	0	1	01	01	H1035_048_0	6		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01	110		1	31		90				1	2	31		90				31		31	93.00		279.00																			93.00		279.00																93.00				93.00		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		Y	Specialty Tier	4	11	1	1	5	1	010		01	010		1	31								31						31		31				1123.19	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1035	050	0	1	01	01	H1035_050_0	9		N	Preferred Generic	4	01	3	1	1	1	110		01	110		1	31		100				1	2	31		100				31		31				1.67	25		25																		25		25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1035	050	0	1	01	01	H1035_050_0	9		N	Generic	4	01	1	1	2	1	110		01	110		1	31		100				1	2	31		100				31		31				8.15	25		25																		25		25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1035	050	0	1	01	01	H1035_050_0	9		N	Preferred Brand	4	11	1	1	3	1	110		01	110		1	31		90				1	2	31		90				31		31				71.61	25		25																		25		25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1035	050	0	1	01	01	H1035_050_0	9		N	Non-Preferred Drug	4	11	1	1	4	1	110		01	110		1	31		90				1	2	31		90				31		31				99.12	25		25																		25		25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1035	050	0	1	01	01	H1035_050_0	9		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	31								31						31		31				756.37	25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	025	0	1	01	01	H1036_025_0	5		Y	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	025	0	1	01	01	H1036_025_0	5		Y	Preferred Generic	4	11	3	2	1	3	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H1036	025	0	1	01	01	H1036_025_0	5		Y	Generic	4	11	1	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	0.00		0.00																									20.00		60.00				0.00		0.00				0.00				0.00		0				0.67	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	025	0	1	01	01	H1036_025_0	5		Y	Generic	4	11	1	2	2	3	110		01		110	1	30		90				2	2				30		90	30		31	0.00		0.00																									20.00		60.00				0.00		0.00				0.00				0.00		0				0.67	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1036	025	0	1	01	01	H1036_025_0	5		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	5.00		15.00																									47.00		141.00				5.00		5.00				5.00				5.00		0.17				1.57	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	025	0	1	01	01	H1036_025_0	5		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	55.00		165.00																									100.00		300.00				55.00		155.00				55.00				55.00		1.83				3.33	1.83	1.77	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	025	0	1	01	01	H1036_025_0	5		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	044	0	1	01	01	H1036_044_0	5		Y	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	044	0	1	01	01	H1036_044_0	5		Y	Preferred Generic	4	11	3	2	1	3	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H1036	044	0	1	01	01	H1036_044_0	5		Y	Generic	4	11	1	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	0.00		0.00																									20.00		60.00				0.00		0.00				0.00				0.00		0				0.67	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	044	0	1	01	01	H1036_044_0	5		Y	Generic	4	11	1	2	2	3	110		01		110	1	30		90				2	2				30		90	30		31	0.00		0.00																									20.00		60.00				0.00		0.00				0.00				0.00		0				0.67	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1036	044	0	1	01	01	H1036_044_0	5		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	35.00		105.00																									47.00		141.00				35.00		95.00				35.00				35.00		1.17				1.57	1.17	1.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	044	0	1	01	01	H1036_044_0	5		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	75.00		225.00																									100.00		300.00				75.00		215.00				75.00				75.00		2.50				3.33	2.50	2.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	044	0	1	01	01	H1036_044_0	5		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	054	0	1	01	01	H1036_054_0	5		Y	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0				0	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	054	0	1	01	01	H1036_054_0	5		Y	Preferred Generic	4	11	3	2	1	3	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0				0	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H1036	054	0	1	01	01	H1036_054_0	5		Y	Generic	4	11	1	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	0.00		0.00																									5.00		15.00				0.00		0.00				0.00				0.00		0				0.17	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	054	0	1	01	01	H1036_054_0	5		Y	Generic	4	11	1	2	2	3	110		01		110	1	30		90				2	2				30		90	30		31	0.00		0.00																									5.00		15.00				0.00		0.00				0.00				0.00		0				0.17	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1036	054	0	1	01	01	H1036_054_0	5		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	0.00		0.00																									5.00		15.00				0.00		0.00				0.00				0.00		0				0.17	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	054	0	1	01	01	H1036_054_0	5		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	5.00		15.00																									50.00		150.00				5.00		5.00				5.00				5.00		0.17				1.67	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	054	0	1	01	01	H1036_054_0	5		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	062	0	1	01	01	H1036_062_0	3		Y	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0				0	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	062	0	1	01	01	H1036_062_0	3		Y	Preferred Generic	4	11	3	2	1	3	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0				0	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H1036	062	0	1	01	01	H1036_062_0	3		Y	Generic	4	11	1	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	062	0	1	01	01	H1036_062_0	3		Y	Generic	4	11	1	2	2	3	110		01		110	1	30		90				2	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1036	062	0	1	01	01	H1036_062_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	15.00		45.00																									47.00		141.00				15.00		35.00				15.00				15.00		0.50				1.57	0.50	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	062	0	1	01	01	H1036_062_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	75.00		225.00																									100.00		300.00				75.00		215.00				75.00				75.00		2.50				3.33	2.50	2.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	062	0	1	01	01	H1036_062_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	065	0	1	01	01	H1036_065_0	5		Y	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									5.00		15.00				0.00		0.00				0.00				0.00		0				0.17	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	065	0	1	01	01	H1036_065_0	5		Y	Preferred Generic	4	11	3	2	1	3	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									5.00		15.00				0.00		0.00				0.00				0.00		0				0.17	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H1036	065	0	1	01	01	H1036_065_0	5		Y	Generic	4	11	1	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	065	0	1	01	01	H1036_065_0	5		Y	Generic	4	11	1	2	2	3	110		01		110	1	30		90				2	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1036	065	0	1	01	01	H1036_065_0	5		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	5.00		15.00																									47.00		141.00				5.00		5.00				5.00				5.00		0.17				1.57	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	065	0	1	01	01	H1036_065_0	5		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	75.00		225.00																									100.00		300.00				75.00		215.00				75.00				75.00		2.50				3.33	2.50	2.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	065	0	1	01	01	H1036_065_0	5		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	068	0	1	01	01	H1036_068_0	5		Y	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	068	0	1	01	01	H1036_068_0	5		Y	Preferred Generic	4	11	3	2	1	3	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H1036	068	0	1	01	01	H1036_068_0	5		Y	Generic	4	11	1	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	0.00		0.00																									20.00		60.00				0.00		0.00				0.00				0.00		0				0.67	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	068	0	1	01	01	H1036_068_0	5		Y	Generic	4	11	1	2	2	3	110		01		110	1	30		90				2	2				30		90	30		31	0.00		0.00																									20.00		60.00				0.00		0.00				0.00				0.00		0				0.67	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1036	068	0	1	01	01	H1036_068_0	5		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	30.00		90.00																									47.00		141.00				30.00		80.00				30.00				30.00		1				1.57	1	0.97	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	068	0	1	01	01	H1036_068_0	5		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	75.00		225.00																									100.00		300.00				75.00		215.00				75.00				75.00		2.50				3.33	2.50	2.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	068	0	1	01	01	H1036_068_0	5		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	074	0	1	01	01	H1036_074_0	5		Y	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	074	0	1	01	01	H1036_074_0	5		Y	Preferred Generic	4	11	3	2	1	3	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H1036	074	0	1	01	01	H1036_074_0	5		Y	Generic	4	11	1	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	0.00		0.00																									20.00		60.00				0.00		0.00				0.00				0.00		0				0.67	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	074	0	1	01	01	H1036_074_0	5		Y	Generic	4	11	1	2	2	3	110		01		110	1	30		90				2	2				30		90	30		31	0.00		0.00																									20.00		60.00				0.00		0.00				0.00				0.00		0				0.67	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1036	074	0	1	01	01	H1036_074_0	5		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	10.00		30.00																									47.00		141.00				10.00		20.00				10.00				10.00		0.33				1.57	0.33	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	074	0	1	01	01	H1036_074_0	5		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	60.00		180.00																									100.00		300.00				60.00		170.00				60.00				60.00		2				3.33	2	1.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	074	0	1	01	01	H1036_074_0	5		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	077	0	1	01	01	H1036_077_0	4		N	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	4.00		12.00																									5.00		15.00				4.00		0.00				4.00				4.00		0.13				0.17	0.13	0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	077	0	1	01	01	H1036_077_0	4		N	Generic	4	11	1	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	16.00		48.00																									16.00		48.00				16.00		0.00				16.00				16.00		0.53				0.53	0.53	0.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	077	0	1	01	01	H1036_077_0	4		N	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	077	0	1	01	01	H1036_077_0	4		N	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		290.00				100.00				100.00		3.33				3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	077	0	1	01	01	H1036_077_0	4		N	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	102	0	1	01	01	H1036_102_0	6		N	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	4.00		12.00																									10.00		30.00				4.00		0.00				4.00				4.00		0.13				0.33	0.13	0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	102	0	1	01	01	H1036_102_0	6		N	Generic	4	11	1	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	6.00		18.00																									20.00		60.00				6.00		0.00				6.00				6.00		0.20				0.67	0.20	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	102	0	1	01	01	H1036_102_0	6		N	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		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	6		N	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		290.00				100.00				100.00		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	6		N	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	121	0	1	01	01	H1036_121_0	4		Y	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0				0	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	121	0	1	01	01	H1036_121_0	4		Y	Preferred Generic	4	11	3	2	1	3	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0				0	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H1036	121	0	1	01	01	H1036_121_0	4		Y	Generic	4	11	1	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	121	0	1	01	01	H1036_121_0	4		Y	Generic	4	11	1	2	2	3	110		01		110	1	30		90				2	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1036	121	0	1	01	01	H1036_121_0	4		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	40.00		120.00																									45.00		135.00				40.00		110.00				40.00				40.00		1.33				1.50	1.33	1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	121	0	1	01	01	H1036_121_0	4		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	85.00		255.00																									90.00		270.00				85.00		245.00				85.00				85.00		2.83				3	2.83	2.74	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	121	0	1	01	01	H1036_121_0	4		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	137	0	1	02	01	H1036_137_0	3		Y	Preferred Generic	4	11	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	137	0	1	02	01	H1036_137_0	3		Y	Generic	4	11	1	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	0.00		0.00																									20.00		60.00				0.00		0.00				0.00				0.00		0				0.67	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	137	0	1	02	01	H1036_137_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	45.00		135.00																									47.00		141.00				45.00		125.00				45.00				45.00		1.50				1.57	1.50	1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	137	0	1	02	01	H1036_137_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	95.00		285.00																									100.00		300.00				95.00		275.00				95.00				95.00		3.17				3.33	3.17	3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	137	0	1	02	01	H1036_137_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	140	0	1	01	01	H1036_140_0	5		Y	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	140	0	1	01	01	H1036_140_0	5		Y	Preferred Generic	4	11	3	2	1	3	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H1036	140	0	1	01	01	H1036_140_0	5		Y	Generic	4	11	1	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	0.00		0.00																									20.00		60.00				0.00		0.00				0.00				0.00		0				0.67	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	140	0	1	01	01	H1036_140_0	5		Y	Generic	4	11	1	2	2	3	110		01		110	1	30		90				2	2				30		90	30		31	0.00		0.00																									20.00		60.00				0.00		0.00				0.00				0.00		0				0.67	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1036	140	0	1	01	01	H1036_140_0	5		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	40.00		120.00																									47.00		141.00				40.00		110.00				40.00				40.00		1.33				1.57	1.33	1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	140	0	1	01	01	H1036_140_0	5		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	75.00		225.00																									100.00		300.00				75.00		215.00				75.00				75.00		2.50				3.33	2.50	2.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	140	0	1	01	01	H1036_140_0	5		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	143	0	1	01	01	H1036_143_0	5		Y	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	143	0	1	01	01	H1036_143_0	5		Y	Preferred Generic	4	11	3	2	1	3	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H1036	143	0	1	01	01	H1036_143_0	5		Y	Generic	4	11	1	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	5.00		15.00																									20.00		60.00				5.00		0.00				5.00				5.00		0.17				0.67	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	143	0	1	01	01	H1036_143_0	5		Y	Generic	4	11	1	2	2	3	110		01		110	1	30		90				2	2				30		90	30		31	5.00		15.00																									20.00		60.00				5.00		0.00				5.00				5.00		0.17				0.67	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1036	143	0	1	01	01	H1036_143_0	5		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	45.00		135.00																									47.00		141.00				45.00		125.00				45.00				45.00		1.50				1.57	1.50	1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	143	0	1	01	01	H1036_143_0	5		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	85.00		255.00																									100.00		300.00				85.00		245.00				85.00				85.00		2.83				3.33	2.83	2.74	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	143	0	1	01	01	H1036_143_0	5		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	146	0	1	01	01	H1036_146_0	5		Y	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	146	0	1	01	01	H1036_146_0	5		Y	Preferred Generic	4	11	3	2	1	3	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H1036	146	0	1	01	01	H1036_146_0	5		Y	Generic	4	11	1	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	0.00		0.00																									20.00		60.00				0.00		0.00				0.00				0.00		0				0.67	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	146	0	1	01	01	H1036_146_0	5		Y	Generic	4	11	1	2	2	3	110		01		110	1	30		90				2	2				30		90	30		31	0.00		0.00																									20.00		60.00				0.00		0.00				0.00				0.00		0				0.67	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1036	146	0	1	01	01	H1036_146_0	5		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	30.00		90.00																									47.00		141.00				30.00		80.00				30.00				30.00		1				1.57	1	0.97	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	146	0	1	01	01	H1036_146_0	5		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	85.00		255.00																									100.00		300.00				85.00		245.00				85.00				85.00		2.83				3.33	2.83	2.74	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	146	0	1	01	01	H1036_146_0	5		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	151	0	1	01	01	H1036_151_0	3		Y	Preferred Generic	4	11	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	151	0	1	01	01	H1036_151_0	3		Y	Generic	4	11	1	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	5.00		15.00																									20.00		60.00				5.00		0.00				5.00				5.00		0.17				0.67	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	151	0	1	01	01	H1036_151_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		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	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	99.00		297.00																									100.00		300.00				99.00		287.00				99.00				99.00		3.30				3.33	3.30	3.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	151	0	1	01	01	H1036_151_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	153	0	1	01	01	H1036_153_0	2		Y	Preferred Generic	4	11	1	2	1	1	110		01		110	1	30		100				1	2				30		100	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	153	0	1	01	01	H1036_153_0	2		Y	Preferred Generic	4	11	1	2	1	3	110		01		110	1	30		100				1	2				30		100	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1036	153	0	1	01	01	H1036_153_0	2		Y	Generic	4	11	1	2	2	1	110		01		110	1	30		100				2	2				30		100	30		31	0.00		0.00																									20.00		60.00				0.00		0.00				0.00				0.00		0				0.67	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	153	0	1	01	01	H1036_153_0	2		Y	Generic	4	11	1	2	2	3	110		01		110	1	30		100				2	2				30		100	30		31	0.00		0.00																									20.00		60.00				0.00		0.00				0.00				0.00		0				0.67	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1036	153	0	1	01	01	H1036_153_0	2		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		100				2	2				30		100	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												
H1036	153	0	1	01	01	H1036_153_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		100				2	2				30		100	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												
H1036	153	0	1	01	01	H1036_153_0	2		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	156	0	1	01	01	H1036_156_0	6		Y	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1036	156	0	1	01	01	H1036_156_0	6		Y	Preferred Generic	4	11	3	2	1	3	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	3	3
H1036	156	0	1	01	01	H1036_156_0	6		Y	Generic	4	11	3	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	0.00		0.00																									20.00		60.00				0.00		0.00				0.00				0.00		0				0.67	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1036	156	0	1	01	01	H1036_156_0	6		Y	Generic	4	11	3	2	2	3	110		01		110	1	30		90				2	2				30		90	30		31	0.00		0.00																									20.00		60.00				0.00		0.00				0.00				0.00		0				0.67	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	3	3
H1036	156	0	1	01	01	H1036_156_0	6		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	45.00		135.00																									47.00		141.00				45.00		125.00				45.00				45.00		1.50				1.57	1.50	1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1036	156	0	1	01	01	H1036_156_0	6		Y	Preferred Brand	4	11	1	2	3	3	110		01		110	1	30		90				2	2				30		90	30		31	45.00		135.00																									47.00		141.00				45.00		125.00				45.00				45.00		1.50				1.57	1.50	1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	3	
H1036	156	0	1	01	01	H1036_156_0	6		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	85.00		255.00																									100.00		300.00				85.00		245.00				85.00				85.00		2.83				3.33	2.83	2.74	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1036	156	0	1	01	01	H1036_156_0	6		Y	Non-Preferred Drug	4	11	1	2	4	3	110		01		110	1	30		90				2	2				30		90	30		31	85.00		255.00																									100.00		300.00				85.00		245.00				85.00				85.00		2.83				3.33	2.83	2.74	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	3	
H1036	156	0	1	01	01	H1036_156_0	6		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1036	156	0	1	01	01	H1036_156_0	6		Y	Specialty Tier	4	11	1	1	5	3	010		01		010	1	30											30			30		31					15																										15						15					15			15								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	3	
H1036	156	0	1	01	01	H1036_156_0	6		Y	Select Care Drugs	4	11	1	2	6	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0				0	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1036	156	0	1	01	01	H1036_156_0	6		Y	Select Care Drugs	4	11	1	2	6	3	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0				0	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H1036	157	0	1	01	01	H1036_157_0	3		Y	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	157	0	1	01	01	H1036_157_0	3		Y	Preferred Generic	4	11	3	2	1	3	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H1036	157	0	1	01	01	H1036_157_0	3		Y	Generic	4	11	1	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	0.00		0.00																									20.00		60.00				0.00		0.00				0.00				0.00		0				0.67	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	157	0	1	01	01	H1036_157_0	3		Y	Generic	4	11	1	2	2	3	110		01		110	1	30		90				2	2				30		90	30		31	0.00		0.00																									20.00		60.00				0.00		0.00				0.00				0.00		0				0.67	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1036	157	0	1	01	01	H1036_157_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	45.00		135.00																									47.00		141.00				45.00		125.00				45.00				45.00		1.50				1.57	1.50	1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	157	0	1	01	01	H1036_157_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	85.00		255.00																									100.00		300.00				85.00		245.00				85.00				85.00		2.83				3.33	2.83	2.74	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	157	0	1	01	01	H1036_157_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	160	0	1	01	01	H1036_160_0	3		Y	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1036	160	0	1	01	01	H1036_160_0	3		Y	Preferred Generic	4	11	3	2	1	3	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	3	3
H1036	160	0	1	01	01	H1036_160_0	3		Y	Generic	4	11	3	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	0.00		0.00																									20.00		60.00				0.00		0.00				0.00				0.00		0				0.67	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1036	160	0	1	01	01	H1036_160_0	3		Y	Generic	4	11	3	2	2	3	110		01		110	1	30		90				2	2				30		90	30		31	0.00		0.00																									20.00		60.00				0.00		0.00				0.00				0.00		0				0.67	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	3	3
H1036	160	0	1	01	01	H1036_160_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	5.00		15.00																									47.00		141.00				5.00		5.00				5.00				5.00		0.17				1.57	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1036	160	0	1	01	01	H1036_160_0	3		Y	Preferred Brand	4	11	1	2	3	3	110		01		110	1	30		90				2	2				30		90	30		31	5.00		15.00																									47.00		141.00				5.00		5.00				5.00				5.00		0.17				1.57	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	3	
H1036	160	0	1	01	01	H1036_160_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	35.00		105.00																									100.00		300.00				35.00		95.00				35.00				35.00		1.17				3.33	1.17	1.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1036	160	0	1	01	01	H1036_160_0	3		Y	Non-Preferred Drug	4	11	1	2	4	3	110		01		110	1	30		90				2	2				30		90	30		31	35.00		105.00																									100.00		300.00				35.00		95.00				35.00				35.00		1.17				3.33	1.17	1.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	3	
H1036	160	0	1	01	01	H1036_160_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1036	160	0	1	01	01	H1036_160_0	3		Y	Specialty Tier	4	11	1	1	5	3	010		01		010	1	30											30			30		31					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	3		Y	Select Care Drugs	4	11	1	2	6	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0				0	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1036	160	0	1	01	01	H1036_160_0	3		Y	Select Care Drugs	4	11	1	2	6	3	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0				0	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H1036	171	0	1	01	01	H1036_171_0	4		Y	Preferred Generic	4	11	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	171	0	1	01	01	H1036_171_0	4		Y	Generic	4	11	1	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	5.00		15.00																									20.00		60.00				5.00		0.00				5.00				5.00		0.17				0.67	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	171	0	1	01	01	H1036_171_0	4		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		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	4		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	99.00		297.00																									100.00		300.00				99.00		287.00				99.00				99.00		3.30				3.33	3.30	3.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	171	0	1	01	01	H1036_171_0	4		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	175	0	1	01	01	H1036_175_0	4		Y	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1036	175	0	1	01	01	H1036_175_0	4		Y	Preferred Generic	4	11	3	2	1	3	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	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	4		Y	Generic	4	11	3	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	0.00		0.00																									20.00		60.00				0.00		0.00				0.00				0.00		0				0.67	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1036	175	0	1	01	01	H1036_175_0	4		Y	Generic	4	11	3	2	2	3	110		01		110	1	30		90				2	2				30		90	30		31	0.00		0.00																									20.00		60.00				0.00		0.00				0.00				0.00		0				0.67	0	0	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	4		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	45.00		135.00																									47.00		141.00				45.00		125.00				45.00				45.00		1.50				1.57	1.50	1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1036	175	0	1	01	01	H1036_175_0	4		Y	Preferred Brand	4	11	1	2	3	3	110		01		110	1	30		90				2	2				30		90	30		31	45.00		135.00																									47.00		141.00				45.00		125.00				45.00				45.00		1.50				1.57	1.50	1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	3	
H1036	175	0	1	01	01	H1036_175_0	4		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	89.00		267.00																									100.00		300.00				89.00		257.00				89.00				89.00		2.97				3.33	2.97	2.87	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1036	175	0	1	01	01	H1036_175_0	4		Y	Non-Preferred Drug	4	11	1	2	4	3	110		01		110	1	30		90				2	2				30		90	30		31	89.00		267.00																									100.00		300.00				89.00		257.00				89.00				89.00		2.97				3.33	2.97	2.87	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	3	
H1036	175	0	1	01	01	H1036_175_0	4		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1036	175	0	1	01	01	H1036_175_0	4		Y	Specialty Tier	4	11	1	1	5	3	010		01		010	1	30											30			30		31					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	4		Y	Select Care Drugs	4	11	1	2	6	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0				0	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1036	175	0	1	01	01	H1036_175_0	4		Y	Select Care Drugs	4	11	1	2	6	3	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0				0	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H1036	209	0	1	01	01	H1036_209_0	3		N	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	6.00		18.00																									10.00		30.00				6.00		0.00				6.00				6.00		0.20				0.33	0.20	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	209	0	1	01	01	H1036_209_0	3		N	Generic	4	11	1	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	18.00		54.00																									20.00		60.00				18.00		0.00				18.00				18.00		0.60				0.67	0.60	0.58	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	209	0	1	01	01	H1036_209_0	3		N	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	209	0	1	01	01	H1036_209_0	3		N	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		290.00				100.00				100.00		3.33				3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	209	0	1	01	01	H1036_209_0	3		N	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	210	0	1	01	01	H1036_210_0	3		N	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	14.00		42.00																									14.00		42.00				14.00		0.00				14.00				14.00		0.47				0.47	0.47	0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	210	0	1	01	01	H1036_210_0	3		N	Generic	4	11	1	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	19.00		57.00																									20.00		60.00				19.00		0.00				19.00				19.00		0.63				0.67	0.63	0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	210	0	1	01	01	H1036_210_0	3		N	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	210	0	1	01	01	H1036_210_0	3		N	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		290.00				100.00				100.00		3.33				3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	210	0	1	01	01	H1036_210_0	3		N	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	213	0	1	01	01	H1036_213_0	3		N	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	12.00		36.00																									12.00		36.00				12.00		0.00				12.00				12.00		0.40				0.40	0.40	0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	213	0	1	01	01	H1036_213_0	3		N	Generic	4	11	1	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	18.00		54.00																									20.00		60.00				18.00		0.00				18.00				18.00		0.60				0.67	0.60	0.58	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	213	0	1	01	01	H1036_213_0	3		N	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		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	3		N	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		290.00				100.00				100.00		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	3		N	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	214	0	1	01	01	H1036_214_0	3		N	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	8.00		24.00																									10.00		30.00				8.00		0.00				8.00				8.00		0.27				0.33	0.27	0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	214	0	1	01	01	H1036_214_0	3		N	Generic	4	11	1	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	19.00		57.00																									20.00		60.00				19.00		0.00				19.00				19.00		0.63				0.67	0.63	0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	214	0	1	01	01	H1036_214_0	3		N	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	214	0	1	01	01	H1036_214_0	3		N	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		290.00				100.00				100.00		3.33				3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	214	0	1	01	01	H1036_214_0	3		N	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	217	0	1	01	01	H1036_217_0	3		Y	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	217	0	1	01	01	H1036_217_0	3		Y	Preferred Generic	4	11	3	2	1	3	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H1036	217	0	1	01	01	H1036_217_0	3		Y	Generic	4	11	1	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	0.00		0.00																									20.00		60.00				0.00		0.00				0.00				0.00		0				0.67	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	217	0	1	01	01	H1036_217_0	3		Y	Generic	4	11	1	2	2	3	110		01		110	1	30		90				2	2				30		90	30		31	0.00		0.00																									20.00		60.00				0.00		0.00				0.00				0.00		0				0.67	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1036	217	0	1	01	01	H1036_217_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	35.00		105.00																									47.00		141.00				35.00		95.00				35.00				35.00		1.17				1.57	1.17	1.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	217	0	1	01	01	H1036_217_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	95.00		285.00																									100.00		300.00				95.00		275.00				95.00				95.00		3.17				3.33	3.17	3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	217	0	1	01	01	H1036_217_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	219	0	1	01	01	H1036_219_0	2		Y	Preferred Generic	4	11	1	2	1	1	110		01		110	1	30		100				1	2				30		100	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	219	0	1	01	01	H1036_219_0	2		Y	Preferred Generic	4	11	1	2	1	3	110		01		110	1	30		100				1	2				30		100	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1036	219	0	1	01	01	H1036_219_0	2		Y	Generic	4	11	1	2	2	1	110		01		110	1	30		100				2	2				30		100	30		31	5.00		15.00																									20.00		60.00				5.00		0.00				5.00				5.00		0.17				0.67	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	219	0	1	01	01	H1036_219_0	2		Y	Generic	4	11	1	2	2	3	110		01		110	1	30		100				2	2				30		100	30		31	5.00		15.00																									20.00		60.00				5.00		0.00				5.00				5.00		0.17				0.67	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1036	219	0	1	01	01	H1036_219_0	2		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		100				2	2				30		100	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												
H1036	219	0	1	01	01	H1036_219_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		100				2	2				30		100	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												
H1036	219	0	1	01	01	H1036_219_0	2		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					31																										31						31					31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	223	0	1	01	01	H1036_223_0	4		Y	Preferred Generic	4	11	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	223	0	1	01	01	H1036_223_0	4		Y	Generic	4	11	1	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	5.00		15.00																									20.00		60.00				5.00		0.00				5.00				5.00		0.17				0.67	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	223	0	1	01	01	H1036_223_0	4		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		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	4		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	99.00		297.00																									100.00		300.00				99.00		287.00				99.00				99.00		3.30				3.33	3.30	3.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	223	0	1	01	01	H1036_223_0	4		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	226	0	1	01	01	H1036_226_0	4		N	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	6.00		18.00																									10.00		30.00				6.00		0.00				6.00				6.00		0.20				0.33	0.20	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	226	0	1	01	01	H1036_226_0	4		N	Generic	4	11	3	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	20.00		60.00																									20.00		60.00				20.00		0.00				20.00				20.00		0.67				0.67	0.67	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	226	0	1	01	01	H1036_226_0	4		N	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		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	4		N	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		290.00				100.00				100.00		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	4		N	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	229	0	1	01	01	H1036_229_0	3		Y	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	229	0	1	01	01	H1036_229_0	3		Y	Generic	4	11	3	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	5.00		15.00																									20.00		60.00				5.00		0.00				5.00				5.00		0.17				0.67	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	229	0	1	01	01	H1036_229_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	30.00		90.00																									47.00		141.00				30.00		80.00				30.00				30.00		1				1.57	1	0.97	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	229	0	1	01	01	H1036_229_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	95.00		285.00																									100.00		300.00				95.00		275.00				95.00				95.00		3.17				3.33	3.17	3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	229	0	1	01	01	H1036_229_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	230	0	1	01	01	H1036_230_0	3		Y	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	230	0	1	01	01	H1036_230_0	3		Y	Preferred Generic	4	11	3	2	1	3	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H1036	230	0	1	01	01	H1036_230_0	3		Y	Generic	4	11	1	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	0.00		0.00																									15.00		45.00				0.00		0.00				0.00				0.00		0				0.50	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	230	0	1	01	01	H1036_230_0	3		Y	Generic	4	11	1	2	2	3	110		01		110	1	30		90				2	2				30		90	30		31	0.00		0.00																									15.00		45.00				0.00		0.00				0.00				0.00		0				0.50	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1036	230	0	1	01	01	H1036_230_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	30.00		90.00																									47.00		141.00				30.00		80.00				30.00				30.00		1				1.57	1	0.97	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	230	0	1	01	01	H1036_230_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	95.00		285.00																									100.00		300.00				95.00		275.00				95.00				95.00		3.17				3.33	3.17	3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	230	0	1	01	01	H1036_230_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	231	0	1	01	01	H1036_231_0	3		N	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	6.00		18.00																									10.00		30.00				6.00		0.00				6.00				6.00		0.20				0.33	0.20	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	231	0	1	01	01	H1036_231_0	3		N	Generic	4	11	1	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	18.00		54.00																									20.00		60.00				18.00		0.00				18.00				18.00		0.60				0.67	0.60	0.58	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	231	0	1	01	01	H1036_231_0	3		N	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	231	0	1	01	01	H1036_231_0	3		N	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		290.00				100.00				100.00		3.33				3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	231	0	1	01	01	H1036_231_0	3		N	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	233	0	1	02	01	H1036_233_0	3		Y	Preferred Generic	4	11	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	233	0	1	02	01	H1036_233_0	3		Y	Generic	4	11	1	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	0.00		0.00																									20.00		60.00				0.00		0.00				0.00				0.00		0				0.67	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	233	0	1	02	01	H1036_233_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	233	0	1	02	01	H1036_233_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	97.00		291.00																									100.00		300.00				97.00		281.00				97.00				97.00		3.23				3.33	3.23	3.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	233	0	1	02	01	H1036_233_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	234	0	1	01	01	H1036_234_0	4		Y	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1036	234	0	1	01	01	H1036_234_0	4		Y	Preferred Generic	4	11	3	2	1	3	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		3
H1036	234	0	1	01	01	H1036_234_0	4		Y	Generic	4	11	3	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	0.00		0.00																									20.00		60.00				0.00		0.00				0.00				0.00		0				0.67	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1036	234	0	1	01	01	H1036_234_0	4		Y	Generic	4	11	3	2	2	3	110		01		110	1	30		90				2	2				30		90	30		31	0.00		0.00																									20.00		60.00				0.00		0.00				0.00				0.00		0				0.67	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		3
H1036	234	0	1	01	01	H1036_234_0	4		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	42.00		126.00																									47.00		141.00				42.00		116.00				42.00				42.00		1.40				1.57	1.40	1.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1036	234	0	1	01	01	H1036_234_0	4		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		290.00				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												
H1036	234	0	1	01	01	H1036_234_0	4		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1036	234	0	1	01	01	H1036_234_0	4		Y	Select Care Drugs	4	11	1	2	6	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0				0	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1036	236	0	1	01	01	H1036_236_0	4		Y	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	236	0	1	01	01	H1036_236_0	4		Y	Preferred Generic	4	11	3	2	1	3	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H1036	236	0	1	01	01	H1036_236_0	4		Y	Generic	4	11	3	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	0.00		0.00																									20.00		60.00				0.00		0.00				0.00				0.00		0				0.67	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	236	0	1	01	01	H1036_236_0	4		Y	Generic	4	11	3	2	2	3	110		01		110	1	30		90				2	2				30		90	30		31	0.00		0.00																									20.00		60.00				0.00		0.00				0.00				0.00		0				0.67	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H1036	236	0	1	01	01	H1036_236_0	4		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	42.00		126.00																									47.00		141.00				42.00		116.00				42.00				42.00		1.40				1.57	1.40	1.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	236	0	1	01	01	H1036_236_0	4		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		290.00				100.00				100.00		3.33				3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	236	0	1	01	01	H1036_236_0	4		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	261	0	1	01	01	H1036_261_0	4		N	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	9.00		27.00																									10.00		30.00				9.00		0.00				9.00				9.00		0.30				0.33	0.30	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	261	0	1	01	01	H1036_261_0	4		N	Generic	4	11	1	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	19.00		57.00																									20.00		60.00				19.00		0.00				19.00				19.00		0.63				0.67	0.63	0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	261	0	1	01	01	H1036_261_0	4		N	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		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	4		N	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		290.00				100.00				100.00		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	4		N	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	265	1	1	01	01	H1036_265_1	3		Y	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	265	1	1	01	01	H1036_265_1	3		Y	Preferred Generic	4	11	3	2	1	3	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H1036	265	1	1	01	01	H1036_265_1	3		Y	Generic	4	11	1	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	0.00		0.00																									20.00		60.00				0.00		0.00				0.00				0.00		0				0.67	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	265	1	1	01	01	H1036_265_1	3		Y	Generic	4	11	1	2	2	3	110		01		110	1	30		90				2	2				30		90	30		31	0.00		0.00																									20.00		60.00				0.00		0.00				0.00				0.00		0				0.67	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1036	265	1	1	01	01	H1036_265_1	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	45.00		135.00																									47.00		141.00				45.00		125.00				45.00				45.00		1.50				1.57	1.50	1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	265	1	1	01	01	H1036_265_1	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	95.00		285.00																									100.00		300.00				95.00		275.00				95.00				95.00		3.17				3.33	3.17	3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	265	1	1	01	01	H1036_265_1	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	265	2	1	01	01	H1036_265_2	3		Y	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	265	2	1	01	01	H1036_265_2	3		Y	Preferred Generic	4	11	3	2	1	3	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H1036	265	2	1	01	01	H1036_265_2	3		Y	Generic	4	11	1	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	0.00		0.00																									20.00		60.00				0.00		0.00				0.00				0.00		0				0.67	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	265	2	1	01	01	H1036_265_2	3		Y	Generic	4	11	1	2	2	3	110		01		110	1	30		90				2	2				30		90	30		31	0.00		0.00																									20.00		60.00				0.00		0.00				0.00				0.00		0				0.67	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1036	265	2	1	01	01	H1036_265_2	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	45.00		135.00																									47.00		141.00				45.00		125.00				45.00				45.00		1.50				1.57	1.50	1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	265	2	1	01	01	H1036_265_2	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	95.00		285.00																									100.00		300.00				95.00		275.00				95.00				95.00		3.17				3.33	3.17	3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	265	2	1	01	01	H1036_265_2	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	266	0	1	01	01	H1036_266_0	3		Y	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	266	0	1	01	01	H1036_266_0	3		Y	Preferred Generic	4	11	3	2	1	3	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H1036	266	0	1	01	01	H1036_266_0	3		Y	Generic	4	11	1	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	0.00		0.00																									20.00		60.00				0.00		0.00				0.00				0.00		0				0.67	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	266	0	1	01	01	H1036_266_0	3		Y	Generic	4	11	1	2	2	3	110		01		110	1	30		90				2	2				30		90	30		31	0.00		0.00																									20.00		60.00				0.00		0.00				0.00				0.00		0				0.67	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1036	266	0	1	01	01	H1036_266_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	45.00		135.00																									47.00		141.00				45.00		125.00				45.00				45.00		1.50				1.57	1.50	1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	266	0	1	01	01	H1036_266_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	95.00		285.00																									100.00		300.00				95.00		275.00				95.00				95.00		3.17				3.33	3.17	3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	266	0	1	01	01	H1036_266_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	268	0	1	01	01	H1036_268_0	3		Y	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	268	0	1	01	01	H1036_268_0	3		Y	Preferred Generic	4	11	3	2	1	3	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H1036	268	0	1	01	01	H1036_268_0	3		Y	Generic	4	11	1	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	0.00		0.00																									20.00		60.00				0.00		0.00				0.00				0.00		0				0.67	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	268	0	1	01	01	H1036_268_0	3		Y	Generic	4	11	1	2	2	3	110		01		110	1	30		90				2	2				30		90	30		31	0.00		0.00																									20.00		60.00				0.00		0.00				0.00				0.00		0				0.67	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1036	268	0	1	01	01	H1036_268_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	45.00		135.00																									47.00		141.00				45.00		125.00				45.00				45.00		1.50				1.57	1.50	1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	268	0	1	01	01	H1036_268_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	95.00		285.00																									100.00		300.00				95.00		275.00				95.00				95.00		3.17				3.33	3.17	3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	268	0	1	01	01	H1036_268_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	269	0	1	01	01	H1036_269_0	3		Y	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	269	0	1	01	01	H1036_269_0	3		Y	Preferred Generic	4	11	3	2	1	3	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H1036	269	0	1	01	01	H1036_269_0	3		Y	Generic	4	11	1	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	0.00		0.00																									20.00		60.00				0.00		0.00				0.00				0.00		0				0.67	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	269	0	1	01	01	H1036_269_0	3		Y	Generic	4	11	1	2	2	3	110		01		110	1	30		90				2	2				30		90	30		31	0.00		0.00																									20.00		60.00				0.00		0.00				0.00				0.00		0				0.67	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1036	269	0	1	01	01	H1036_269_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	35.00		105.00																									47.00		141.00				35.00		95.00				35.00				35.00		1.17				1.57	1.17	1.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	269	0	1	01	01	H1036_269_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	95.00		285.00																									100.00		300.00				95.00		275.00				95.00				95.00		3.17				3.33	3.17	3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	269	0	1	01	01	H1036_269_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	270	0	1	01	01	H1036_270_0	3		Y	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	270	0	1	01	01	H1036_270_0	3		Y	Preferred Generic	4	11	3	2	1	3	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H1036	270	0	1	01	01	H1036_270_0	3		Y	Generic	4	11	1	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	0.00		0.00																									20.00		60.00				0.00		0.00				0.00				0.00		0				0.67	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	270	0	1	01	01	H1036_270_0	3		Y	Generic	4	11	1	2	2	3	110		01		110	1	30		90				2	2				30		90	30		31	0.00		0.00																									20.00		60.00				0.00		0.00				0.00				0.00		0				0.67	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1036	270	0	1	01	01	H1036_270_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	45.00		135.00																									47.00		141.00				45.00		125.00				45.00				45.00		1.50				1.57	1.50	1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	270	0	1	01	01	H1036_270_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	95.00		285.00																									100.00		300.00				95.00		275.00				95.00				95.00		3.17				3.33	3.17	3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	270	0	1	01	01	H1036_270_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	271	0	1	01	01	H1036_271_0	3		Y	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	271	0	1	01	01	H1036_271_0	3		Y	Preferred Generic	4	11	3	2	1	3	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H1036	271	0	1	01	01	H1036_271_0	3		Y	Generic	4	11	1	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	0.00		0.00																									20.00		60.00				0.00		0.00				0.00				0.00		0				0.67	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	271	0	1	01	01	H1036_271_0	3		Y	Generic	4	11	1	2	2	3	110		01		110	1	30		90				2	2				30		90	30		31	0.00		0.00																									20.00		60.00				0.00		0.00				0.00				0.00		0				0.67	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1036	271	0	1	01	01	H1036_271_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	45.00		135.00																									47.00		141.00				45.00		125.00				45.00				45.00		1.50				1.57	1.50	1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	271	0	1	01	01	H1036_271_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		290.00				100.00				100.00		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	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	278	0	1	01	01	H1036_278_0	3		Y	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	278	0	1	01	01	H1036_278_0	3		Y	Preferred Generic	4	11	3	2	1	3	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H1036	278	0	1	01	01	H1036_278_0	3		Y	Generic	4	11	1	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	0.00		0.00																									20.00		60.00				0.00		0.00				0.00				0.00		0				0.67	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	278	0	1	01	01	H1036_278_0	3		Y	Generic	4	11	1	2	2	3	110		01		110	1	30		90				2	2				30		90	30		31	0.00		0.00																									20.00		60.00				0.00		0.00				0.00				0.00		0				0.67	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1036	278	0	1	01	01	H1036_278_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	45.00		135.00																									47.00		141.00				45.00		125.00				45.00				45.00		1.50				1.57	1.50	1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	278	0	1	01	01	H1036_278_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	95.00		285.00																									100.00		300.00				95.00		275.00				95.00				95.00		3.17				3.33	3.17	3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	278	0	1	01	01	H1036_278_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	280	0	1	01	01	H1036_280_0	4		N	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	1.00		3.00																									2.00		6.00				1.00		0.00				1.00				1.00		0.03				0.07	0.03	0.03	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	280	0	1	01	01	H1036_280_0	4		N	Generic	4	11	1	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	16.00		48.00																									16.00		48.00				16.00		0.00				16.00				16.00		0.53				0.53	0.53	0.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	280	0	1	01	01	H1036_280_0	4		N	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		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	4		N	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		290.00				100.00				100.00		3.33				3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	280	0	1	01	01	H1036_280_0	4		N	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	284	0	1	01	01	H1036_284_0	3		N	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	15.00		45.00																									16.00		48.00				15.00		0.00				15.00				15.00		0.50				0.53	0.50	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	284	0	1	01	01	H1036_284_0	3		N	Generic	4	11	1	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	20.00		60.00																									20.00		60.00				20.00		0.00				20.00				20.00		0.67				0.67	0.67	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	284	0	1	01	01	H1036_284_0	3		N	Preferred Brand	4	11	1	1	3	1	110		01		110	1	30		90				2	2				30		90	30		31				42.00	18		18																								18		18				18		18			18			18								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	284	0	1	01	01	H1036_284_0	3		N	Non-Preferred Drug	4	11	1	1	4	1	110		01		110	1	30		90				2	2				30		90	30		31				79.00	35		35																								35		35				35		35			35			35								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	284	0	1	01	01	H1036_284_0	3		N	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	285	0	1	01	01	H1036_285_0	3		N	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	7.00		21.00																									10.00		30.00				7.00		0.00				7.00				7.00		0.23				0.33	0.23	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	285	0	1	01	01	H1036_285_0	3		N	Generic	4	11	1	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	17.00		51.00																									20.00		60.00				17.00		0.00				17.00				17.00		0.57				0.67	0.57	0.55	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	285	0	1	01	01	H1036_285_0	3		N	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	285	0	1	01	01	H1036_285_0	3		N	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		290.00				100.00				100.00		3.33				3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	285	0	1	01	01	H1036_285_0	3		N	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	286	0	1	01	01	H1036_286_0	3		Y	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	286	0	1	01	01	H1036_286_0	3		Y	Generic	4	11	3	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	5.00		15.00																									20.00		60.00				5.00		0.00				5.00				5.00		0.17				0.67	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	286	0	1	01	01	H1036_286_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	45.00		135.00																									47.00		141.00				45.00		125.00				45.00				45.00		1.50				1.57	1.50	1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	286	0	1	01	01	H1036_286_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	95.00		285.00																									100.00		300.00				95.00		275.00				95.00				95.00		3.17				3.33	3.17	3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	286	0	1	01	01	H1036_286_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	291	0	1	02	01	H1036_291_0	3		Y	Preferred Generic	4	11	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	291	0	1	02	01	H1036_291_0	3		Y	Generic	4	11	1	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	0.00		0.00																									20.00		60.00				0.00		0.00				0.00				0.00		0				0.67	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	291	0	1	02	01	H1036_291_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	45.00		135.00																									47.00		141.00				45.00		125.00				45.00				45.00		1.50				1.57	1.50	1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	291	0	1	02	01	H1036_291_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	95.00		285.00																									100.00		300.00				95.00		275.00				95.00				95.00		3.17				3.33	3.17	3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	291	0	1	02	01	H1036_291_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	292	0	1	01	01	H1036_292_0	4		Y	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	292	0	1	01	01	H1036_292_0	4		Y	Generic	4	11	3	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	5.00		15.00																									20.00		60.00				5.00		0.00				5.00				5.00		0.17				0.67	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	292	0	1	01	01	H1036_292_0	4		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	35.00		105.00																									47.00		141.00				35.00		95.00				35.00				35.00		1.17				1.57	1.17	1.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	292	0	1	01	01	H1036_292_0	4		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		290.00				100.00				100.00		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		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	295	0	1	01	01	H1036_295_0	3		Y	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	295	0	1	01	01	H1036_295_0	3		Y	Preferred Generic	4	11	3	2	1	3	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H1036	295	0	1	01	01	H1036_295_0	3		Y	Generic	4	11	1	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	0.00		0.00																									20.00		60.00				0.00		0.00				0.00				0.00		0				0.67	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	295	0	1	01	01	H1036_295_0	3		Y	Generic	4	11	1	2	2	3	110		01		110	1	30		90				2	2				30		90	30		31	0.00		0.00																									20.00		60.00				0.00		0.00				0.00				0.00		0				0.67	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1036	295	0	1	01	01	H1036_295_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	30.00		90.00																									47.00		141.00				30.00		80.00				30.00				30.00		1				1.57	1	0.97	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	295	0	1	01	01	H1036_295_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	90.00		270.00																									100.00		300.00				90.00		260.00				90.00				90.00		3				3.33	3	2.90	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	295	0	1	01	01	H1036_295_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	296	0	1	01	01	H1036_296_0	4		Y	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1036	296	0	1	01	01	H1036_296_0	4		Y	Preferred Generic	4	11	3	2	1	3	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	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	4		Y	Generic	4	11	3	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	0.00		0.00																									20.00		60.00				0.00		0.00				0.00				0.00		0				0.67	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1036	296	0	1	01	01	H1036_296_0	4		Y	Generic	4	11	3	2	2	3	110		01		110	1	30		90				2	2				30		90	30		31	0.00		0.00																									20.00		60.00				0.00		0.00				0.00				0.00		0				0.67	0	0	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	4		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	35.00		105.00																									47.00		141.00				35.00		95.00				35.00				35.00		1.17				1.57	1.17	1.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1036	296	0	1	01	01	H1036_296_0	4		Y	Preferred Brand	4	11	1	2	3	3	110		01		110	1	30		90				2	2				30		90	30		31	35.00		105.00																									47.00		141.00				35.00		95.00				35.00				35.00		1.17				1.57	1.17	1.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	3	
H1036	296	0	1	01	01	H1036_296_0	4		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	95.00		285.00																									100.00		300.00				95.00		275.00				95.00				95.00		3.17				3.33	3.17	3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1036	296	0	1	01	01	H1036_296_0	4		Y	Non-Preferred Drug	4	11	1	2	4	3	110		01		110	1	30		90				2	2				30		90	30		31	95.00		285.00																									100.00		300.00				95.00		275.00				95.00				95.00		3.17				3.33	3.17	3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	3	
H1036	296	0	1	01	01	H1036_296_0	4		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1036	296	0	1	01	01	H1036_296_0	4		Y	Specialty Tier	4	11	1	1	5	3	010		01		010	1	30											30			30		31					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	4		Y	Select Care Drugs	4	11	1	2	6	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0				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	4		Y	Select Care Drugs	4	11	1	2	6	3	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0				0	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H1036	297	0	1	01	01	H1036_297_0	4		Y	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0				0	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	297	0	1	01	01	H1036_297_0	4		Y	Preferred Generic	4	11	3	2	1	3	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0				0	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H1036	297	0	1	01	01	H1036_297_0	4		Y	Generic	4	11	1	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	297	0	1	01	01	H1036_297_0	4		Y	Generic	4	11	1	2	2	3	110		01		110	1	30		90				2	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1036	297	0	1	01	01	H1036_297_0	4		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	40.00		120.00																									45.00		135.00				40.00		110.00				40.00				40.00		1.33				1.50	1.33	1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	297	0	1	01	01	H1036_297_0	4		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	85.00		255.00																									90.00		270.00				85.00		245.00				85.00				85.00		2.83				3	2.83	2.74	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	297	0	1	01	01	H1036_297_0	4		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	298	0	1	01	01	H1036_298_0	4		Y	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	298	0	1	01	01	H1036_298_0	4		Y	Generic	4	11	3	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	5.00		15.00																									20.00		60.00				5.00		0.00				5.00				5.00		0.17				0.67	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	298	0	1	01	01	H1036_298_0	4		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	35.00		105.00																									47.00		141.00				35.00		95.00				35.00				35.00		1.17				1.57	1.17	1.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	298	0	1	01	01	H1036_298_0	4		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		290.00				100.00				100.00		3.33				3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	298	0	1	01	01	H1036_298_0	4		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	299	0	1	01	01	H1036_299_0	4		Y	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1036	299	0	1	01	01	H1036_299_0	4		Y	Preferred Generic	4	11	3	2	1	3	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	3	3
H1036	299	0	1	01	01	H1036_299_0	4		Y	Generic	4	11	3	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	0.00		0.00																									20.00		60.00				0.00		0.00				0.00				0.00		0				0.67	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1036	299	0	1	01	01	H1036_299_0	4		Y	Generic	4	11	3	2	2	3	110		01		110	1	30		90				2	2				30		90	30		31	0.00		0.00																									20.00		60.00				0.00		0.00				0.00				0.00		0				0.67	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	3	3
H1036	299	0	1	01	01	H1036_299_0	4		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	45.00		135.00																									47.00		141.00				45.00		125.00				45.00				45.00		1.50				1.57	1.50	1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1036	299	0	1	01	01	H1036_299_0	4		Y	Preferred Brand	4	11	1	2	3	3	110		01		110	1	30		90				2	2				30		90	30		31	45.00		135.00																									47.00		141.00				45.00		125.00				45.00				45.00		1.50				1.57	1.50	1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	3	
H1036	299	0	1	01	01	H1036_299_0	4		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		290.00				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												
H1036	299	0	1	01	01	H1036_299_0	4		Y	Non-Preferred Drug	4	11	1	2	4	3	110		01		110	1	30		90				2	2				30		90	30		31	100.00		300.00																									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, Select Care Drugs										2	3	
H1036	299	0	1	01	01	H1036_299_0	4		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1036	299	0	1	01	01	H1036_299_0	4		Y	Specialty Tier	4	11	1	1	5	3	010		01		010	1	30											30			30		31					15																										15						15					15			15								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	3	
H1036	299	0	1	01	01	H1036_299_0	4		Y	Select Care Drugs	4	11	1	2	6	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0				0	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1036	299	0	1	01	01	H1036_299_0	4		Y	Select Care Drugs	4	11	1	2	6	3	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0				0	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H1036	300	0	1	01	01	H1036_300_0	4		Y	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1036	300	0	1	01	01	H1036_300_0	4		Y	Preferred Generic	4	11	3	2	1	3	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	3	3
H1036	300	0	1	01	01	H1036_300_0	4		Y	Generic	4	11	3	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	0.00		0.00																									20.00		60.00				0.00		0.00				0.00				0.00		0				0.67	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1036	300	0	1	01	01	H1036_300_0	4		Y	Generic	4	11	3	2	2	3	110		01		110	1	30		90				2	2				30		90	30		31	0.00		0.00																									20.00		60.00				0.00		0.00				0.00				0.00		0				0.67	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	3	3
H1036	300	0	1	01	01	H1036_300_0	4		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	45.00		135.00																									47.00		141.00				45.00		125.00				45.00				45.00		1.50				1.57	1.50	1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1036	300	0	1	01	01	H1036_300_0	4		Y	Preferred Brand	4	11	1	2	3	3	110		01		110	1	30		90				2	2				30		90	30		31	45.00		135.00																									47.00		141.00				45.00		125.00				45.00				45.00		1.50				1.57	1.50	1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	3	
H1036	300	0	1	01	01	H1036_300_0	4		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		290.00				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												
H1036	300	0	1	01	01	H1036_300_0	4		Y	Non-Preferred Drug	4	11	1	2	4	3	110		01		110	1	30		90				2	2				30		90	30		31	100.00		300.00																									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, Select Care Drugs										2	3	
H1036	300	0	1	01	01	H1036_300_0	4		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1036	300	0	1	01	01	H1036_300_0	4		Y	Specialty Tier	4	11	1	1	5	3	010		01		010	1	30											30			30		31					15																										15						15					15			15								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	3	
H1036	300	0	1	01	01	H1036_300_0	4		Y	Select Care Drugs	4	11	1	2	6	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0				0	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1036	300	0	1	01	01	H1036_300_0	4		Y	Select Care Drugs	4	11	1	2	6	3	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0				0	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H1036	301	0	1	01	01	H1036_301_0	4		Y	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1036	301	0	1	01	01	H1036_301_0	4		Y	Preferred Generic	4	11	3	2	1	3	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	3	3
H1036	301	0	1	01	01	H1036_301_0	4		Y	Generic	4	11	3	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	0.00		0.00																									20.00		60.00				0.00		0.00				0.00				0.00		0				0.67	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1036	301	0	1	01	01	H1036_301_0	4		Y	Generic	4	11	3	2	2	3	110		01		110	1	30		90				2	2				30		90	30		31	0.00		0.00																									20.00		60.00				0.00		0.00				0.00				0.00		0				0.67	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	3	3
H1036	301	0	1	01	01	H1036_301_0	4		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	45.00		135.00																									47.00		141.00				45.00		125.00				45.00				45.00		1.50				1.57	1.50	1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1036	301	0	1	01	01	H1036_301_0	4		Y	Preferred Brand	4	11	1	2	3	3	110		01		110	1	30		90				2	2				30		90	30		31	45.00		135.00																									47.00		141.00				45.00		125.00				45.00				45.00		1.50				1.57	1.50	1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	3	
H1036	301	0	1	01	01	H1036_301_0	4		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		290.00				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												
H1036	301	0	1	01	01	H1036_301_0	4		Y	Non-Preferred Drug	4	11	1	2	4	3	110		01		110	1	30		90				2	2				30		90	30		31	100.00		300.00																									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, Select Care Drugs										2	3	
H1036	301	0	1	01	01	H1036_301_0	4		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1036	301	0	1	01	01	H1036_301_0	4		Y	Specialty Tier	4	11	1	1	5	3	010		01		010	1	30											30			30		31					15																										15						15					15			15								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	3	
H1036	301	0	1	01	01	H1036_301_0	4		Y	Select Care Drugs	4	11	1	2	6	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0				0	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1036	301	0	1	01	01	H1036_301_0	4		Y	Select Care Drugs	4	11	1	2	6	3	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0				0	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H1036	302	0	1	01	01	H1036_302_0	4		Y	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1036	302	0	1	01	01	H1036_302_0	4		Y	Preferred Generic	4	11	3	2	1	3	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	3	3
H1036	302	0	1	01	01	H1036_302_0	4		Y	Generic	4	11	3	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	0.00		0.00																									20.00		60.00				0.00		0.00				0.00				0.00		0				0.67	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1036	302	0	1	01	01	H1036_302_0	4		Y	Generic	4	11	3	2	2	3	110		01		110	1	30		90				2	2				30		90	30		31	0.00		0.00																									20.00		60.00				0.00		0.00				0.00				0.00		0				0.67	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	3	3
H1036	302	0	1	01	01	H1036_302_0	4		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	45.00		135.00																									47.00		141.00				45.00		125.00				45.00				45.00		1.50				1.57	1.50	1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1036	302	0	1	01	01	H1036_302_0	4		Y	Preferred Brand	4	11	1	2	3	3	110		01		110	1	30		90				2	2				30		90	30		31	45.00		135.00																									47.00		141.00				45.00		125.00				45.00				45.00		1.50				1.57	1.50	1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	3	
H1036	302	0	1	01	01	H1036_302_0	4		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		290.00				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												
H1036	302	0	1	01	01	H1036_302_0	4		Y	Non-Preferred Drug	4	11	1	2	4	3	110		01		110	1	30		90				2	2				30		90	30		31	100.00		300.00																									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, Select Care Drugs										2	3	
H1036	302	0	1	01	01	H1036_302_0	4		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1036	302	0	1	01	01	H1036_302_0	4		Y	Specialty Tier	4	11	1	1	5	3	010		01		010	1	30											30			30		31					15																										15						15					15			15								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	3	
H1036	302	0	1	01	01	H1036_302_0	4		Y	Select Care Drugs	4	11	1	2	6	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0				0	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1036	302	0	1	01	01	H1036_302_0	4		Y	Select Care Drugs	4	11	1	2	6	3	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0				0	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H1036	303	0	1	01	01	H1036_303_0	4		Y	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1036	303	0	1	01	01	H1036_303_0	4		Y	Preferred Generic	4	11	3	2	1	3	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	3	3
H1036	303	0	1	01	01	H1036_303_0	4		Y	Generic	4	11	3	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	0.00		0.00																									20.00		60.00				0.00		0.00				0.00				0.00		0				0.67	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1036	303	0	1	01	01	H1036_303_0	4		Y	Generic	4	11	3	2	2	3	110		01		110	1	30		90				2	2				30		90	30		31	0.00		0.00																									20.00		60.00				0.00		0.00				0.00				0.00		0				0.67	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	3	3
H1036	303	0	1	01	01	H1036_303_0	4		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	45.00		135.00																									47.00		141.00				45.00		125.00				45.00				45.00		1.50				1.57	1.50	1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1036	303	0	1	01	01	H1036_303_0	4		Y	Preferred Brand	4	11	1	2	3	3	110		01		110	1	30		90				2	2				30		90	30		31	45.00		135.00																									47.00		141.00				45.00		125.00				45.00				45.00		1.50				1.57	1.50	1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	3	
H1036	303	0	1	01	01	H1036_303_0	4		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		290.00				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												
H1036	303	0	1	01	01	H1036_303_0	4		Y	Non-Preferred Drug	4	11	1	2	4	3	110		01		110	1	30		90				2	2				30		90	30		31	100.00		300.00																									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, Select Care Drugs										2	3	
H1036	303	0	1	01	01	H1036_303_0	4		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1036	303	0	1	01	01	H1036_303_0	4		Y	Specialty Tier	4	11	1	1	5	3	010		01		010	1	30											30			30		31					15																										15						15					15			15								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	3	
H1036	303	0	1	01	01	H1036_303_0	4		Y	Select Care Drugs	4	11	1	2	6	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0				0	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1036	303	0	1	01	01	H1036_303_0	4		Y	Select Care Drugs	4	11	1	2	6	3	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0				0	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H1036	305	0	1	01	01	H1036_305_0	3		Y	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									5.00		15.00				0.00		0.00				0.00				0.00		0				0.17	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	305	0	1	01	01	H1036_305_0	3		Y	Generic	4	11	1	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	0.00		0.00																									20.00		60.00				0.00		0.00				0.00				0.00		0				0.67	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	305	0	1	01	01	H1036_305_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	40.00		120.00																									47.00		141.00				40.00		110.00				40.00				40.00		1.33				1.57	1.33	1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	305	0	1	01	01	H1036_305_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	80.00		240.00																									100.00		300.00				80.00		230.00				80.00				80.00		2.67				3.33	2.67	2.58	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	305	0	1	01	01	H1036_305_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	306	0	1	01	01	H1036_306_0	4		Y	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		100				1	2				30		100	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	306	0	1	01	01	H1036_306_0	4		Y	Preferred Generic	4	11	3	2	1	3	110		01		110	1	30		100				1	2				30		100	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H1036	306	0	1	01	01	H1036_306_0	4		Y	Generic	4	11	1	2	2	1	110		01		110	1	30		100				2	2				30		100	30		31	0.00		0.00																									20.00		60.00				0.00		0.00				0.00				0.00		0				0.67	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	306	0	1	01	01	H1036_306_0	4		Y	Generic	4	11	1	2	2	3	110		01		110	1	30		100				2	2				30		100	30		31	0.00		0.00																									20.00		60.00				0.00		0.00				0.00				0.00		0				0.67	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1036	306	0	1	01	01	H1036_306_0	4		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		100				2	2				30		100	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												
H1036	306	0	1	01	01	H1036_306_0	4		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		100				2	2				30		100	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												
H1036	306	0	1	01	01	H1036_306_0	4		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					29																										29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1045	001	0	1	01	01	H1045_001_0	2		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1045	001	0	1	01	01	H1045_001_0	2		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1045	001	0	1	01	01	H1045_001_0	2		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1045	001	0	1	01	01	H1045_001_0	2		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H1045	001	0	1	01	01	H1045_001_0	2		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1045	001	0	1	01	01	H1045_001_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	40.00		120.00																											120.00						110.00				40.00				40.00		1.33						1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1045	001	0	1	01	01	H1045_001_0	2		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				596.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1045	005	0	1	01	01	H1045_005_0	2		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1045	005	0	1	01	01	H1045_005_0	2		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1045	005	0	1	01	01	H1045_005_0	2		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1045	005	0	1	01	01	H1045_005_0	2		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H1045	005	0	1	01	01	H1045_005_0	2		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	25.00		75.00																											75.00						65.00				25.00				25.00		0.83						0.80	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1045	005	0	1	01	01	H1045_005_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1045	005	0	1	01	01	H1045_005_0	2		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				568.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1045	018	0	1	01	01	H1045_018_0	2		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1045	018	0	1	01	01	H1045_018_0	2		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1045	018	0	1	01	01	H1045_018_0	2		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1045	018	0	1	01	01	H1045_018_0	2		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H1045	018	0	1	01	01	H1045_018_0	2		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	3.00		9.00																											9.00						9.00				3.00				3.00		0.10						0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1045	018	0	1	01	01	H1045_018_0	2		Y	Preferred Brand	4	11	1	2	3	3	110		01		100	1	30		100				2	2						100	30		31	3.00		9.00																											9.00						9.00				3.00				3.00		0.10						0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1045	018	0	1	01	01	H1045_018_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1045	018	0	1	01	01	H1045_018_0	2		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				430.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1045	025	0	1	02	01	H1045_025_0	2		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1045	025	0	1	02	01	H1045_025_0	2		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1045	025	0	1	02	01	H1045_025_0	2		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1045	025	0	1	02	01	H1045_025_0	2		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H1045	025	0	1	02	01	H1045_025_0	2		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1045	025	0	1	02	01	H1045_025_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1045	025	0	1	02	01	H1045_025_0	2		Y	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												
H1045	026	0	1	02	01	H1045_026_0	2		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1045	026	0	1	02	01	H1045_026_0	2		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1045	026	0	1	02	01	H1045_026_0	2		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	6.00		18.00																											18.00						0.00				6.00				6.00		0.20						0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1045	026	0	1	02	01	H1045_026_0	2		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	6.00		18.00																											18.00						0.00				6.00				6.00		0.20						0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H1045	026	0	1	02	01	H1045_026_0	2		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1045	026	0	1	02	01	H1045_026_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1045	026	0	1	02	01	H1045_026_0	2		Y	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												
H1045	028	0	1	02	01	H1045_028_0	2		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1045	028	0	1	02	01	H1045_028_0	2		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1045	028	0	1	02	01	H1045_028_0	2		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1045	028	0	1	02	01	H1045_028_0	2		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H1045	028	0	1	02	01	H1045_028_0	2		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1045	028	0	1	02	01	H1045_028_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1045	028	0	1	02	01	H1045_028_0	2		Y	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												
H1045	030	0	1	02	01	H1045_030_0	2		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1045	030	0	1	02	01	H1045_030_0	2		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1045	030	0	1	02	01	H1045_030_0	2		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	5.00		15.00																											15.00						0.00				5.00				5.00		0.16						0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1045	030	0	1	02	01	H1045_030_0	2		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	5.00		15.00																											15.00						0.00				5.00				5.00		0.16						0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H1045	030	0	1	02	01	H1045_030_0	2		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1045	030	0	1	02	01	H1045_030_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1045	030	0	1	02	01	H1045_030_0	2		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				440.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1045	031	0	1	02	01	H1045_031_0	2		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1045	031	0	1	02	01	H1045_031_0	2		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1045	031	0	1	02	01	H1045_031_0	2		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1045	031	0	1	02	01	H1045_031_0	2		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H1045	031	0	1	02	01	H1045_031_0	2		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1045	031	0	1	02	01	H1045_031_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1045	031	0	1	02	01	H1045_031_0	2		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				451.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1045	033	0	1	02	01	H1045_033_0	2		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1045	033	0	1	02	01	H1045_033_0	2		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1045	033	0	1	02	01	H1045_033_0	2		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1045	033	0	1	02	01	H1045_033_0	2		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H1045	033	0	1	02	01	H1045_033_0	2		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1045	033	0	1	02	01	H1045_033_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1045	033	0	1	02	01	H1045_033_0	2		Y	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												
H1045	034	0	1	02	01	H1045_034_0	2		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1045	034	0	1	02	01	H1045_034_0	2		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1045	034	0	1	02	01	H1045_034_0	2		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	5.00		15.00																											15.00						0.00				5.00				5.00		0.16						0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1045	034	0	1	02	01	H1045_034_0	2		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	5.00		15.00																											15.00						0.00				5.00				5.00		0.16						0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H1045	034	0	1	02	01	H1045_034_0	2		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1045	034	0	1	02	01	H1045_034_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1045	034	0	1	02	01	H1045_034_0	2		Y	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												
H1045	036	0	1	02	01	H1045_036_0	2		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1045	036	0	1	02	01	H1045_036_0	2		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1045	036	0	1	02	01	H1045_036_0	2		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	6.00		18.00																											18.00						0.00				6.00				6.00		0.20						0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1045	036	0	1	02	01	H1045_036_0	2		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	6.00		18.00																											18.00						0.00				6.00				6.00		0.20						0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H1045	036	0	1	02	01	H1045_036_0	2		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1045	036	0	1	02	01	H1045_036_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1045	036	0	1	02	01	H1045_036_0	2		Y	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												
H1045	037	0	1	01	01	H1045_037_0	2		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1045	037	0	1	01	01	H1045_037_0	2		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1045	037	0	1	01	01	H1045_037_0	2		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1045	037	0	1	01	01	H1045_037_0	2		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H1045	037	0	1	01	01	H1045_037_0	2		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	15.00		45.00																											45.00						35.00				15.00				15.00		0.50						0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1045	037	0	1	01	01	H1045_037_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1045	037	0	1	01	01	H1045_037_0	2		Y	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												
H1045	041	0	1	02	01	H1045_041_0	2		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1045	041	0	1	02	01	H1045_041_0	2		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1045	041	0	1	02	01	H1045_041_0	2		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	5.00		15.00																											15.00						0.00				5.00				5.00		0.16						0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1045	041	0	1	02	01	H1045_041_0	2		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	5.00		15.00																											15.00						0.00				5.00				5.00		0.16						0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H1045	041	0	1	02	01	H1045_041_0	2		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1045	041	0	1	02	01	H1045_041_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1045	041	0	1	02	01	H1045_041_0	2		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				444.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1045	042	0	1	02	01	H1045_042_0	2		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1045	042	0	1	02	01	H1045_042_0	2		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1045	042	0	1	02	01	H1045_042_0	2		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1045	042	0	1	02	01	H1045_042_0	2		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H1045	042	0	1	02	01	H1045_042_0	2		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1045	042	0	1	02	01	H1045_042_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1045	042	0	1	02	01	H1045_042_0	2		Y	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												
H1045	043	0	1	02	01	H1045_043_0	2		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1045	043	0	1	02	01	H1045_043_0	2		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1045	043	0	1	02	01	H1045_043_0	2		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1045	043	0	1	02	01	H1045_043_0	2		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H1045	043	0	1	02	01	H1045_043_0	2		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1045	043	0	1	02	01	H1045_043_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1045	043	0	1	02	01	H1045_043_0	2		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				435.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1045	045	0	1	02	01	H1045_045_0	2		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1045	045	0	1	02	01	H1045_045_0	2		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1045	045	0	1	02	01	H1045_045_0	2		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	5.00		15.00																											15.00						0.00				5.00				5.00		0.16						0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1045	045	0	1	02	01	H1045_045_0	2		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	5.00		15.00																											15.00						0.00				5.00				5.00		0.16						0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H1045	045	0	1	02	01	H1045_045_0	2		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1045	045	0	1	02	01	H1045_045_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1045	045	0	1	02	01	H1045_045_0	2		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				529.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1045	048	1	1	02	01	H1045_048_1	2		Y	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		100	2	2						100	30		31								10.00		30.00					0.00		0.00													30.00						0.00				10.00				10.00			0.33	0.00				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1045	048	1	1	02	01	H1045_048_1	2		Y	Preferred Generic	4	01	1	2	1	3		110	01		100	1				30		100	2	2						100	30		31								10.00		30.00					0.00		0.00													30.00						0.00				10.00				10.00			0.33	0.00				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1045	048	1	1	02	01	H1045_048_1	2		Y	Generic	4	01	3	2	2	1		110	01		100	1				30		100	2	2						100	30		31								20.00		60.00					0.00		0.00													60.00						0.00				20.00				20.00			0.66	0.00				0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1045	048	1	1	02	01	H1045_048_1	2		Y	Generic	4	01	3	2	2	3		110	01		100	1				30		100	2	2						100	30		31								20.00		60.00					0.00		0.00													60.00						0.00				20.00				20.00			0.66	0.00				0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H1045	048	1	1	02	01	H1045_048_1	2		Y	Preferred Brand	4	11	1	2	3	1		110	01		100	1				30		100	2	2						100	30		31								47.00		141.00					47.00		131.00													141.00						131.00				47.00				47.00			1.56	1.56				1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1045	048	1	1	02	01	H1045_048_1	2		Y	Non-Preferred Drug	4	11	1	2	4	1		110	01		100	1				30		100	2	2						100	30		31								100.00		300.00					100.00		290.00													300.00						290.00				100.00				100.00			3.33	3.33				3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1045	048	1	1	02	01	H1045_048_1	2		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											463.00	33						423.00	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1045	048	2	1	02	01	H1045_048_2	2		Y	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		100	2	2						100	30		31								10.00		30.00					0.00		0.00													30.00						0.00				10.00				10.00			0.33	0.00				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1045	048	2	1	02	01	H1045_048_2	2		Y	Preferred Generic	4	01	1	2	1	3		110	01		100	1				30		100	2	2						100	30		31								10.00		30.00					0.00		0.00													30.00						0.00				10.00				10.00			0.33	0.00				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1045	048	2	1	02	01	H1045_048_2	2		Y	Generic	4	01	3	2	2	1		110	01		100	1				30		100	2	2						100	30		31								20.00		60.00					0.00		0.00													60.00						0.00				20.00				20.00			0.66	0.00				0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1045	048	2	1	02	01	H1045_048_2	2		Y	Generic	4	01	3	2	2	3		110	01		100	1				30		100	2	2						100	30		31								20.00		60.00					0.00		0.00													60.00						0.00				20.00				20.00			0.66	0.00				0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H1045	048	2	1	02	01	H1045_048_2	2		Y	Preferred Brand	4	11	1	2	3	1		110	01		100	1				30		100	2	2						100	30		31								47.00		141.00					47.00		131.00													141.00						131.00				47.00				47.00			1.56	1.56				1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1045	048	2	1	02	01	H1045_048_2	2		Y	Non-Preferred Drug	4	11	1	2	4	1		110	01		100	1				30		100	2	2						100	30		31								100.00		300.00					100.00		290.00													300.00						290.00				100.00				100.00			3.33	3.33				3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1045	048	2	1	02	01	H1045_048_2	2		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											463.00	33						423.00	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1045	048	3	1	02	01	H1045_048_3	2		Y	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		100	2	2						100	30		31								10.00		30.00					0.00		0.00													30.00						0.00				10.00				10.00			0.33	0.00				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1045	048	3	1	02	01	H1045_048_3	2		Y	Preferred Generic	4	01	1	2	1	3		110	01		100	1				30		100	2	2						100	30		31								10.00		30.00					0.00		0.00													30.00						0.00				10.00				10.00			0.33	0.00				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1045	048	3	1	02	01	H1045_048_3	2		Y	Generic	4	01	3	2	2	1		110	01		100	1				30		100	2	2						100	30		31								20.00		60.00					0.00		0.00													60.00						0.00				20.00				20.00			0.66	0.00				0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1045	048	3	1	02	01	H1045_048_3	2		Y	Generic	4	01	3	2	2	3		110	01		100	1				30		100	2	2						100	30		31								20.00		60.00					0.00		0.00													60.00						0.00				20.00				20.00			0.66	0.00				0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H1045	048	3	1	02	01	H1045_048_3	2		Y	Preferred Brand	4	11	1	2	3	1		110	01		100	1				30		100	2	2						100	30		31								47.00		141.00					47.00		131.00													141.00						131.00				47.00				47.00			1.56	1.56				1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1045	048	3	1	02	01	H1045_048_3	2		Y	Non-Preferred Drug	4	11	1	2	4	1		110	01		100	1				30		100	2	2						100	30		31								100.00		300.00					100.00		290.00													300.00						290.00				100.00				100.00			3.33	3.33				3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1045	048	3	1	02	01	H1045_048_3	2		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											463.00	33						423.00	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1045	048	4	1	02	01	H1045_048_4	2		Y	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		100	2	2						100	30		31								10.00		30.00					0.00		0.00													30.00						0.00				10.00				10.00			0.33	0.00				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1045	048	4	1	02	01	H1045_048_4	2		Y	Preferred Generic	4	01	1	2	1	3		110	01		100	1				30		100	2	2						100	30		31								10.00		30.00					0.00		0.00													30.00						0.00				10.00				10.00			0.33	0.00				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1045	048	4	1	02	01	H1045_048_4	2		Y	Generic	4	01	3	2	2	1		110	01		100	1				30		100	2	2						100	30		31								20.00		60.00					0.00		0.00													60.00						0.00				20.00				20.00			0.66	0.00				0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1045	048	4	1	02	01	H1045_048_4	2		Y	Generic	4	01	3	2	2	3		110	01		100	1				30		100	2	2						100	30		31								20.00		60.00					0.00		0.00													60.00						0.00				20.00				20.00			0.66	0.00				0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H1045	048	4	1	02	01	H1045_048_4	2		Y	Preferred Brand	4	11	1	2	3	1		110	01		100	1				30		100	2	2						100	30		31								47.00		141.00					47.00		131.00													141.00						131.00				47.00				47.00			1.56	1.56				1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1045	048	4	1	02	01	H1045_048_4	2		Y	Non-Preferred Drug	4	11	1	2	4	1		110	01		100	1				30		100	2	2						100	30		31								100.00		300.00					100.00		290.00													300.00						290.00				100.00				100.00			3.33	3.33				3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1045	048	4	1	02	01	H1045_048_4	2		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											463.00	33						423.00	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1045	055	0	1	02	01	H1045_055_0	2		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1045	055	0	1	02	01	H1045_055_0	2		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1045	055	0	1	02	01	H1045_055_0	2		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1045	055	0	1	02	01	H1045_055_0	2		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H1045	055	0	1	02	01	H1045_055_0	2		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1045	055	0	1	02	01	H1045_055_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1045	055	0	1	02	01	H1045_055_0	2		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				735.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1045	056	0	1	02	01	H1045_056_0	2		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1045	056	0	1	02	01	H1045_056_0	2		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1045	056	0	1	02	01	H1045_056_0	2		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1045	056	0	1	02	01	H1045_056_0	2		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H1045	056	0	1	02	01	H1045_056_0	2		Y	Preferred Brand	4	11	1	2	3	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	056	0	1	02	01	H1045_056_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	90.00		270.00																											270.00						260.00				90.00				90.00		3.00						2.90	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1045	056	0	1	02	01	H1045_056_0	2		Y	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												
H1099	001	0	1	02	01	H1099_001_0	6		Y	Preferred Generic	4	11	1	2	1	1		110	01	100		1				30		90	1	2			90				30		31								0.00		0.00					0.00		0.00							0.00																0.00				0.00			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	6		Y	Preferred Generic	4	11	1	2	1	3		110	01	100		1				30		90	1	2			90				30		31								0.00		0.00					0.00		0.00							0.00																0.00				0.00			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	6		Y	Generic	4	11	1	2	2	1		110	01	100		1				30		90	1	2			90				30		31								15.00		45.00					10.00		30.00							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	6		Y	Generic	4	11	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	6		Y	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	6		Y	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	6		Y	Specialty Tier	4	11	1	1	5	1		010	01			1				30											30		31											2420.39	33						992.60	33																							33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1099	006	0	1	01	01	H1099_006_0	5		Y	Preferred Generic	4	11	1	2	1	1		110	01	100		1				30		90	1	2			90				30		31								0.00		0.00					0.00		0.00							0.00																0.00				0.00			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	5		Y	Preferred Generic	4	11	1	2	1	3		110	01	100		1				30		90	1	2			90				30		31								0.00		0.00					0.00		0.00							0.00																0.00				0.00			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	5		Y	Generic	4	11	1	2	2	1		110	01	100		1				30		90	1	2			90				30		31								15.00		45.00					10.00		30.00							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	5		Y	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	5		Y	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	5		Y	Specialty Tier	4	11	1	1	5	1		010	01			1				30											30		31											2278.59	33						892.40	33																							33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1099	014	0	1	01	01	H1099_014_0	5		Y	Preferred Generic	4	11	1	2	1	1		110	01	100		1				30		90	1	2			90				30		31								0.00		0.00					0.00		0.00							0.00																0.00				0.00			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	5		Y	Preferred Generic	4	11	1	2	1	3		110	01	100		1				30		90	1	2			90				30		31								0.00		0.00					0.00		0.00							0.00																0.00				0.00			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	5		Y	Generic	4	11	1	2	2	1		110	01	100		1				30		90	1	2			90				30		31								15.00		45.00					10.00		30.00							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	5		Y	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	5		Y	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	5		Y	Specialty Tier	4	11	1	1	5	1		010	01			1				30											30		31											1817.08	33						878.98	33																							33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1099	016	0	1	01	01	H1099_016_0	5		Y	Preferred Generic	4	11	1	2	1	1		110	01	100		1				30		90	1	2			90				30		31								0.00		0.00					0.00		0.00							0.00																0.00				0.00			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	5		Y	Preferred Generic	4	11	1	2	1	3		110	01	100		1				30		90	1	2			90				30		31								0.00		0.00					0.00		0.00							0.00																0.00				0.00			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	5		Y	Generic	4	11	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	5		Y	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	5		Y	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	5		Y	Specialty Tier	4	11	1	1	5	1		010	01			1				30											30		31											2598.98	33						792.12	33																							33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1109	005	0	1	01	01	H1109_005_0	3		Y	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												
H1109	005	0	1	01	01	H1109_005_0	3		Y	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		
H1109	005	0	1	01	01	H1109_005_0	3		Y	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												
H1109	005	0	1	01	01	H1109_005_0	3		Y	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		
H1109	005	0	1	01	01	H1109_005_0	3		Y	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					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	3		Y	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					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	3		Y	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1009.17	33						667.46	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1109	006	0	1	01	01	H1109_006_0	2		Y	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												
H1109	006	0	1	01	01	H1109_006_0	2		Y	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		
H1109	006	0	1	01	01	H1109_006_0	2		Y	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												
H1109	006	0	1	01	01	H1109_006_0	2		Y	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		
H1109	006	0	1	01	01	H1109_006_0	2		Y	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					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	2		Y	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					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	2		Y	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											981.66	33						711.71	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1111	011	0	1	02	01	H1111_011_0	2		Y	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		100	2	2						100	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	02	01	H1111_011_0	2		Y	Preferred Generic	4	01	1	2	1	3		110	01		100	1				30		100	2	2						100	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	02	01	H1111_011_0	2		Y	Generic	4	01	3	2	2	1		110	01		100	1				30		100	2	2						100	30		31								15.00		45.00					0.00		0.00													45.00						0.00				15.00				15.00			0.50	0.00				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1111	011	0	1	02	01	H1111_011_0	2		Y	Generic	4	01	3	2	2	3		110	01		100	1				30		100	2	2						100	30		31								15.00		45.00					0.00		0.00													45.00						0.00				15.00				15.00			0.50	0.00				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H1111	011	0	1	02	01	H1111_011_0	2		Y	Preferred Brand	4	11	1	2	3	1		110	01		100	1				30		100	2	2						100	30		31								47.00		141.00					47.00		131.00													141.00						131.00				47.00				47.00			1.56	1.56				1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1111	011	0	1	02	01	H1111_011_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1		110	01		100	1				30		100	2	2						100	30		31								95.00		285.00					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	02	01	H1111_011_0	2		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											651.00	33						439.00	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
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								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00				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	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								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												
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											89.28	50	50	50				85.71	48	48	48										50	50	50				48	48	48			50			50								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								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00				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	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								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												
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											77.56	50	50	50				74.46	48	48	48										50	50	50				48	48	48			50			50								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								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00				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			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
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								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00				15.00				15.00			0.5	0.00		0.5	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
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								44.00	88.00	132.00					25.00	50.00	75.00											44.00	88.00	132.00				25.00	50.00	50.00				44.00				44.00			1.47	0.83		1.47	0.83	1.42	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								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00				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	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								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												
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											82.91	50	50	50				79.60	48	48	48										50	50	50				48	48	48			50			50								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												25							25												25						25					25			25								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	3	11	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								19.00	38.00	57.00					0.00	0.00	0.00											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												
H1112	043	0	1	01	01	H1112_043_0	4			Generic	3	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					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												
H1112	043	0	1	01	01	H1112_043_0	4			Preferred Brand	3	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	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, Select Care Drugs												
H1112	043	0	1	01	01	H1112_043_0	4			Non-Preferred Drug	3	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											99.71	43	43	43				99.71	43	43	43										43	43	43				43	43	43			43			43								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	3	11	1	1	5	1		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												
H1112	043	0	1	01	01	H1112_043_0	4			Select Care Drugs	3	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred 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								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00				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			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					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00				15.00				15.00			0.5	0.00		0.5	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, 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	10			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	10			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	10			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	10			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	10			Preferred Brand	4	10	1	2	3	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	94.00																47.00				47.00		1.56			1.56			1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H1170	002	0	1	01	01	H1170_002_0	10			Non-Preferred Brand	4	11	1	2	4	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31	95.00	190.00	285.00																			95.00	190.00	190.00																95.00				95.00		3.16			3.16			3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H1170	002	0	1	01	01	H1170_002_0	10			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	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												
H1170	002	0	1	01	01	H1170_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		
H1170	008	0	1	01	01	H1170_008_0	10		N	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	10		N	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	10		N	Preferred Brand	4	10	1	2	3	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	94.00																47.00				47.00		1.56			1.56			1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H1170	008	0	1	01	01	H1170_008_0	10		N	Non-Preferred Brand	4	11	1	2	4	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31	100.00	200.00	300.00																			100.00	200.00	200.00																100.00				100.00		3.33			3.33			3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H1170	008	0	1	01	01	H1170_008_0	10		N	Specialty Tier	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	10		N	Vaccines	4	10	1	2	6	1	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H1170	009	0	1	01	01	H1170_009_0	10			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	10			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	10			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	10			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	10			Preferred Brand	4	10	1	2	3	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31	47.00	94.00	141.00																			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	10			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	10			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	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												
H1170	009	0	1	01	01	H1170_009_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		
H1170	010	0	1	01	01	H1170_010_0	10			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	10			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	10			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	10			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	10			Preferred Brand	4	10	1	2	3	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31	47.00	94.00	141.00																			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	10			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	10			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	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												
H1170	010	0	1	01	01	H1170_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		
H1170	011	0	1	01	01	H1170_011_0	9		N	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		N	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		N	Preferred Brand	4	10	1	2	3	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	94.00																47.00				47.00		1.56			1.56			1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H1170	011	0	1	01	01	H1170_011_0	9		N	Non-Preferred Brand	4	11	1	2	4	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31	100.00	200.00	300.00																			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		N	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		N	Vaccines	4	10	1	2	6	1	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H1170	012	0	1	01	01	H1170_012_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	012	0	1	01	01	H1170_012_0	9			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	9			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	9			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	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	012	0	1	01	01	H1170_012_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	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	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								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H1170	012	0	1	01	01	H1170_012_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	9			Vaccines	4	10	1	2	6	3	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H1170	013	0	1	02	01	H1170_013_0	10			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	013	0	1	02	01	H1170_013_0	10			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	013	0	1	02	01	H1170_013_0	10			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	013	0	1	02	01	H1170_013_0	10			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	013	0	1	02	01	H1170_013_0	10			Preferred Brand	4	10	1	2	3	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31	47.00	94.00	141.00																			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	013	0	1	02	01	H1170_013_0	10			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	013	0	1	02	01	H1170_013_0	10			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	013	0	1	02	01	H1170_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												
H1170	013	0	1	02	01	H1170_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		
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	47.00		141.00																					47.00																47.00				47.00		1.52						1.38	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	2	4	1	110		01	100		1	31		90				1	2			90				31		34	100.00		300.00																					100.00																100.00				100.00		3.23						2.94	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	010		01	010		1	31								31						31		34				845.39	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1189	003	0	1	01	01	H1189_003_0	4			Preferred Generic	4	01	1	2	1	1	110		01	100		1	31		90				1	2			90				31		34	4.00		12.00																					0.00																4.00				4.00		0.13						0.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1189	003	0	1	01	01	H1189_003_0	4			Generic	4	01	1	2	2	1	110		01	100		1	31		90				1	2			90				31		34	10.00		30.00																					0.00																10.00				10.00		0.32						0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1189	003	0	1	01	01	H1189_003_0	4			Preferred Brand	4	10	1	2	3	1	110		01	100		1	31		90				1	2			90				31		34	47.00		141.00																					47.00																47.00				47.00		1.52						1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1189	003	0	1	01	01	H1189_003_0	4			Non-Preferred Drug	4	10	1	2	4	1	110		01	100		1	31		90				1	2			90				31		34	100.00		300.00																					100.00																100.00				100.00		3.23						2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1189	003	0	1	01	01	H1189_003_0	4			Specialty Tier	4	11	1	1	5	1	010		01	010		1	31								31						31		34				1060.16	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1189	004	0	1	01	01	H1189_004_0	4			Preferred Generic	4	01	1	2	1	1	110		01	100		1	31		90				1	2			90				31		34	4.00		12.00																					0.00																4.00				4.00		0.13						0.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1189	004	0	1	01	01	H1189_004_0	4			Generic	4	01	1	2	2	1	110		01	100		1	31		90				1	2			90				31		34	10.00		30.00																					0.00																10.00				10.00		0.32						0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1189	004	0	1	01	01	H1189_004_0	4			Preferred Brand	4	10	1	2	3	1	110		01	100		1	31		90				1	2			90				31		34	47.00		141.00																					47.00																47.00				47.00		1.52						1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1189	004	0	1	01	01	H1189_004_0	4			Non-Preferred Drug	4	10	1	2	4	1	110		01	100		1	31		90				1	2			90				31		34	100.00		300.00																					100.00																100.00				100.00		3.23						2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1189	004	0	1	01	01	H1189_004_0	4			Specialty Tier	4	11	1	1	5	1	010		01	010		1	31								31						31		34				1181.35	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1189	005	0	1	01	01	H1189_005_0	4			Preferred Generic	4	01	1	2	1	1	110		01	100		1	31		90				1	2			90				31		34	4.00		12.00																					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	4			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	4			Preferred Brand	4	10	1	2	3	1	110		01	100		1	31		90				1	2			90				31		34	47.00		141.00																					47.00																47.00				47.00		1.52						1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1189	005	0	1	01	01	H1189_005_0	4			Non-Preferred Drug	4	10	1	2	4	1	110		01	100		1	31		90				1	2			90				31		34	100.00		300.00																					100.00																100.00				100.00		3.23						2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1189	005	0	1	01	01	H1189_005_0	4			Specialty Tier	4	11	1	1	5	1	010		01	010		1	31								31						31		34				1186.63	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1189	009	0	1	01	01	H1189_009_0	4			Preferred Generic	4	01	1	2	1	1	110		01	100		1	31		90				1	2			90				31		34	4.00		12.00																					0.00																4.00				4.00		0.13						0.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1189	009	0	1	01	01	H1189_009_0	4			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	009	0	1	01	01	H1189_009_0	4			Preferred Brand	4	10	1	2	3	1	110		01	100		1	31		90				1	2			90				31		34	47.00		141.00																					47.00																47.00				47.00		1.52						1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1189	009	0	1	01	01	H1189_009_0	4			Non-Preferred Drug	4	10	1	2	4	1	110		01	100		1	31		90				1	2			90				31		34	100.00		300.00																					100.00																100.00				100.00		3.23						2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1189	009	0	1	01	01	H1189_009_0	4			Specialty Tier	4	11	1	1	5	1	010		01	010		1	31								31						31		34				1181.38	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1189	010	0	1	01	01	H1189_010_0	4			Preferred Generic	4	01	1	2	1	1	110		01	100		1	31		90				1	2			90				31		34	4.00		12.00																					0.00																4.00				4.00		0.13						0.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1189	010	0	1	01	01	H1189_010_0	4			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	010	0	1	01	01	H1189_010_0	4			Preferred Brand	4	10	1	2	3	1	110		01	100		1	31		90				1	2			90				31		34	47.00		141.00																					47.00																47.00				47.00		1.52						1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1189	010	0	1	01	01	H1189_010_0	4			Non-Preferred Drug	4	10	1	2	4	1	110		01	100		1	31		90				1	2			90				31		34	100.00		300.00																					100.00																100.00				100.00		3.23						2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1189	010	0	1	01	01	H1189_010_0	4			Specialty Tier	4	11	1	1	5	1	010		01	010		1	31								31						31		34				1181.36	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1215	002	0	1	01	01	H1215_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												
H1215	002	0	1	01	01	H1215_002_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												
H1215	002	0	1	01	01	H1215_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												
H1215	002	0	1	01	01	H1215_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												
H1215	002	0	1	01	01	H1215_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												
H1215	002	0	1	01	01	H1215_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												
H1215	003	0	1	01	01	H1215_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												
H1215	003	0	1	01	01	H1215_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					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	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												
H1215	003	0	1	01	01	H1215_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											90.56	50	50	50				86.94	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	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												
H1215	003	0	1	01	01	H1215_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												
H1224	001	0	1	01	01	H1224_001_0	12		N	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	100				2	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1224	001	0	1	01	01	H1224_001_0	12		N	Preferred Generic	4	01	1	2	1	3	111		01	111		1	30	60	100				2	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H1224	001	0	1	01	01	H1224_001_0	12		N	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	60.00																			20.00	40.00	60.00																20.00				20.00		0.67			0.67			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1224	001	0	1	01	01	H1224_001_0	12		N	Preferred Brand	4	10	1	2	3	1	111		01	111		1	30	60	100				2	2	30	60	100				30		31	47.00	94.00	141.00																			47.00	94.00	141.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1224	001	0	1	01	01	H1224_001_0	12		N	Non-Preferred Brand	4	10	1	2	4	1	111		01	111		1	30	60	100				2	2	30	60	100				30		31	100.00	200.00	300.00																			100.00	200.00	300.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1224	001	0	1	01	01	H1224_001_0	12		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				854.80	25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1225	001	0	1	01	01	H1225_001_0	11		Y	Preferred Generic	4	11	1	2	1	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1225	001	0	1	01	01	H1225_001_0	11		Y	Preferred Generic	4	11	1	2	1	3	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1225	001	0	1	01	01	H1225_001_0	11		Y	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	11		Y	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	47.00	94.00	141.00																			47.00	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	11		Y	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	100.00	200.00	300.00																			100.00	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	11		Y	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31					33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1230	001	0	1	01	01	H1230_001_0	6			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	6			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	6			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	6			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	6			Preferred Brand	4	10	1	2	3	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31	45.00	90.00	135.00																			45.00	90.00	90.00																45.00				45.00		1.50			1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H1230	001	0	1	01	01	H1230_001_0	6			Non-Preferred Brand	4	11	1	2	4	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31	100.00	200.00	300.00																			100.00	200.00	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	6			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	6			Vaccines	4	10	1	2	6	1	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H1230	001	0	1	01	01	H1230_001_0	6			Vaccines	4	10	1	2	6	3	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H1230	003	0	1	01	01	H1230_003_0	6			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	6			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	6			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	6			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	6			Preferred Brand	4	10	1	2	3	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31	45.00	90.00	135.00																			45.00	90.00	90.00																45.00				45.00		1.50			1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H1230	003	0	1	01	01	H1230_003_0	6			Non-Preferred Brand	4	11	1	2	4	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31	100.00	200.00	300.00																			100.00	200.00	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	6			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	6			Vaccines	4	10	1	2	6	1	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H1230	003	0	1	01	01	H1230_003_0	6			Vaccines	4	10	1	2	6	3	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H1230	013	0	1	01	01	H1230_013_0	6			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	6			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	6			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	6			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	6			Preferred Brand	4	10	1	2	3	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31	45.00	90.00	135.00																			45.00	90.00	90.00																45.00				45.00		1.50			1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H1230	013	0	1	01	01	H1230_013_0	6			Non-Preferred Brand	4	11	1	2	4	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31	100.00	200.00	300.00																			100.00	200.00	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	6			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	6			Vaccines	4	10	1	2	6	1	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H1230	013	0	1	01	01	H1230_013_0	6			Vaccines	4	10	1	2	6	3	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H1230	014	0	1	01	01	H1230_014_0	6			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	014	0	1	01	01	H1230_014_0	6			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	014	0	1	01	01	H1230_014_0	6			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	014	0	1	01	01	H1230_014_0	6			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	014	0	1	01	01	H1230_014_0	6			Preferred Brand	4	10	1	2	3	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31	45.00	90.00	135.00																			45.00	90.00	90.00																45.00				45.00		1.50			1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H1230	014	0	1	01	01	H1230_014_0	6			Non-Preferred Brand	4	11	1	2	4	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31	100.00	200.00	300.00																			100.00	200.00	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	6			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	014	0	1	01	01	H1230_014_0	6			Vaccines	4	10	1	2	6	1	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H1230	014	0	1	01	01	H1230_014_0	6			Vaccines	4	10	1	2	6	3	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H1248	004	0	1	04	01	H1248_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	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	7			Preferred Generic	4	01	1	2	1	3		111	01		111	1				30	60	100	1	2				30	60	100	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	7			Generic	4	01	1	2	2	1		111	01		111	1				30	60	100	1	2				30	60	100	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	7			Generic	4	01	1	2	2	3		111	01		111	1				30	60	100	1	2				30	60	100	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	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					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	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	200.00	300.00				100.00	200.00	300.00				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	7			Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											1120.92	33						755.49	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1248	007	0	1	04	01	H1248_007_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					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	7			Preferred Generic	4	01	1	2	1	3		111	01		111	1				30	60	100	1	2				30	60	100	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	7			Generic	4	01	1	2	2	1		111	01		111	1				30	60	100	1	2				30	60	100	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	7			Generic	4	01	1	2	2	3		111	01		111	1				30	60	100	1	2				30	60	100	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	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					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	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	200.00	300.00				100.00	200.00	300.00				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	7			Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											971.55	29						608.60	29												29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1277	001	0	1	01	01	H1277_001_0	5		Y	Preferred Generic	4	01	1	2	1	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	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	5		Y	Generic	4	01	1	2	2	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	15.00	30.00	45.00																			15.00	30.00	45.00																	15.00			15.00		0.50			0.50			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1277	001	0	1	01	01	H1277_001_0	5		Y	Preferred Brand	4	10	1	2	3	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	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	5		Y	Non-Preferred Brand	4	10	1	2	4	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	95.00	190.00	285.00																			95.00	190.00	285.00																	95.00			95.00		3.17			3.17			3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1277	001	0	1	01	01	H1277_001_0	5		Y	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	5		Y	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	5		Y	Generic	4	01	1	2	2	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	15.00	30.00	45.00																			15.00	30.00	45.00																	15.00			15.00		0.50			0.50			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1277	002	0	1	01	01	H1277_002_0	5		Y	Preferred Brand	4	10	1	2	3	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	45.00	90.00	135.00																			45.00	90.00	135.00																	45.00			45.00		1.50			1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1277	002	0	1	01	01	H1277_002_0	5		Y	Non-Preferred Brand	4	10	1	2	4	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	95.00	190.00	285.00																			95.00	190.00	285.00																	95.00			95.00		3.17			3.17			3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1277	002	0	1	01	01	H1277_002_0	5		Y	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	004	0	1	01	01	H1277_004_0	8		Y	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, Select Care Drugs												
H1277	004	0	1	01	01	H1277_004_0	8		Y	Generic	4	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																			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												
H1277	004	0	1	01	01	H1277_004_0	8		Y	Preferred Brand	4	10	1	2	3	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	45.00	90.00	135.00																			45.00	90.00	135.00																	45.00			45.00		1.50			1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H1277	004	0	1	01	01	H1277_004_0	8		Y	Non-Preferred Brand	4	10	1	2	4	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	95.00	190.00	285.00																			95.00	190.00	285.00																	95.00			95.00		3.17			3.17			3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H1277	004	0	1	01	01	H1277_004_0	8		Y	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, Select Care Drugs												
H1277	004	0	1	01	01	H1277_004_0	8		Y	Select Care Drugs	4	11	1	2	6	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 Brand, Specialty Tier, Select Care Drugs												
H1277	005	0	1	02	01	H1277_005_0	5		Y	Preferred Generic	4	01	1	2	1	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	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	005	0	1	02	01	H1277_005_0	5		Y	Generic	4	01	1	2	2	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	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	005	0	1	02	01	H1277_005_0	5		Y	Preferred Brand	4	10	1	2	3	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	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	005	0	1	02	01	H1277_005_0	5		Y	Non-Preferred Brand	4	10	1	2	4	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	95.00	190.00	285.00																			95.00	190.00	285.00																	95.00			95.00		3.17			3.17			3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1277	005	0	1	02	01	H1277_005_0	5		Y	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	4		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1278	001	0	1	04	01	H1278_001_0	4		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1278	001	0	1	04	01	H1278_001_0	4		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1278	001	0	1	04	01	H1278_001_0	4		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H1278	001	0	1	04	01	H1278_001_0	4		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1278	001	0	1	04	01	H1278_001_0	4		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1278	001	0	1	04	01	H1278_001_0	4		Y	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												
H1278	003	0	1	04	01	H1278_003_0	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1278	003	0	1	04	01	H1278_003_0	3		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1278	003	0	1	04	01	H1278_003_0	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	14.00		42.00																											42.00						0.00				14.00				14.00		0.46						0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1278	003	0	1	04	01	H1278_003_0	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	14.00		42.00																											42.00						0.00				14.00				14.00		0.46						0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H1278	003	0	1	04	01	H1278_003_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1278	003	0	1	04	01	H1278_003_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1278	003	0	1	04	01	H1278_003_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				497.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1278	004	0	1	04	01	H1278_004_0	3		Y	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		100	2	2						100	30		31								10.00		30.00					0.00		0.00													30.00						0.00				10.00				10.00			0.33	0.00				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1278	004	0	1	04	01	H1278_004_0	3		Y	Preferred Generic	4	01	1	2	1	3		110	01		100	1				30		100	2	2						100	30		31								10.00		30.00					0.00		0.00													30.00						0.00				10.00				10.00			0.33	0.00				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1278	004	0	1	04	01	H1278_004_0	3		Y	Generic	4	01	3	2	2	1		110	01		100	1				30		100	2	2						100	30		31								20.00		60.00					0.00		0.00													60.00						0.00				20.00				20.00			0.66	0.00				0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1278	004	0	1	04	01	H1278_004_0	3		Y	Generic	4	01	3	2	2	3		110	01		100	1				30		100	2	2						100	30		31								20.00		60.00					0.00		0.00													60.00						0.00				20.00				20.00			0.66	0.00				0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H1278	004	0	1	04	01	H1278_004_0	3		Y	Preferred Brand	4	11	1	2	3	1		110	01		100	1				30		100	2	2						100	30		31								47.00		141.00					47.00		131.00													141.00						131.00				47.00				47.00			1.56	1.56				1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1278	004	0	1	04	01	H1278_004_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1		110	01		100	1				30		100	2	2						100	30		31								100.00		300.00					100.00		290.00													300.00						290.00				100.00				100.00			3.33	3.33				3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1278	004	0	1	04	01	H1278_004_0	3		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											536.00	33						454.00	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1278	005	0	1	04	01	H1278_005_0	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1278	005	0	1	04	01	H1278_005_0	3		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1278	005	0	1	04	01	H1278_005_0	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	14.00		42.00																											42.00						0.00				14.00				14.00		0.46						0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1278	005	0	1	04	01	H1278_005_0	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	14.00		42.00																											42.00						0.00				14.00				14.00		0.46						0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H1278	005	0	1	04	01	H1278_005_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1278	005	0	1	04	01	H1278_005_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1278	005	0	1	04	01	H1278_005_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				382.00	29																										29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1278	007	0	1	04	01	H1278_007_0	4		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1278	007	0	1	04	01	H1278_007_0	4		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1278	007	0	1	04	01	H1278_007_0	4		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1278	007	0	1	04	01	H1278_007_0	4		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H1278	007	0	1	04	01	H1278_007_0	4		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1278	007	0	1	04	01	H1278_007_0	4		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1278	007	0	1	04	01	H1278_007_0	4		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				325.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1278	009	0	1	04	01	H1278_009_0	4		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1278	009	0	1	04	01	H1278_009_0	4		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1278	009	0	1	04	01	H1278_009_0	4		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	14.00		42.00																											42.00						0.00				14.00				14.00		0.46						0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1278	009	0	1	04	01	H1278_009_0	4		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	14.00		42.00																											42.00						0.00				14.00				14.00		0.46						0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H1278	009	0	1	04	01	H1278_009_0	4		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1278	009	0	1	04	01	H1278_009_0	4		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1278	009	0	1	04	01	H1278_009_0	4		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				453.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1278	010	0	1	04	01	H1278_010_0	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1278	010	0	1	04	01	H1278_010_0	3		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1278	010	0	1	04	01	H1278_010_0	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	14.00		42.00																											42.00						0.00				14.00				14.00		0.46						0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1278	010	0	1	04	01	H1278_010_0	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	14.00		42.00																											42.00						0.00				14.00				14.00		0.46						0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H1278	010	0	1	04	01	H1278_010_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1278	010	0	1	04	01	H1278_010_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1278	010	0	1	04	01	H1278_010_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				552.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1278	013	0	1	04	01	H1278_013_0	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1278	013	0	1	04	01	H1278_013_0	3		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1278	013	0	1	04	01	H1278_013_0	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	14.00		42.00																											42.00						0.00				14.00				14.00		0.46						0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1278	013	0	1	04	01	H1278_013_0	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	14.00		42.00																											42.00						0.00				14.00				14.00		0.46						0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H1278	013	0	1	04	01	H1278_013_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1278	013	0	1	04	01	H1278_013_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1278	013	0	1	04	01	H1278_013_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				340.00	29																										29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1278	014	0	1	04	01	H1278_014_0	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1278	014	0	1	04	01	H1278_014_0	3		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1278	014	0	1	04	01	H1278_014_0	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1278	014	0	1	04	01	H1278_014_0	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H1278	014	0	1	04	01	H1278_014_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1278	014	0	1	04	01	H1278_014_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1278	014	0	1	04	01	H1278_014_0	3		Y	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												
H1278	015	0	1	04	01	H1278_015_0	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1278	015	0	1	04	01	H1278_015_0	3		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1278	015	0	1	04	01	H1278_015_0	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1278	015	0	1	04	01	H1278_015_0	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H1278	015	0	1	04	01	H1278_015_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1278	015	0	1	04	01	H1278_015_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1278	015	0	1	04	01	H1278_015_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				293.00	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		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1278	016	0	1	04	01	H1278_016_0	3		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1278	016	0	1	04	01	H1278_016_0	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1278	016	0	1	04	01	H1278_016_0	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H1278	016	0	1	04	01	H1278_016_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1278	016	0	1	04	01	H1278_016_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1278	016	0	1	04	01	H1278_016_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				391.00	29																										29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1278	020	0	1	04	01	H1278_020_0	4		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1278	020	0	1	04	01	H1278_020_0	4		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1278	020	0	1	04	01	H1278_020_0	4		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	14.00		42.00																											42.00						0.00				14.00				14.00		0.46						0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1278	020	0	1	04	01	H1278_020_0	4		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	14.00		42.00																											42.00						0.00				14.00				14.00		0.46						0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H1278	020	0	1	04	01	H1278_020_0	4		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1278	020	0	1	04	01	H1278_020_0	4		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1278	020	0	1	04	01	H1278_020_0	4		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				564.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1280	001	0	1	01	01	H1280_001_0	6		Y	Preferred Generic	4	01	1	2	1	1	110		01	110		1	30		100				2	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												
H1280	001	0	1	01	01	H1280_001_0	6		Y	Generic	4	01	1	2	2	1	110		01	110		1	30		100				2	2	30		100				30		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	6		Y	Preferred Brand	4	11	1	2	3	1	110		01	110		1	30		100				2	2	30		100				30		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	6		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01	110		1	30		100				2	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												
H1280	001	0	1	01	01	H1280_001_0	6		Y	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		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	6		Y	Preferred Generic	4	01	1	2	1	1	110		01	110		1	30		100				2	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												
H1280	002	0	1	01	01	H1280_002_0	6		Y	Generic	4	01	1	2	2	1	110		01	110		1	30		100				2	2	30		100				30		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	6		Y	Preferred Brand	4	11	1	2	3	1	110		01	110		1	30		100				2	2	30		100				30		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	6		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01	110		1	30		100				2	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												
H1280	002	0	1	01	01	H1280_002_0	6		Y	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		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	10		Y	Preferred Generic	4	11	1	2	1	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1290	001	0	1	01	01	H1290_001_0	10		Y	Preferred Generic	4	11	1	2	1	3	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H1290	001	0	1	01	01	H1290_001_0	10		Y	Generic	4	11	3	2	2	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1290	001	0	1	01	01	H1290_001_0	10		Y	Generic	4	11	3	2	2	3	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	3
H1290	001	0	1	01	01	H1290_001_0	10		Y	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1290	001	0	1	01	01	H1290_001_0	10		Y	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	10		Y	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												
H1290	002	0	1	01	01	H1290_002_0	10		Y	Preferred Generic	4	11	1	2	1	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1290	002	0	1	01	01	H1290_002_0	10		Y	Preferred Generic	4	11	1	2	1	3	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H1290	002	0	1	01	01	H1290_002_0	10		Y	Generic	4	11	3	2	2	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1290	002	0	1	01	01	H1290_002_0	10		Y	Generic	4	11	3	2	2	3	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	3
H1290	002	0	1	01	01	H1290_002_0	10		Y	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		Y	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	85.00	170.00	255.00																			85.00	170.00	255.00																85.00				85.00		2.83			2.83			2.74	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1290	002	0	1	01	01	H1290_002_0	10		Y	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												
H1290	003	0	1	01	01	H1290_003_0	10		Y	Preferred Generic	4	11	1	2	1	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1290	003	0	1	01	01	H1290_003_0	10		Y	Preferred Generic	4	11	1	2	1	3	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H1290	003	0	1	01	01	H1290_003_0	10		Y	Generic	4	11	3	2	2	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1290	003	0	1	01	01	H1290_003_0	10		Y	Generic	4	11	3	2	2	3	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	3
H1290	003	0	1	01	01	H1290_003_0	10		Y	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		Y	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	95.00	190.00	285.00																			95.00	190.00	285.00																95.00				95.00		3.17			3.17			3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1290	003	0	1	01	01	H1290_003_0	10		Y	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												
H1290	005	0	1	01	01	H1290_005_0	10		Y	Preferred Generic	4	11	1	2	1	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1290	005	0	1	01	01	H1290_005_0	10		Y	Preferred Generic	4	11	1	2	1	3	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H1290	005	0	1	01	01	H1290_005_0	10		Y	Generic	4	11	3	2	2	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1290	005	0	1	01	01	H1290_005_0	10		Y	Generic	4	11	3	2	2	3	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	3
H1290	005	0	1	01	01	H1290_005_0	10		Y	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		Y	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	85.00	170.00	255.00																			85.00	170.00	255.00																85.00				85.00		2.83			2.83			2.74	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1290	005	0	1	01	01	H1290_005_0	10		Y	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												
H1290	013	0	1	01	01	H1290_013_0	11		Y	Preferred Generic	4	11	1	2	1	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1290	013	0	1	01	01	H1290_013_0	11		Y	Preferred Generic	4	11	1	2	1	3	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H1290	013	0	1	01	01	H1290_013_0	11		Y	Generic	4	11	3	2	2	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1290	013	0	1	01	01	H1290_013_0	11		Y	Generic	4	11	3	2	2	3	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	2	2
H1290	013	0	1	01	01	H1290_013_0	11		Y	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	30.00	60.00	90.00																			30.00	60.00	75.00																30.00				30.00		1.00			1.00			0.97	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1290	013	0	1	01	01	H1290_013_0	11		Y	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	85.00	170.00	255.00																			85.00	170.00	255.00																85.00				85.00		2.83			2.83			2.74	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1290	013	0	1	01	01	H1290_013_0	11		Y	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												
H1290	014	0	1	01	01	H1290_014_0	11		Y	Preferred Generic	4	11	1	2	1	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1290	014	0	1	01	01	H1290_014_0	11		Y	Preferred Generic	4	11	1	2	1	3	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H1290	014	0	1	01	01	H1290_014_0	11		Y	Generic	4	11	3	2	2	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1290	014	0	1	01	01	H1290_014_0	11		Y	Generic	4	11	3	2	2	3	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	2	2
H1290	014	0	1	01	01	H1290_014_0	11		Y	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	45.00	90.00	135.00																			45.00	90.00	112.50																45.00				45.00		1.50			1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1290	014	0	1	01	01	H1290_014_0	11		Y	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	95.00	190.00	285.00																			95.00	190.00	285.00																95.00				95.00		3.17			3.17			3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1290	014	0	1	01	01	H1290_014_0	11		Y	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				1.00	31																				31																	31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1290	015	0	1	01	01	H1290_015_0	11		Y	Preferred Generic	4	11	1	2	1	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1290	015	0	1	01	01	H1290_015_0	11		Y	Preferred Generic	4	11	1	2	1	3	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H1290	015	0	1	01	01	H1290_015_0	11		Y	Generic	4	11	3	2	2	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	5.00	10.00	15.00																			0.00	0.00	0.00																5.00				5.00		0.17			0.00			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1290	015	0	1	01	01	H1290_015_0	11		Y	Generic	4	11	3	2	2	3	111		01	111		1	30	60	100				1	2	30	60	100				30		31	5.00	10.00	15.00																			0.00	0.00	0.00																5.00				5.00		0.17			0.00			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	2	2
H1290	015	0	1	01	01	H1290_015_0	11		Y	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	45.00	90.00	135.00																			45.00	90.00	112.50																45.00				45.00		1.50			1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1290	015	0	1	01	01	H1290_015_0	11		Y	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	95.00	190.00	285.00																			95.00	190.00	285.00																95.00				95.00		3.17			3.17			3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1290	015	0	1	01	01	H1290_015_0	11		Y	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				1.00	31																				31																	31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1290	018	0	1	01	01	H1290_018_0	11		Y	Preferred Generic	4	11	1	2	1	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1290	018	0	1	01	01	H1290_018_0	11		Y	Preferred Generic	4	11	1	2	1	3	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H1290	018	0	1	01	01	H1290_018_0	11		Y	Generic	4	11	3	2	2	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	5.00	10.00	15.00																			0.00	0.00	0.00																5.00				5.00		0.17			0.00			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1290	018	0	1	01	01	H1290_018_0	11		Y	Generic	4	11	3	2	2	3	111		01	111		1	30	60	100				1	2	30	60	100				30		31	5.00	10.00	15.00																			0.00	0.00	0.00																5.00				5.00		0.17			0.00			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	2	2
H1290	018	0	1	01	01	H1290_018_0	11		Y	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	47.00	94.00	141.00																			47.00	94.00	117.50																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1290	018	0	1	01	01	H1290_018_0	11		Y	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	95.00	190.00	285.00																			95.00	190.00	285.00																95.00				95.00		3.17			3.17			3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1290	018	0	1	01	01	H1290_018_0	11		Y	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												
H1290	019	0	1	01	01	H1290_019_0	9		N	Preferred Generic	4	11	1	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	9		N	Generic	4	11	3	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	9		N	Generic	4	11	3	2	2	3	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	2	2
H1290	019	0	1	01	01	H1290_019_0	9		N	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	9		N	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	9		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31					25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1290	020	0	1	01	01	H1290_020_0	9		N	Preferred Generic	4	11	1	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	9		N	Generic	4	11	3	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	9		N	Generic	4	11	3	2	2	3	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	2	2
H1290	020	0	1	01	01	H1290_020_0	9		N	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	9		N	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	9		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31					25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1290	021	0	1	01	01	H1290_021_0	9		N	Preferred Generic	4	11	1	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	9		N	Generic	4	11	3	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	9		N	Generic	4	11	3	2	2	3	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	2	2
H1290	021	0	1	01	01	H1290_021_0	9		N	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	9		N	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	9		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31					25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1290	022	0	1	01	01	H1290_022_0	9		N	Preferred Generic	4	11	1	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	9		N	Generic	4	11	3	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	9		N	Generic	4	11	3	2	2	3	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	2	2
H1290	022	0	1	01	01	H1290_022_0	9		N	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	9		N	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	9		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31					25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1290	023	0	1	01	01	H1290_023_0	9		N	Preferred Generic	4	11	1	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	9		N	Generic	4	11	3	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	9		N	Generic	4	11	3	2	2	3	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	2	2
H1290	023	0	1	01	01	H1290_023_0	9		N	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	9		N	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	9		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31					25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1290	024	0	1	01	01	H1290_024_0	9		N	Preferred Generic	4	11	1	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	9		N	Generic	4	11	3	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	9		N	Generic	4	11	3	2	2	3	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	2	2
H1290	024	0	1	01	01	H1290_024_0	9		N	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	9		N	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	9		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31					25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1290	025	0	1	01	01	H1290_025_0	10		Y	Preferred Generic	4	11	1	2	1	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1290	025	0	1	01	01	H1290_025_0	10		Y	Preferred Generic	4	11	1	2	1	3	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	2	
H1290	025	0	1	01	01	H1290_025_0	10		Y	Generic	4	11	3	2	2	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1290	025	0	1	01	01	H1290_025_0	10		Y	Generic	4	11	3	2	2	3	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	2	3
H1290	025	0	1	01	01	H1290_025_0	10		Y	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	10.00	20.00	30.00																			10.00	20.00	25.00																10.00				10.00		0.33			0.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1290	025	0	1	01	01	H1290_025_0	10		Y	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	95.00	190.00	285.00																			95.00	190.00	285.00																95.00				95.00		3.17			3.17			3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1290	025	0	1	01	01	H1290_025_0	10		Y	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												
H1290	027	0	1	01	01	H1290_027_0	10		Y	Preferred Generic	4	11	1	2	1	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1290	027	0	1	01	01	H1290_027_0	10		Y	Preferred Generic	4	11	1	2	1	3	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H1290	027	0	1	01	01	H1290_027_0	10		Y	Generic	4	11	3	2	2	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1290	027	0	1	01	01	H1290_027_0	10		Y	Generic	4	11	3	2	2	3	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	3
H1290	027	0	1	01	01	H1290_027_0	10		Y	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	20.00	40.00	60.00																			20.00	40.00	50.00																20.00				20.00		0.67			0.67			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1290	027	0	1	01	01	H1290_027_0	10		Y	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	85.00	170.00	255.00																			85.00	170.00	255.00																85.00				85.00		2.83			2.83			2.74	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1290	027	0	1	01	01	H1290_027_0	10		Y	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												
H1290	029	0	1	01	01	H1290_029_0	10		Y	Preferred Generic	4	11	1	2	1	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1290	029	0	1	01	01	H1290_029_0	10		Y	Preferred Generic	4	11	1	2	1	3	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H1290	029	0	1	01	01	H1290_029_0	10		Y	Generic	4	11	3	2	2	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1290	029	0	1	01	01	H1290_029_0	10		Y	Generic	4	11	3	2	2	3	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	3
H1290	029	0	1	01	01	H1290_029_0	10		Y	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	45.00	90.00	135.00																			45.00	90.00	112.50																45.00				45.00		1.50			1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1290	029	0	1	01	01	H1290_029_0	10		Y	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	95.00	190.00	285.00																			95.00	190.00	285.00																95.00				95.00		3.17			3.17			3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1290	029	0	1	01	01	H1290_029_0	10		Y	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												
H1290	031	0	1	01	01	H1290_031_0	11		Y	Preferred Generic	4	11	1	2	1	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1290	031	0	1	01	01	H1290_031_0	11		Y	Preferred Generic	4	11	1	2	1	3	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H1290	031	0	1	01	01	H1290_031_0	11		Y	Generic	4	11	3	2	2	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	5.00	10.00	15.00																			5.00	10.00	12.50																5.00				5.00		0.17			0.17			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1290	031	0	1	01	01	H1290_031_0	11		Y	Generic	4	11	3	2	2	3	111		01	111		1	30	60	100				1	2	30	60	100				30		31	5.00	10.00	15.00																			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										2	2	2
H1290	031	0	1	01	01	H1290_031_0	11		Y	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	45.00	90.00	135.00																			45.00	90.00	112.50																45.00				45.00		1.50			1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1290	031	0	1	01	01	H1290_031_0	11		Y	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	95.00	190.00	285.00																			95.00	190.00	285.00																95.00				95.00		3.17			3.17			3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1290	031	0	1	01	01	H1290_031_0	11		Y	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				1.00	31																				31																	31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1290	032	0	1	01	01	H1290_032_0	11		Y	Preferred Generic	4	11	1	2	1	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1290	032	0	1	01	01	H1290_032_0	11		Y	Preferred Generic	4	11	1	2	1	3	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H1290	032	0	1	01	01	H1290_032_0	11		Y	Generic	4	11	3	2	2	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1290	032	0	1	01	01	H1290_032_0	11		Y	Generic	4	11	3	2	2	3	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	2	2
H1290	032	0	1	01	01	H1290_032_0	11		Y	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	47.00	94.00	141.00																			47.00	94.00	117.50																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1290	032	0	1	01	01	H1290_032_0	11		Y	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	95.00	190.00	285.00																			95.00	190.00	285.00																95.00				95.00		3.17			3.17			3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1290	032	0	1	01	01	H1290_032_0	11		Y	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												
H1290	033	0	1	01	01	H1290_033_0	9		N	Preferred Generic	4	11	1	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	9		N	Generic	4	11	3	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	9		N	Generic	4	11	3	2	2	3	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	2	2
H1290	033	0	1	01	01	H1290_033_0	9		N	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	9		N	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	9		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31					25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1290	034	0	1	01	01	H1290_034_0	9		N	Preferred Generic	4	11	1	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	9		N	Generic	4	11	3	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	9		N	Generic	4	11	3	2	2	3	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	2	2
H1290	034	0	1	01	01	H1290_034_0	9		N	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	9		N	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	9		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31					25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1290	035	0	1	01	01	H1290_035_0	11		Y	Preferred Generic	4	11	1	2	1	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1290	035	0	1	01	01	H1290_035_0	11		Y	Preferred Generic	4	11	1	2	1	3	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H1290	035	0	1	01	01	H1290_035_0	11		Y	Generic	4	11	3	2	2	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	5.00	10.00	15.00																			5.00	10.00	12.50																5.00				5.00		0.17			0.17			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1290	035	0	1	01	01	H1290_035_0	11		Y	Generic	4	11	3	2	2	3	111		01	111		1	30	60	100				1	2	30	60	100				30		31	5.00	10.00	15.00																			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										2	2	2
H1290	035	0	1	01	01	H1290_035_0	11		Y	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	35.00	70.00	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	11		Y	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	85.00	170.00	255.00																			85.00	170.00	255.00																85.00				85.00		2.83			2.83			2.74	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1290	035	0	1	01	01	H1290_035_0	11		Y	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												
H1290	036	1	1	01	01	H1290_036_1	10		Y	Preferred Generic	4	11	1	2	1	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1290	036	1	1	01	01	H1290_036_1	10		Y	Preferred Generic	4	11	1	2	1	3	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H1290	036	1	1	01	01	H1290_036_1	10		Y	Generic	4	11	3	2	2	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1290	036	1	1	01	01	H1290_036_1	10		Y	Generic	4	11	3	2	2	3	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	3
H1290	036	1	1	01	01	H1290_036_1	10		Y	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	8.00	16.00	24.00																			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	10		Y	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	100.00	200.00	300.00																			100.00	200.00	300.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1290	036	1	1	01	01	H1290_036_1	10		Y	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												
H1290	036	2	1	01	01	H1290_036_2	12		Y	Preferred Generic	4	11	1	2	1	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1290	036	2	1	01	01	H1290_036_2	12		Y	Preferred Generic	4	11	1	2	1	3	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H1290	036	2	1	01	01	H1290_036_2	12		Y	Generic	4	11	3	2	2	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1290	036	2	1	01	01	H1290_036_2	12		Y	Generic	4	11	3	2	2	3	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	3
H1290	036	2	1	01	01	H1290_036_2	12		Y	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	8.00	16.00	24.00																			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	12		Y	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	100.00	200.00	300.00																			100.00	200.00	300.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1290	036	2	1	01	01	H1290_036_2	12		Y	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												
H1290	037	1	1	01	01	H1290_037_1	10		Y	Preferred Generic	4	11	1	2	1	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1290	037	1	1	01	01	H1290_037_1	10		Y	Preferred Generic	4	11	1	2	1	3	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H1290	037	1	1	01	01	H1290_037_1	10		Y	Generic	4	11	3	2	2	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1290	037	1	1	01	01	H1290_037_1	10		Y	Generic	4	11	3	2	2	3	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	3
H1290	037	1	1	01	01	H1290_037_1	10		Y	Preferred Brand	4	11	1	1	3	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31				1.00	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		Y	Non-Preferred Drug	4	11	1	1	4	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31				1.00	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		Y	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												
H1290	037	2	1	01	01	H1290_037_2	10		Y	Preferred Generic	4	11	1	2	1	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1290	037	2	1	01	01	H1290_037_2	10		Y	Preferred Generic	4	11	1	2	1	3	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H1290	037	2	1	01	01	H1290_037_2	10		Y	Generic	4	11	3	2	2	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1290	037	2	1	01	01	H1290_037_2	10		Y	Generic	4	11	3	2	2	3	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	3
H1290	037	2	1	01	01	H1290_037_2	10		Y	Preferred Brand	4	11	1	1	3	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31				1.00	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	10		Y	Non-Preferred Drug	4	11	1	1	4	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31				1.00	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	10		Y	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												
H1290	037	3	1	01	01	H1290_037_3	10		Y	Preferred Generic	4	11	1	2	1	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1290	037	3	1	01	01	H1290_037_3	10		Y	Preferred Generic	4	11	1	2	1	3	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H1290	037	3	1	01	01	H1290_037_3	10		Y	Generic	4	11	3	2	2	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1290	037	3	1	01	01	H1290_037_3	10		Y	Generic	4	11	3	2	2	3	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	3
H1290	037	3	1	01	01	H1290_037_3	10		Y	Preferred Brand	4	11	1	1	3	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31				1.00	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	10		Y	Non-Preferred Drug	4	11	1	1	4	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31				1.00	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	10		Y	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												
H1290	037	4	1	01	01	H1290_037_4	10		Y	Preferred Generic	4	11	1	2	1	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1290	037	4	1	01	01	H1290_037_4	10		Y	Preferred Generic	4	11	1	2	1	3	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H1290	037	4	1	01	01	H1290_037_4	10		Y	Generic	4	11	3	2	2	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1290	037	4	1	01	01	H1290_037_4	10		Y	Generic	4	11	3	2	2	3	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	3
H1290	037	4	1	01	01	H1290_037_4	10		Y	Preferred Brand	4	11	1	1	3	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31				1.00	25	25	25																		25	25	25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1290	037	4	1	01	01	H1290_037_4	10		Y	Non-Preferred Drug	4	11	1	1	4	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31				1.00	25	25	25																		25	25	25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1290	037	4	1	01	01	H1290_037_4	10		Y	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												
H1290	037	5	1	01	01	H1290_037_5	10		Y	Preferred Generic	4	11	1	2	1	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1290	037	5	1	01	01	H1290_037_5	10		Y	Preferred Generic	4	11	1	2	1	3	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H1290	037	5	1	01	01	H1290_037_5	10		Y	Generic	4	11	3	2	2	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1290	037	5	1	01	01	H1290_037_5	10		Y	Generic	4	11	3	2	2	3	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	3
H1290	037	5	1	01	01	H1290_037_5	10		Y	Preferred Brand	4	11	1	1	3	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31				1.00	25	25	25																		25	25	25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1290	037	5	1	01	01	H1290_037_5	10		Y	Non-Preferred Drug	4	11	1	1	4	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31				1.00	25	25	25																		25	25	25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1290	037	5	1	01	01	H1290_037_5	10		Y	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												
H1290	039	0	1	01	01	H1290_039_0	9		N	Preferred Generic	4	11	1	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	039	0	1	01	01	H1290_039_0	9		N	Generic	4	11	3	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	039	0	1	01	01	H1290_039_0	9		N	Generic	4	11	3	2	2	3	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	2	2
H1290	039	0	1	01	01	H1290_039_0	9		N	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	039	0	1	01	01	H1290_039_0	9		N	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	039	0	1	01	01	H1290_039_0	9		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31					25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1290	041	0	1	01	01	H1290_041_0	9		N	Preferred Generic	4	11	1	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	041	0	1	01	01	H1290_041_0	9		N	Generic	4	11	3	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	041	0	1	01	01	H1290_041_0	9		N	Generic	4	11	3	2	2	3	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	2	2
H1290	041	0	1	01	01	H1290_041_0	9		N	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	041	0	1	01	01	H1290_041_0	9		N	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	041	0	1	01	01	H1290_041_0	9		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31					25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1290	042	0	1	01	01	H1290_042_0	10		N	Preferred Generic	4	11	1	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	042	0	1	01	01	H1290_042_0	10		N	Generic	4	11	3	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	042	0	1	01	01	H1290_042_0	10		N	Generic	4	11	3	2	2	3	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	2	2
H1290	042	0	1	01	01	H1290_042_0	10		N	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	042	0	1	01	01	H1290_042_0	10		N	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	042	0	1	01	01	H1290_042_0	10		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31					25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1290	043	0	1	01	01	H1290_043_0	10		N	Preferred Generic	4	11	1	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	043	0	1	01	01	H1290_043_0	10		N	Generic	4	11	3	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	043	0	1	01	01	H1290_043_0	10		N	Generic	4	11	3	2	2	3	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	2	2
H1290	043	0	1	01	01	H1290_043_0	10		N	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	043	0	1	01	01	H1290_043_0	10		N	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	043	0	1	01	01	H1290_043_0	10		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31					25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1290	044	1	1	01	01	H1290_044_1	13		Y	Preferred Generic	4	11	1	2	1	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1290	044	1	1	01	01	H1290_044_1	13		Y	Preferred Generic	4	11	1	2	1	3	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H1290	044	1	1	01	01	H1290_044_1	13		Y	Generic	4	11	3	2	2	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1290	044	1	1	01	01	H1290_044_1	13		Y	Generic	4	11	3	2	2	3	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	3
H1290	044	1	1	01	01	H1290_044_1	13		Y	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	45.00	90.00	135.00																			45.00	90.00	112.50																45.00				45.00		1.50			1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1290	044	1	1	01	01	H1290_044_1	13		Y	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	95.00	190.00	285.00																			95.00	190.00	285.00																95.00				95.00		3.17			3.17			3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1290	044	1	1	01	01	H1290_044_1	13		Y	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												
H1290	044	2	1	01	01	H1290_044_2	13		Y	Preferred Generic	4	11	1	2	1	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1290	044	2	1	01	01	H1290_044_2	13		Y	Preferred Generic	4	11	1	2	1	3	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H1290	044	2	1	01	01	H1290_044_2	13		Y	Generic	4	11	3	2	2	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1290	044	2	1	01	01	H1290_044_2	13		Y	Generic	4	11	3	2	2	3	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	3
H1290	044	2	1	01	01	H1290_044_2	13		Y	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	45.00	90.00	135.00																			45.00	90.00	112.50																45.00				45.00		1.50			1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1290	044	2	1	01	01	H1290_044_2	13		Y	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	95.00	190.00	285.00																			95.00	190.00	285.00																95.00				95.00		3.17			3.17			3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1290	044	2	1	01	01	H1290_044_2	13		Y	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												
H1290	044	3	1	01	01	H1290_044_3	13		Y	Preferred Generic	4	11	1	2	1	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1290	044	3	1	01	01	H1290_044_3	13		Y	Preferred Generic	4	11	1	2	1	3	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H1290	044	3	1	01	01	H1290_044_3	13		Y	Generic	4	11	3	2	2	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1290	044	3	1	01	01	H1290_044_3	13		Y	Generic	4	11	3	2	2	3	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	3
H1290	044	3	1	01	01	H1290_044_3	13		Y	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	45.00	90.00	135.00																			45.00	90.00	112.50																45.00				45.00		1.50			1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1290	044	3	1	01	01	H1290_044_3	13		Y	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	95.00	190.00	285.00																			95.00	190.00	285.00																95.00				95.00		3.17			3.17			3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1290	044	3	1	01	01	H1290_044_3	13		Y	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												
H1290	045	0	1	01	01	H1290_045_0	11		Y	Preferred Generic	4	11	1	2	1	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1290	045	0	1	01	01	H1290_045_0	11		Y	Preferred Generic	4	11	1	2	1	3	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H1290	045	0	1	01	01	H1290_045_0	11		Y	Generic	4	11	3	2	2	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1290	045	0	1	01	01	H1290_045_0	11		Y	Generic	4	11	3	2	2	3	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	2	2
H1290	045	0	1	01	01	H1290_045_0	11		Y	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	40.00	80.00	120.00																			40.00	80.00	100.00																40.00				40.00		1.33			1.33			1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1290	045	0	1	01	01	H1290_045_0	11		Y	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	95.00	190.00	285.00																			95.00	190.00	285.00																95.00				95.00		3.17			3.17			3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1290	045	0	1	01	01	H1290_045_0	11		Y	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												
H1290	046	0	1	01	01	H1290_046_0	10		Y	Preferred Generic	4	11	1	2	1	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1290	046	0	1	01	01	H1290_046_0	10		Y	Preferred Generic	4	11	1	2	1	3	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H1290	046	0	1	01	01	H1290_046_0	10		Y	Generic	4	11	3	2	2	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1290	046	0	1	01	01	H1290_046_0	10		Y	Generic	4	11	3	2	2	3	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	3
H1290	046	0	1	01	01	H1290_046_0	10		Y	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	35.00	70.00	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	046	0	1	01	01	H1290_046_0	10		Y	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	100				1	2	30	60	100				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												
H1290	046	0	1	01	01	H1290_046_0	10		Y	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												
H1290	049	0	1	01	01	H1290_049_0	11		Y	Preferred Generic	4	11	1	2	1	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1290	049	0	1	01	01	H1290_049_0	11		Y	Preferred Generic	4	11	1	2	1	3	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H1290	049	0	1	01	01	H1290_049_0	11		Y	Generic	4	11	3	2	2	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	5.00	10.00	15.00																			5.00	10.00	12.50																5.00				5.00		0.17			0.17			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1290	049	0	1	01	01	H1290_049_0	11		Y	Generic	4	11	3	2	2	3	111		01	111		1	30	60	100				1	2	30	60	100				30		31	5.00	10.00	15.00																			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										2	2	2
H1290	049	0	1	01	01	H1290_049_0	11		Y	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	45.00	90.00	135.00																			45.00	90.00	112.50																45.00				45.00		1.50			1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1290	049	0	1	01	01	H1290_049_0	11		Y	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	85.00	170.00	255.00																			85.00	170.00	255.00																85.00				85.00		2.83			2.83			2.74	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1290	049	0	1	01	01	H1290_049_0	11		Y	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												
H1290	050	0	1	01	01	H1290_050_0	10		Y	Preferred Generic	4	11	1	2	1	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1290	050	0	1	01	01	H1290_050_0	10		Y	Preferred Generic	4	11	1	2	1	3	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H1290	050	0	1	01	01	H1290_050_0	10		Y	Generic	4	11	3	2	2	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1290	050	0	1	01	01	H1290_050_0	10		Y	Generic	4	11	3	2	2	3	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	3
H1290	050	0	1	01	01	H1290_050_0	10		Y	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	40.00	80.00	120.00																			40.00	80.00	100.00																40.00				40.00		1.33			1.33			1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1290	050	0	1	01	01	H1290_050_0	10		Y	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	80.00	160.00	240.00																			80.00	160.00	240.00																80.00				80.00		2.67			2.67			2.58	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1290	050	0	1	01	01	H1290_050_0	10		Y	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												
H1290	051	1	1	01	01	H1290_051_1	11		Y	Preferred Generic	4	11	1	2	1	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1290	051	1	1	01	01	H1290_051_1	11		Y	Preferred Generic	4	11	1	2	1	3	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H1290	051	1	1	01	01	H1290_051_1	11		Y	Generic	4	11	3	2	2	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	5.00	10.00	15.00																			0.00	0.00	0.00																5.00				5.00		0.17			0.00			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1290	051	1	1	01	01	H1290_051_1	11		Y	Generic	4	11	3	2	2	3	111		01	111		1	30	60	100				1	2	30	60	100				30		31	5.00	10.00	15.00																			0.00	0.00	0.00																5.00				5.00		0.17			0.00			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	2	2
H1290	051	1	1	01	01	H1290_051_1	11		Y	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	47.00	94.00	141.00																			47.00	94.00	117.50																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1290	051	1	1	01	01	H1290_051_1	11		Y	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	100.00	200.00	300.00																			100.00	200.00	300.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1290	051	1	1	01	01	H1290_051_1	11		Y	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												
H1290	051	2	1	01	01	H1290_051_2	11		Y	Preferred Generic	4	11	1	2	1	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1290	051	2	1	01	01	H1290_051_2	11		Y	Preferred Generic	4	11	1	2	1	3	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H1290	051	2	1	01	01	H1290_051_2	11		Y	Generic	4	11	3	2	2	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	5.00	10.00	15.00																			0.00	0.00	0.00																5.00				5.00		0.17			0.00			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1290	051	2	1	01	01	H1290_051_2	11		Y	Generic	4	11	3	2	2	3	111		01	111		1	30	60	100				1	2	30	60	100				30		31	5.00	10.00	15.00																			0.00	0.00	0.00																5.00				5.00		0.17			0.00			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	2	2
H1290	051	2	1	01	01	H1290_051_2	11		Y	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	47.00	94.00	141.00																			47.00	94.00	117.50																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1290	051	2	1	01	01	H1290_051_2	11		Y	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	100.00	200.00	300.00																			100.00	200.00	300.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1290	051	2	1	01	01	H1290_051_2	11		Y	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												
H1304	004	0	1	04	01	H1304_004_0	8		Y	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	8		Y	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	8		Y	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	100	1	2	30	60	100				30		31								47.00	94.00	117.50					40.00	80.00	100.00					40.00	80.00	100.00																47.00				47.00			1.57	1.33	1.33			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1304	004	0	1	04	01	H1304_004_0	8		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	100	1	2	30	60	100				30		31								100.00	200.00	250.00					100.00	200.00	250.00					100.00	200.00	250.00																100.00				100.00			3.33	3.33	3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1304	004	0	1	04	01	H1304_004_0	8		Y	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											1138.94	33						1138.94	33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1304	011	1	1	04	01	H1304_011_1	9		Y	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	9		Y	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	9		Y	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	100	1	2	30	60	100				30		31								47.00	94.00	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	9		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	100	1	2	30	60	100				30		31								100.00	200.00	300.00					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												
H1304	011	1	1	04	01	H1304_011_1	9		Y	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											1000.89	28						1000.89	28						28																	28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1304	011	2	1	04	01	H1304_011_2	9		Y	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	9		Y	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	9		Y	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	100	1	2	30	60	100				30		31								47.00	94.00	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	9		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	100	1	2	30	60	100				30		31								100.00	200.00	300.00					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												
H1304	011	2	1	04	01	H1304_011_2	9		Y	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											1000.89	28						1000.89	28						28																	28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1304	012	1	1	04	01	H1304_012_1	8		Y	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	8		Y	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	8		Y	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	100	1	2	30	60	100				30		31								47.00	94.00	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	8		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	100	1	2	30	60	100				30		31								100.00	200.00	250.00					100.00	200.00	250.00					100.00	200.00	250.00																100.00				100.00			3.33	3.33	3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1304	012	1	1	04	01	H1304_012_1	8		Y	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											1000.89	29						1000.89	29						29																	29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1304	012	2	1	04	01	H1304_012_2	8		Y	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	8		Y	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	8		Y	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	100	1	2	30	60	100				30		31								47.00	94.00	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	8		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	100	1	2	30	60	100				30		31								100.00	200.00	250.00					100.00	200.00	250.00					100.00	200.00	250.00																100.00				100.00			3.33	3.33	3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1304	012	2	1	04	01	H1304_012_2	8		Y	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											1000.89	29						1000.89	29						29																	29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1347	001	0	1	04	01	H1347_001_0	3		Y	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											10.00		20.00				3.00		6.00				10.00				10.00			0.33	0.10		0.33	0.10	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1347	001	0	1	04	01	H1347_001_0	3		Y	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											20.00		40.00				13.00		26.00				20.00				20.00			0.66	0.43		0.66	0.43	0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1347	001	0	1	04	01	H1347_001_0	3		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	1	2				30		90	30		31								47.00		141.00					40.00		80.00											47.00		94.00				40.00		80.00				47.00				47.00			1.56	1.33		1.56	1.33	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1347	001	0	1	04	01	H1347_001_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	1	2				30		90	30		31								100.00		300.00					93.00		186.00											100.00		200.00				93.00		186.00				100.00				100.00			3.33	3.10		3.33	3.10	3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1347	001	0	1	04	01	H1347_001_0	3		Y	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			30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1347	001	0	1	04	01	H1347_001_0	3		Y	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		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1347	001	0	1	04	01	H1347_001_0	3		Y	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		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
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	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	1	1	01	01	H1350_024_1	4			Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	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	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	1	1	01	01	H1350_024_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	024	1	1	01	01	H1350_024_1	4			Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											990.00	29						990.00	29												29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H1350	024	1	1	01	01	H1350_024_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					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	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	3	1	01	01	H1350_024_3	4			Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					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	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	3	1	01	01	H1350_024_3	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	3	1	01	01	H1350_024_3	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	3	1	01	01	H1350_024_3	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	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	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 Brand, Specialty Tier, Select Care Drugs												
H1350	027	2	1	01	01	H1350_027_2	3			Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					6.00	12.00	18.00											20.00	40.00	60.00				6.00	12.00	18.00				20.00				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	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	027	2	1	01	01	H1350_027_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	027	2	1	01	01	H1350_027_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	027	2	1	01	01	H1350_027_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					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	028	0	1	01	01	H1350_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								5.00	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	028	0	1	01	01	H1350_028_0	4			Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					12.00	24.00	36.00											20.00	40.00	60.00				12.00	24.00	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	028	0	1	01	01	H1350_028_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 Drug, Specialty Tier, Select Care Drugs												
H1350	028	0	1	01	01	H1350_028_0	4			Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	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	028	0	1	01	01	H1350_028_0	4			Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											990.00	33						990.00	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1350	028	0	1	01	01	H1350_028_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								5.00	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	029	0	1	01	01	H1350_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								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	029	0	1	01	01	H1350_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					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	029	0	1	01	01	H1350_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	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	029	0	1	01	01	H1350_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	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	029	0	1	01	01	H1350_029_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 Drug, Specialty Tier, Select Care Drugs												
H1350	029	0	1	01	01	H1350_029_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								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	030	0	1	01	01	H1350_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					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	030	0	1	01	01	H1350_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					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	030	0	1	01	01	H1350_030_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	030	0	1	01	01	H1350_030_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	030	0	1	01	01	H1350_030_0	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	030	0	1	01	01	H1350_030_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					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												
H1352	003	0	1	01	01	H1352_003_0	6		Y	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	6		Y	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	6		Y	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	6		Y	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	6		Y	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	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	6		Y	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	100.00	200.00	300.00																			100.00	200.00	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	6		Y	Specialty Tier	4	11	1	3	5	1	010		01	010		1	30								30						30		31	100.00			1320.00	33																	100.00			33															100.00		33		100.00	33	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	6		Y	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	6		Y	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	6		Y	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	6		Y	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	6		Y	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	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	6		Y	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	100.00	200.00	300.00																			100.00	200.00	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	6		Y	Specialty Tier	4	11	1	3	5	1	010		01	010		1	30								30						30		31	100.00			1320.00	33																	100.00			33															100.00		33		100.00	33	3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1353	005	0	1	01	01	H1353_005_0	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												
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								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			0.5	0.13		0.5	0.13	0.48	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								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00				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												
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								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												
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	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, 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	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												
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	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, 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											98.33	42	42	42				98.33	42	42	42										42	42	42				42	42	42			42			42								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			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	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		Y	Preferred Generic	4	11	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								4.00	8.00	12.00					0.00	0.00	0.00					4.00	8.00	10.00																4.00				4.00			0.13	0.00	0.13			0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1365	001	0	1	04	01	H1365_001_0	6		Y	Generic	4	11	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								18.00	36.00	54.00					10.00	20.00	30.00					18.00	36.00	45.00																18.00				18.00			0.60	0.33	0.60			0.58	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1365	001	0	1	04	01	H1365_001_0	6		Y	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					40.00	80.00	120.00					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		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	300.00					95.00	190.00	285.00					100.00	200.00	250.00																100.00				100.00			3.33	3.17	3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1365	001	0	1	04	01	H1365_001_0	6		Y	Specialty Tier	4	10	1	1	5	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											600.00	33	33	33				600.00	33	33	33				33	33	33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1365	004	1	1	04	01	H1365_004_1	5		Y	Preferred Generic	4	11	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								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		Y	Generic	4	11	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								18.00	36.00	54.00					10.00	20.00	30.00					18.00	36.00	45.00																18.00				18.00			0.60	0.33	0.60			0.58	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1365	004	1	1	04	01	H1365_004_1	5		Y	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					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		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	300.00					95.00	190.00	285.00					100.00	200.00	250.00																100.00				100.00			3.33	3.17	3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1365	004	1	1	04	01	H1365_004_1	5		Y	Specialty Tier	4	10	1	1	5	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											600.00	28	28	28				600.00	28	28	28				28	28	28															28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1365	004	2	1	04	01	H1365_004_2	5		Y	Preferred Generic	4	11	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								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		Y	Generic	4	11	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								18.00	36.00	54.00					10.00	20.00	30.00					18.00	36.00	45.00																18.00				18.00			0.60	0.33	0.60			0.58	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1365	004	2	1	04	01	H1365_004_2	5		Y	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								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		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	300.00					95.00	190.00	285.00					100.00	200.00	250.00																100.00				100.00			3.33	3.17	3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1365	004	2	1	04	01	H1365_004_2	5		Y	Specialty Tier	4	10	1	1	5	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											600.00	28	28	28				600.00	28	28	28				28	28	28															28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1372	002	0	1	01	01	H1372_002_0	8		Y	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 Brand, Specialty Tier												
H1372	002	0	1	01	01	H1372_002_0	8		Y	Generic	4	01	1	2	2	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	15.00	30.00	45.00																			15.00	30.00	45.00																	15.00			15.00		0.50			0.50			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1372	002	0	1	01	01	H1372_002_0	8		Y	Preferred Brand	4	10	1	2	3	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	45.00	90.00	135.00																			45.00	90.00	135.00																	45.00			45.00		1.50			1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1372	002	0	1	01	01	H1372_002_0	8		Y	Non-Preferred Brand	4	10	1	2	4	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	95.00	190.00	285.00																			95.00	190.00	285.00																	95.00			95.00		3.17			3.17			3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1372	002	0	1	01	01	H1372_002_0	8		Y	Specialty Tier	4	01	1	1	5	1	010		10	010		1	30								30							10	31					28																				28																		28		28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1372	003	0	1	01	01	H1372_003_0	9		Y	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 Brand, Specialty Tier												
H1372	003	0	1	01	01	H1372_003_0	9		Y	Generic	4	01	1	2	2	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	15.00	30.00	45.00																			15.00	30.00	45.00																	15.00			15.00		0.50			0.50			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1372	003	0	1	01	01	H1372_003_0	9		Y	Preferred Brand	4	10	1	2	3	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	45.00	90.00	135.00																			45.00	90.00	135.00																	45.00			45.00		1.50			1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1372	003	0	1	01	01	H1372_003_0	9		Y	Non-Preferred Brand	4	10	1	2	4	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	95.00	190.00	285.00																			95.00	190.00	285.00																	95.00			95.00		3.17			3.17			3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1372	003	0	1	01	01	H1372_003_0	9		Y	Specialty Tier	4	01	1	1	5	1	010		10	010		1	30								30							10	31					28																				28																		28		28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1395	002	0	1	04	01	H1395_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												
H1395	002	0	1	04	01	H1395_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												
H1395	002	0	1	04	01	H1395_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												
H1395	002	0	1	04	01	H1395_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											71.74	45	45	45				68.56	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	4			Specialty Tier	4	11	1	1	5	1		010	01		010	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	4			Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			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	4			Preferred Generic	4	11	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								19.00	38.00	57.00					0.00	0.00	0.00											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												
H1395	003	0	1	04	01	H1395_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					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												
H1395	003	0	1	04	01	H1395_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	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, Select Care Drugs												
H1395	003	0	1	04	01	H1395_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											98.79	47	47	47				98.79	47	47	47										47	47	47				47	47	47			47			47								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1395	003	0	1	04	01	H1395_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												
H1395	003	0	1	04	01	H1395_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												
H1415	021	0	1	02	01	H1415_021_0	5			Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								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	5			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				0.00	0.00	0.00				12.00				12.00			0.40	0.13		0.40	0.00	0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1415	021	0	1	02	01	H1415_021_0	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												
H1415	021	0	1	02	01	H1415_021_0	5			Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											98.85	45	45	45				85.89	45	45	45										45	45	45				45	45	45			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1415	021	0	1	02	01	H1415_021_0	5			Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											760.82	33						828.77	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1415	024	0	1	01	01	H1415_024_0	5		Y	Preferred Generic	4	01	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												
H1415	024	0	1	01	01	H1415_024_0	5		Y	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00				20.00				20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1415	024	0	1	01	01	H1415_024_0	5		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1415	024	0	1	01	01	H1415_024_0	5		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1415	024	0	1	01	01	H1415_024_0	5		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											785.85	33						723.08	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											66.57	50	50	50				63.90	48	48	48										50	50	50				48	48	48			50			50								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	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, 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	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												
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	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, 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											97.15	50	50	50				97.15	50	50	50										50	50	50				50	50	50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
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			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	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								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00				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												
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	041	0	1	01	01	H1416_041_0	5			Preferred Generic	3	11	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								19.00	38.00	57.00					0.00	0.00	0.00											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												
H1416	041	0	1	01	01	H1416_041_0	5			Generic	3	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					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												
H1416	041	0	1	01	01	H1416_041_0	5			Preferred Brand	3	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	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, Select Care Drugs												
H1416	041	0	1	01	01	H1416_041_0	5			Non-Preferred Drug	3	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											82.27	45	45	45				82.27	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	041	0	1	01	01	H1416_041_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												
H1416	041	0	1	01	01	H1416_041_0	5			Select Care Drugs	3	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			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	4			Preferred Generic	3	11	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								19.00	38.00	57.00					0.00	0.00	0.00											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												
H1416	042	0	1	01	01	H1416_042_0	4			Generic	3	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					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												
H1416	042	0	1	01	01	H1416_042_0	4			Preferred Brand	3	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	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, Select Care Drugs												
H1416	042	0	1	01	01	H1416_042_0	4			Non-Preferred Drug	3	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											99.16	47	47	47				99.16	47	47	47										47	47	47				47	47	47			47			47								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1416	042	0	1	01	01	H1416_042_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, Select Care Drugs												
H1416	042	0	1	01	01	H1416_042_0	4			Select Care Drugs	3	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred 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	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					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												
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					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	84.00				47.00				47.00			1.57	1.4		1.57	1.4	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, 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					94.00	188.00	282.00											99.00	198.00	297.00				94.00	188.00	188.00				99.00				99.00			3.3	3.13		3.3	3.13	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			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	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								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00				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												
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											74.13	47	47	47				70.98	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								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00				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												
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					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												
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					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	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					35.00	70.00	105.00											40.00	80.00	120.00				35.00	70.00	70.00				40.00				40.00			1.33	1.17		1.33	1.17	1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, 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					94.00	188.00	282.00											99.00	198.00	297.00				94.00	188.00	188.00				99.00				99.00			3.3	3.13		3.3	3.13	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			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	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								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00				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												
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	068	0	1	01	01	H1416_068_0	5			Preferred Generic	3	11	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								19.00	38.00	57.00					0.00	0.00	0.00											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												
H1416	068	0	1	01	01	H1416_068_0	5			Generic	3	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					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												
H1416	068	0	1	01	01	H1416_068_0	5			Preferred Brand	3	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	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, Select Care Drugs												
H1416	068	0	1	01	01	H1416_068_0	5			Non-Preferred Drug	3	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											97.64	45	45	45				97.64	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	068	0	1	01	01	H1416_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												
H1416	068	0	1	01	01	H1416_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								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			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								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												
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								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
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											94.08	50	50	50				90.32	48	48	48										50	50	50				48	48	48			50			50								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								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												
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								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
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											78.63	47	47	47				75.28	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								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00				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												
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								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00				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
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											82.25	46	46	46				78.68	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	075	0	1	02	01	H1416_075_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	075	0	1	02	01	H1416_075_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												
H1416	075	0	1	02	01	H1416_075_0	4			Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											47.00	94.00	141.00				37.00	74.00	74.00				47.00				47.00			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	4			Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											95.99	48	48	48				91.99	46	46	46										48	48	48				46	46	46			48			48								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1416	075	0	1	02	01	H1416_075_0	4			Specialty Tier	4	11	1	1	5	1		010	01		010	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	4			Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			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	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	076	0	1	02	01	H1416_076_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												
H1416	076	0	1	02	01	H1416_076_0	4			Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											47.00	94.00	141.00				37.00	74.00	74.00				47.00				47.00			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	4			Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											95.78	49	49	49				91.88	47	47	47										49	49	49				47	47	47			49			49								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1416	076	0	1	02	01	H1416_076_0	4			Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1416	076	0	1	02	01	H1416_076_0	4			Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			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	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	077	0	1	02	01	H1416_077_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												
H1416	077	0	1	02	01	H1416_077_0	4			Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											47.00	94.00	141.00				37.00	74.00	74.00				47.00				47.00			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	4			Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											80.54	45	45	45				76.96	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	4			Specialty Tier	4	11	1	1	5	1		010	01		010	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	4			Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1416	078	0	1	01	01	H1416_078_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	078	0	1	01	01	H1416_078_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												
H1416	078	0	1	01	01	H1416_078_0	4			Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											47.00	94.00	141.00				37.00	74.00	74.00				47.00				47.00			1.57	1.23		1.57	1.23	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1416	078	0	1	01	01	H1416_078_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											83.07	45	45	45				79.38	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	078	0	1	01	01	H1416_078_0	4			Specialty Tier	4	11	1	1	5	1		010	01		010	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	078	0	1	01	01	H1416_078_0	4			Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1416	079	0	1	01	01	H1416_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								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1416	079	0	1	01	01	H1416_079_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												
H1416	079	0	1	01	01	H1416_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												
H1416	079	0	1	01	01	H1416_079_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											89.33	45	45	45				85.36	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	079	0	1	01	01	H1416_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												
H1416	079	0	1	01	01	H1416_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												
H1416	080	0	1	01	01	H1416_080_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												
H1416	080	0	1	01	01	H1416_080_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												
H1416	080	0	1	01	01	H1416_080_0	4			Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											47.00	94.00	141.00				37.00	74.00	74.00				47.00				47.00			1.57	1.23		1.57	1.23	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1416	080	0	1	01	01	H1416_080_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											86.89	45	45	45				83.02	43	43	43										45	45	45				43	43	43			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1416	080	0	1	01	01	H1416_080_0	4			Specialty Tier	4	11	1	1	5	1		010	01		010	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	080	0	1	01	01	H1416_080_0	4			Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1423	001	0	1	01	01	H1423_001_0	5		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								5.00	10.00	15.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.15	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1423	001	0	1	01	01	H1423_001_0	5		N	Preferred Generic	4	01	1	2	1	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								5.00	10.00	15.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.15	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H1423	001	0	1	01	01	H1423_001_0	5		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								12.50	25.00	37.50					7.50	15.00	22.50					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	5		N	Generic	4	01	1	2	2	3		111	01	111		1				30	60	90	2	2	30	60	90				30		34								12.50	25.00	37.50					7.50	15.00	22.50					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	5		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								45.00	90.00	135.00					40.00	80.00	120.00					40.00	80.00	80.00																45.00				45.00			1.50	1.33	1.33			1.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1423	001	0	1	01	01	H1423_001_0	5		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								95.00	190.00	285.00					85.00	170.00	255.00					85.00	170.00	170.00																95.00				95.00			3.17	2.83	2.83			2.79	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1423	001	0	1	01	01	H1423_001_0	5		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1423	001	0	1	01	01	H1423_001_0	5		N	Select Care Drugs	4	11	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1423	001	0	1	01	01	H1423_001_0	5		N	Select Care Drugs	4	11	1	2	6	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	3	
H1423	002	0	1	01	01	H1423_002_0	5		Y	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								5.00	10.00	15.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.15	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1423	002	0	1	01	01	H1423_002_0	5		Y	Preferred Generic	4	01	1	2	1	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								5.00	10.00	15.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.15	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H1423	002	0	1	01	01	H1423_002_0	5		Y	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	5		Y	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	5		Y	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	5		Y	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	5		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								95.00	190.00	285.00					85.00	170.00	255.00					85.00	170.00	170.00																95.00				95.00			3.17	2.83	2.83			2.79	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1423	002	0	1	01	01	H1423_002_0	5		Y	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1423	002	0	1	01	01	H1423_002_0	5		Y	Select Care Drugs	4	11	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1423	002	0	1	01	01	H1423_002_0	5		Y	Select Care Drugs	4	11	1	2	6	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	3	
H1423	003	0	1	01	01	H1423_003_0	5		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								5.00	10.00	15.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.15	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1423	003	0	1	01	01	H1423_003_0	5		N	Preferred Generic	4	01	1	2	1	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								5.00	10.00	15.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.15	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H1423	003	0	1	01	01	H1423_003_0	5		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								12.50	25.00	37.50					7.50	15.00	22.50					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	5		N	Generic	4	01	1	2	2	3		111	01	111		1				30	60	90	2	2	30	60	90				30		34								12.50	25.00	37.50					7.50	15.00	22.50					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	5		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								45.00	90.00	135.00					40.00	80.00	120.00					40.00	80.00	80.00																45.00				45.00			1.50	1.33	1.33			1.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1423	003	0	1	01	01	H1423_003_0	5		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								95.00	190.00	285.00					85.00	170.00	255.00					85.00	170.00	170.00																95.00				95.00			3.17	2.83	2.83			2.79	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1423	003	0	1	01	01	H1423_003_0	5		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1423	003	0	1	01	01	H1423_003_0	5		N	Select Care Drugs	4	11	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1423	003	0	1	01	01	H1423_003_0	5		N	Select Care Drugs	4	11	1	2	6	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	3	
H1423	004	0	1	01	01	H1423_004_0	5			Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								5.00	10.00	15.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.15	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1423	004	0	1	01	01	H1423_004_0	5			Preferred Generic	4	01	1	2	1	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								5.00	10.00	15.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.15	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H1423	004	0	1	01	01	H1423_004_0	5			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	5			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	5			Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								45.00	90.00	135.00					40.00	80.00	120.00					40.00	80.00	80.00																45.00				45.00			1.50	1.33	1.33			1.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1423	004	0	1	01	01	H1423_004_0	5			Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								95.00	190.00	285.00					85.00	170.00	255.00					85.00	170.00	170.00																95.00				95.00			3.17	2.83	2.83			2.79	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1423	004	0	1	01	01	H1423_004_0	5			Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1423	004	0	1	01	01	H1423_004_0	5			Select Care Drugs	4	11	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1423	004	0	1	01	01	H1423_004_0	5			Select Care Drugs	4	11	1	2	6	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	3	
H1423	005	0	1	01	01	H1423_005_0	5			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	5			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	5			Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								45.00	90.00	135.00					40.00	80.00	120.00					40.00	80.00	80.00																45.00				45.00			1.50	1.33	1.33			1.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1423	005	0	1	01	01	H1423_005_0	5			Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								95.00	190.00	285.00					90.00	180.00	270.00					90.00	180.00	180.00																95.00				95.00			3.17	3.00	3.00			2.79	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1423	005	0	1	01	01	H1423_005_0	5			Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1423	005	0	1	01	01	H1423_005_0	5			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	5		N	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		34	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1423	007	0	1	01	01	H1423_007_0	5		N	Preferred Generic	4	01	1	2	1	3	111		01	111		1	30	60	90				1	2	30	60	90				30		34	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H1423	007	0	1	01	01	H1423_007_0	5		N	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				2	2	30	60	90				30		34	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	5		N	Generic	4	01	1	2	2	3	111		01	111		1	30	60	90				2	2	30	60	90				30		34	7.50	15.00	22.50																			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	5		N	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				2	2	30	60	90				30		34	40.00	80.00	120.00																			40.00	80.00	80.00																40.00				40.00		1.33			1.33			1.18	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1423	007	0	1	01	01	H1423_007_0	5		N	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	90				2	2	30	60	90				30		34	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	5		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		34					33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1423	007	0	1	01	01	H1423_007_0	5		N	Select Care Drugs	4	11	1	2	6	1	111		01	111		1	30	60	100				1	2	30	60	100				30		34	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1423	007	0	1	01	01	H1423_007_0	5		N	Select Care Drugs	4	11	1	2	6	3	111		01	111		1	30	60	100				1	2	30	60	100				30		34	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	3	
H1423	008	0	1	01	01	H1423_008_0	5		N	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		34	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1423	008	0	1	01	01	H1423_008_0	5		N	Preferred Generic	4	01	1	2	1	3	111		01	111		1	30	60	90				1	2	30	60	90				30		34	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H1423	008	0	1	01	01	H1423_008_0	5		N	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				2	2	30	60	90				30		34	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	5		N	Generic	4	01	1	2	2	3	111		01	111		1	30	60	90				2	2	30	60	90				30		34	7.50	15.00	22.50																			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	5		N	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				2	2	30	60	90				30		34	40.00	80.00	120.00																			40.00	80.00	80.00																40.00				40.00		1.33			1.33			1.18	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1423	008	0	1	01	01	H1423_008_0	5		N	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	90				2	2	30	60	90				30		34	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	5		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		34					33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1423	008	0	1	01	01	H1423_008_0	5		N	Select Care Drugs	4	11	1	2	6	1	111		01	111		1	30	60	100				1	2	30	60	100				30		34	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1423	008	0	1	01	01	H1423_008_0	5		N	Select Care Drugs	4	11	1	2	6	3	111		01	111		1	30	60	100				1	2	30	60	100				30		34	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	3	
H1423	009	0	1	01	01	H1423_009_0	5		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1423	009	0	1	01	01	H1423_009_0	5		N	Preferred Generic	4	01	1	2	1	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1423	009	0	1	01	01	H1423_009_0	5		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								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	5		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								45.00	90.00	135.00					40.00	80.00	120.00					40.00	80.00	80.00																45.00				45.00			1.50	1.33	1.33			1.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1423	009	0	1	01	01	H1423_009_0	5		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								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	5		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1426	001	0	1	01	01	H1426_001_0	6		Y	Preferred Generic	4	01	1	2	1	1	110		01	110		1	30		90				2	2	30		90				30		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1426	001	0	1	01	01	H1426_001_0	6		Y	Preferred Generic	4	01	1	2	1	3	110		01	110		1	30		90				2	2	30		90				30		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1426	001	0	1	01	01	H1426_001_0	6		Y	Generic	4	01	3	2	2	1	110		01	110		1	30		90				2	2	30		90				30		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1426	001	0	1	01	01	H1426_001_0	6		Y	Generic	4	01	3	2	2	3	110		01	110		1	30		90				2	2	30		90				30		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H1426	001	0	1	01	01	H1426_001_0	6		Y	Preferred Brand	4	10	1	2	3	1	110		01	110		1	30		90				2	2	30		90				30		31	30.00		60.00																			30.00		60.00																30.00				30.00		1.00			1.00			0.97	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1426	001	0	1	01	01	H1426_001_0	6		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01	110		1	30		90				2	2	30		90				30		31	90.00		180.00																			90.00		180.00																90.00				90.00		3.00			3.00			2.90	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1426	001	0	1	01	01	H1426_001_0	6		Y	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				361.89	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1426	002	0	1	01	01	H1426_002_0	5		Y	Preferred Generic	4	01	1	2	1	1	110		01	110		1	30		90				2	2	30		90				30		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1426	002	0	1	01	01	H1426_002_0	5		Y	Preferred Generic	4	01	1	2	1	3	110		01	110		1	30		90				2	2	30		90				30		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1426	002	0	1	01	01	H1426_002_0	5		Y	Generic	4	01	3	2	2	1	110		01	110		1	30		90				2	2	30		90				30		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1426	002	0	1	01	01	H1426_002_0	5		Y	Preferred Brand	4	10	1	2	3	1	110		01	110		1	30		90				2	2	30		90				30		31	35.00		70.00																			35.00		70.00																35.00				35.00		1.17			1.17			1.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1426	002	0	1	01	01	H1426_002_0	5		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01	110		1	30		90				2	2	30		90				30		31	90.00		180.00																			90.00		180.00																90.00				90.00		3.00			3.00			2.90	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1426	002	0	1	01	01	H1426_002_0	5		Y	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				361.89	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1463	003	0	1	01	01	H1463_003_0	5		Y	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	2.00	4.00	6.00																			2.00	4.00	4.00																2.00				2.00		0.07			0.07			0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1463	003	0	1	01	01	H1463_003_0	5		Y	Preferred Generic	4	01	1	2	1	3	111		01	111		1	30	60	90				1	2	30	60	90				30		31	2.00	4.00	6.00																			2.00	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	5		Y	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	15.00	30.00	45.00																			15.00	30.00	30.00																15.00				15.00		0.50			0.50			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1463	003	0	1	01	01	H1463_003_0	5		Y	Preferred Brand	4	10	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	94.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1463	003	0	1	01	01	H1463_003_0	5		Y	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												
H1463	003	0	1	01	01	H1463_003_0	5		Y	Specialty Tier	4	11	1	1	5	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31					33	33	33																		33	33	33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1463	009	0	1	01	01	H1463_009_0	5		Y	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	2.00	4.00	6.00																			2.00	4.00	4.00																2.00				2.00		0.07			0.07			0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1463	009	0	1	01	01	H1463_009_0	5		Y	Preferred Generic	4	01	1	2	1	3	111		01	111		1	30	60	90				1	2	30	60	90				30		31	2.00	4.00	6.00																			2.00	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	5		Y	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	15.00	30.00	45.00																			15.00	30.00	30.00																15.00				15.00		0.50			0.50			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1463	009	0	1	01	01	H1463_009_0	5		Y	Preferred Brand	4	10	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	94.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1463	009	0	1	01	01	H1463_009_0	5		Y	Non-Preferred Drug	4	11	1	1	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31				81.89	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	5		Y	Specialty Tier	4	11	1	1	5	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31					33	33	33																		33	33	33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1463	010	0	1	01	01	H1463_010_0	5		Y	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	2.00	4.00	6.00																			2.00	4.00	4.00																2.00				2.00		0.07			0.07			0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1463	010	0	1	01	01	H1463_010_0	5		Y	Preferred Generic	4	01	1	2	1	3	111		01	111		1	30	60	90				1	2	30	60	90				30		31	2.00	4.00	6.00																			2.00	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	5		Y	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	15.00	30.00	45.00																			15.00	30.00	30.00																15.00				15.00		0.50			0.50			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1463	010	0	1	01	01	H1463_010_0	5		Y	Preferred Brand	4	10	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	94.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1463	010	0	1	01	01	H1463_010_0	5		Y	Non-Preferred Drug	4	11	1	1	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31				64.76	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	5		Y	Specialty Tier	4	11	1	1	5	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31					33	33	33																		33	33	33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1463	015	0	1	02	01	H1463_015_0	5		Y	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	2.00	4.00	6.00																			2.00	4.00	4.00																2.00				2.00		0.07			0.07			0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1463	015	0	1	02	01	H1463_015_0	5		Y	Preferred Generic	4	01	1	2	1	3	111		01	111		1	30	60	90				1	2	30	60	90				30		31	2.00	4.00	6.00																			2.00	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	5		Y	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	15.00	30.00	45.00																			15.00	30.00	30.00																15.00				15.00		0.50			0.50			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1463	015	0	1	02	01	H1463_015_0	5		Y	Preferred Brand	4	10	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	94.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1463	015	0	1	02	01	H1463_015_0	5		Y	Non-Preferred Drug	4	11	1	1	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31				67.87	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	5		Y	Specialty Tier	4	11	1	1	5	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31					33	33	33																		33	33	33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1463	017	0	1	02	01	H1463_017_0	5		Y	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	2.00	4.00	6.00																			2.00	4.00	4.00																2.00				2.00		0.07			0.07			0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1463	017	0	1	02	01	H1463_017_0	5		Y	Preferred Generic	4	01	1	2	1	3	111		01	111		1	30	60	90				1	2	30	60	90				30		31	2.00	4.00	6.00																			2.00	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	5		Y	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	15.00	30.00	45.00																			15.00	30.00	30.00																15.00				15.00		0.50			0.50			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1463	017	0	1	02	01	H1463_017_0	5		Y	Preferred Brand	4	10	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	94.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1463	017	0	1	02	01	H1463_017_0	5		Y	Non-Preferred Drug	4	11	1	1	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31				60.56	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	5		Y	Specialty Tier	4	11	1	1	5	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31					33	33	33																		33	33	33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1463	019	0	1	02	01	H1463_019_0	5		Y	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	2.00	4.00	6.00																			2.00	4.00	4.00																2.00				2.00		0.07			0.07			0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1463	019	0	1	02	01	H1463_019_0	5		Y	Preferred Generic	4	01	1	2	1	3	111		01	111		1	30	60	90				1	2	30	60	90				30		31	2.00	4.00	6.00																			2.00	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	5		Y	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	15.00	30.00	45.00																			15.00	30.00	30.00																15.00				15.00		0.50			0.50			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1463	019	0	1	02	01	H1463_019_0	5		Y	Preferred Brand	4	10	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	94.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1463	019	0	1	02	01	H1463_019_0	5		Y	Non-Preferred Drug	4	11	1	1	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31				56.66	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	5		Y	Specialty Tier	4	11	1	1	5	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31					33	33	33																		33	33	33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1463	021	0	1	01	01	H1463_021_0	5		Y	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	2.00	4.00	6.00																			2.00	4.00	4.00																2.00				2.00		0.07			0.07			0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1463	021	0	1	01	01	H1463_021_0	5		Y	Preferred Generic	4	01	1	2	1	3	111		01	111		1	30	60	90				1	2	30	60	90				30		31	2.00	4.00	6.00																			2.00	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	5		Y	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	15.00	30.00	45.00																			15.00	30.00	30.00																15.00				15.00		0.50			0.50			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1463	021	0	1	01	01	H1463_021_0	5		Y	Preferred Brand	4	10	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	94.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1463	021	0	1	01	01	H1463_021_0	5		Y	Non-Preferred Drug	4	11	1	1	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31				74.17	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	5		Y	Specialty Tier	4	11	1	1	5	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31					33	33	33																		33	33	33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1463	022	0	1	02	01	H1463_022_0	5		Y	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	2.00	4.00	6.00																			2.00	4.00	4.00																2.00				2.00		0.07			0.07			0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1463	022	0	1	02	01	H1463_022_0	5		Y	Preferred Generic	4	01	1	2	1	3	111		01	111		1	30	60	90				1	2	30	60	90				30		31	2.00	4.00	6.00																			2.00	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	5		Y	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	15.00	30.00	45.00																			15.00	30.00	30.00																15.00				15.00		0.50			0.50			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1463	022	0	1	02	01	H1463_022_0	5		Y	Preferred Brand	4	10	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	94.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1463	022	0	1	02	01	H1463_022_0	5		Y	Non-Preferred Drug	4	11	1	1	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31				54.00	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	5		Y	Specialty Tier	4	11	1	1	5	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31					33	33	33																		33	33	33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1463	023	0	1	01	01	H1463_023_0	5		Y	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	2.00	4.00	6.00																			2.00	4.00	4.00																2.00				2.00		0.07			0.07			0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1463	023	0	1	01	01	H1463_023_0	5		Y	Preferred Generic	4	01	1	2	1	3	111		01	111		1	30	60	90				1	2	30	60	90				30		31	2.00	4.00	6.00																			2.00	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	5		Y	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	15.00	30.00	45.00																			15.00	30.00	30.00																15.00				15.00		0.50			0.50			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1463	023	0	1	01	01	H1463_023_0	5		Y	Preferred Brand	4	10	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	94.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1463	023	0	1	01	01	H1463_023_0	5		Y	Non-Preferred Drug	4	11	1	1	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31				61.88	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	5		Y	Specialty Tier	4	11	1	1	5	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31					33	33	33																		33	33	33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1463	024	0	1	01	01	H1463_024_0	5		Y	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	2.00	4.00	6.00																			2.00	4.00	4.00																2.00				2.00		0.07			0.07			0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1463	024	0	1	01	01	H1463_024_0	5		Y	Preferred Generic	4	01	1	2	1	3	111		01	111		1	30	60	90				1	2	30	60	90				30		31	2.00	4.00	6.00																			2.00	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	5		Y	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	15.00	30.00	45.00																			15.00	30.00	30.00																15.00				15.00		0.50			0.50			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1463	024	0	1	01	01	H1463_024_0	5		Y	Preferred Brand	4	10	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	94.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1463	024	0	1	01	01	H1463_024_0	5		Y	Non-Preferred Drug	4	11	1	1	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31				64.98	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	5		Y	Specialty Tier	4	11	1	1	5	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31					33	33	33																		33	33	33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1463	025	0	1	02	01	H1463_025_0	5		Y	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	2.00	4.00	6.00																			2.00	4.00	4.00																2.00				2.00		0.07			0.07			0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1463	025	0	1	02	01	H1463_025_0	5		Y	Preferred Generic	4	01	1	2	1	3	111		01	111		1	30	60	90				1	2	30	60	90				30		31	2.00	4.00	6.00																			2.00	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	5		Y	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	15.00	30.00	45.00																			15.00	30.00	30.00																15.00				15.00		0.50			0.50			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1463	025	0	1	02	01	H1463_025_0	5		Y	Preferred Brand	4	10	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	94.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1463	025	0	1	02	01	H1463_025_0	5		Y	Non-Preferred Drug	4	11	1	1	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31				60.72	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	5		Y	Specialty Tier	4	11	1	1	5	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31					33	33	33																		33	33	33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1463	035	0	1	01	01	H1463_035_0	5		Y	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	2.00	4.00	6.00																			2.00	4.00	4.00																2.00				2.00		0.07			0.07			0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1463	035	0	1	01	01	H1463_035_0	5		Y	Preferred Generic	4	01	1	2	1	3	111		01	111		1	30	60	90				1	2	30	60	90				30		31	2.00	4.00	6.00																			2.00	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	5		Y	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	15.00	30.00	45.00																			15.00	30.00	30.00																15.00				15.00		0.50			0.50			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1463	035	0	1	01	01	H1463_035_0	5		Y	Preferred Brand	4	10	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	94.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1463	035	0	1	01	01	H1463_035_0	5		Y	Non-Preferred Drug	4	11	1	1	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31				60.53	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	5		Y	Specialty Tier	4	11	1	1	5	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31					33	33	33																		33	33	33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1463	036	0	1	02	01	H1463_036_0	5		Y	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	2.00	4.00	6.00																			2.00	4.00	4.00																2.00				2.00		0.07			0.07			0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1463	036	0	1	02	01	H1463_036_0	5		Y	Preferred Generic	4	01	1	2	1	3	111		01	111		1	30	60	90				1	2	30	60	90				30		31	2.00	4.00	6.00																			2.00	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	5		Y	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	15.00	30.00	45.00																			15.00	30.00	30.00																15.00				15.00		0.50			0.50			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1463	036	0	1	02	01	H1463_036_0	5		Y	Preferred Brand	4	10	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	94.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1463	036	0	1	02	01	H1463_036_0	5		Y	Non-Preferred Drug	4	11	1	1	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31				58.49	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	5		Y	Specialty Tier	4	11	1	1	5	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31					33	33	33																		33	33	33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1463	039	0	1	01	01	H1463_039_0	5		Y	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	2.00	4.00	6.00																			2.00	4.00	4.00																2.00				2.00		0.07			0.07			0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1463	039	0	1	01	01	H1463_039_0	5		Y	Preferred Generic	4	01	1	2	1	3	111		01	111		1	30	60	90				1	2	30	60	90				30		31	2.00	4.00	6.00																			2.00	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	5		Y	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	15.00	30.00	45.00																			15.00	30.00	30.00																15.00				15.00		0.50			0.50			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1463	039	0	1	01	01	H1463_039_0	5		Y	Preferred Brand	4	10	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	94.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1463	039	0	1	01	01	H1463_039_0	5		Y	Non-Preferred Drug	4	11	1	1	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31				71.42	50	50	50																		50	50	50															50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1463	039	0	1	01	01	H1463_039_0	5		Y	Specialty Tier	4	11	1	1	5	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31					33	33	33																		33	33	33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1463	040	0	1	02	01	H1463_040_0	5		Y	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	2.00	4.00	6.00																			2.00	4.00	4.00																2.00				2.00		0.07			0.07			0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1463	040	0	1	02	01	H1463_040_0	5		Y	Preferred Generic	4	01	1	2	1	3	111		01	111		1	30	60	90				1	2	30	60	90				30		31	2.00	4.00	6.00																			2.00	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	5		Y	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	15.00	30.00	45.00																			15.00	30.00	30.00																15.00				15.00		0.50			0.50			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1463	040	0	1	02	01	H1463_040_0	5		Y	Preferred Brand	4	10	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	94.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1463	040	0	1	02	01	H1463_040_0	5		Y	Non-Preferred Drug	4	11	1	1	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31				89.43	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	5		Y	Specialty Tier	4	11	1	1	5	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31					31	31	31																		31	31	31															31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1463	041	0	1	01	01	H1463_041_0	5		Y	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	2.00	4.00	6.00																			2.00	4.00	4.00																2.00				2.00		0.07			0.07			0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1463	041	0	1	01	01	H1463_041_0	5		Y	Preferred Generic	4	01	1	2	1	3	111		01	111		1	30	60	90				1	2	30	60	90				30		31	2.00	4.00	6.00																			2.00	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	5		Y	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	15.00	30.00	45.00																			15.00	30.00	30.00																15.00				15.00		0.50			0.50			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1463	041	0	1	01	01	H1463_041_0	5		Y	Preferred Brand	4	10	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	94.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1463	041	0	1	01	01	H1463_041_0	5		Y	Non-Preferred Drug	4	11	1	1	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31				87.89	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	5		Y	Specialty Tier	4	11	1	1	5	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31					31	31	31																		31	31	31															31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1463	042	0	1	02	01	H1463_042_0	5		Y	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	2.00	4.00	6.00																			2.00	4.00	4.00																2.00				2.00		0.07			0.07			0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1463	042	0	1	02	01	H1463_042_0	5		Y	Preferred Generic	4	01	1	2	1	3	111		01	111		1	30	60	90				1	2	30	60	90				30		31	2.00	4.00	6.00																			2.00	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	5		Y	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	15.00	30.00	45.00																			15.00	30.00	30.00																15.00				15.00		0.50			0.50			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1463	042	0	1	02	01	H1463_042_0	5		Y	Preferred Brand	4	10	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	94.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1463	042	0	1	02	01	H1463_042_0	5		Y	Non-Preferred Drug	4	11	1	1	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31				81.21	50	50	50																		50	50	50															50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1463	042	0	1	02	01	H1463_042_0	5		Y	Specialty Tier	4	11	1	1	5	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31					30	30	30																		30	30	30															30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1463	043	0	1	01	01	H1463_043_0	5		Y	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	2.00	4.00	6.00																			2.00	4.00	4.00																2.00				2.00		0.07			0.07			0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1463	043	0	1	01	01	H1463_043_0	5		Y	Preferred Generic	4	01	1	2	1	3	111		01	111		1	30	60	90				1	2	30	60	90				30		31	2.00	4.00	6.00																			2.00	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	043	0	1	01	01	H1463_043_0	5		Y	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	15.00	30.00	45.00																			15.00	30.00	30.00																15.00				15.00		0.50			0.50			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1463	043	0	1	01	01	H1463_043_0	5		Y	Preferred Brand	4	10	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	94.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1463	043	0	1	01	01	H1463_043_0	5		Y	Non-Preferred Drug	4	11	1	1	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31				71.66	50	50	50																		50	50	50															50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1463	043	0	1	01	01	H1463_043_0	5		Y	Specialty Tier	4	11	1	1	5	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31					31	31	31																		31	31	31															31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1468	007	0	1	01	01	H1468_007_0	3		Y	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1468	007	0	1	01	01	H1468_007_0	3		Y	Preferred Generic	4	11	3	2	1	3	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H1468	007	0	1	01	01	H1468_007_0	3		Y	Generic	4	11	3	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	0.00		0.00																									20.00		60.00				0.00		0.00				0.00				0.00		0				0.67	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1468	007	0	1	01	01	H1468_007_0	3		Y	Generic	4	11	3	2	2	3	110		01		110	1	30		90				2	2				30		90	30		31	0.00		0.00																									20.00		60.00				0.00		0.00				0.00				0.00		0				0.67	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H1468	007	0	1	01	01	H1468_007_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		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	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		290.00				100.00				100.00		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	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1468	013	0	1	01	01	H1468_013_0	3		Y	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1468	013	0	1	01	01	H1468_013_0	3		Y	Preferred Generic	4	11	3	2	1	3	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H1468	013	0	1	01	01	H1468_013_0	3		Y	Generic	4	11	3	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	0.00		0.00																									20.00		60.00				0.00		0.00				0.00				0.00		0				0.67	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1468	013	0	1	01	01	H1468_013_0	3		Y	Generic	4	11	3	2	2	3	110		01		110	1	30		90				2	2				30		90	30		31	0.00		0.00																									20.00		60.00				0.00		0.00				0.00				0.00		0				0.67	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H1468	013	0	1	01	01	H1468_013_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		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	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		290.00				100.00				100.00		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	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1468	014	0	1	01	01	H1468_014_0	3		Y	Preferred Generic	4	11	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	6.00		18.00																									10.00		30.00				6.00		0.00				6.00				6.00		0.20				0.33	0.20	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1468	014	0	1	01	01	H1468_014_0	3		Y	Generic	4	11	1	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	15.00		45.00																									20.00		60.00				15.00		0.00				15.00				15.00		0.50				0.67	0.50	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1468	014	0	1	01	01	H1468_014_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		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	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		290.00				100.00				100.00		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	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1468	017	0	1	01	01	H1468_017_0	4		Y	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1468	017	0	1	01	01	H1468_017_0	4		Y	Preferred Generic	4	11	3	2	1	3	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		3
H1468	017	0	1	01	01	H1468_017_0	4		Y	Generic	4	11	3	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	0.00		0.00																									20.00		60.00				0.00		0.00				0.00				0.00		0				0.67	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1468	017	0	1	01	01	H1468_017_0	4		Y	Generic	4	11	3	2	2	3	110		01		110	1	30		90				2	2				30		90	30		31	0.00		0.00																									20.00		60.00				0.00		0.00				0.00				0.00		0				0.67	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		3
H1468	017	0	1	01	01	H1468_017_0	4		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				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												
H1468	017	0	1	01	01	H1468_017_0	4		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	99.00		297.00																									100.00		300.00				99.00		287.00				99.00				99.00		3.30				3.33	3.30	3.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1468	017	0	1	01	01	H1468_017_0	4		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1468	017	0	1	01	01	H1468_017_0	4		Y	Select Care Drugs	4	11	1	2	6	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0				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	3		Y	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1468	018	0	1	01	01	H1468_018_0	3		Y	Preferred Generic	4	11	3	2	1	3	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H1468	018	0	1	01	01	H1468_018_0	3		Y	Generic	4	11	3	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	0.00		0.00																									20.00		60.00				0.00		0.00				0.00				0.00		0				0.67	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1468	018	0	1	01	01	H1468_018_0	3		Y	Generic	4	11	3	2	2	3	110		01		110	1	30		90				2	2				30		90	30		31	0.00		0.00																									20.00		60.00				0.00		0.00				0.00				0.00		0				0.67	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H1468	018	0	1	01	01	H1468_018_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		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	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		290.00				100.00				100.00		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	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1468	019	0	1	02	01	H1468_019_0	4		Y	Preferred Generic	4	11	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	2.00		6.00																									5.00		15.00				2.00		0.00				2.00				2.00		0.07				0.17	0.07	0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1468	019	0	1	02	01	H1468_019_0	4		Y	Generic	4	11	1	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	12.00		36.00																									12.00		36.00				12.00		0.00				12.00				12.00		0.40				0.40	0.40	0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1468	019	0	1	02	01	H1468_019_0	4		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1468	019	0	1	02	01	H1468_019_0	4		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		290.00				100.00				100.00		3.33				3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1468	019	0	1	02	01	H1468_019_0	4		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					29																										29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1468	020	0	1	02	01	H1468_020_0	3		Y	Preferred Generic	4	11	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	2.00		6.00																									10.00		30.00				2.00		0.00				2.00				2.00		0.07				0.33	0.07	0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1468	020	0	1	02	01	H1468_020_0	3		Y	Generic	4	11	1	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	12.00		36.00																									20.00		60.00				12.00		0.00				12.00				12.00		0.40				0.67	0.40	0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1468	020	0	1	02	01	H1468_020_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1468	020	0	1	02	01	H1468_020_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		290.00				100.00				100.00		3.33				3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1468	020	0	1	02	01	H1468_020_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					29																										29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1607	012	0	1	04	01	H1607_012_0	5		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								9.00	18.00	27.00					4.00	8.00	12.00					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	5		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								17.00	34.00	51.00					12.00	24.00	36.00					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	5		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00	84.00	84.00																47.00				47.00			1.57	1.40	1.40			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1607	012	0	1	04	01	H1607_012_0	5		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	190.00	190.00																100.00				100.00			3.33	3.17	3.17			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1607	012	0	1	04	01	H1607_012_0	5		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												32							32						32																	32			32								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1607	012	0	1	04	01	H1607_012_0	5		N	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1607	012	0	1	04	01	H1607_012_0	5		N	Select Care Drugs	4	01	1	2	6	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H1607	015	0	1	04	01	H1607_015_0	5		Y	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								9.00	18.00	27.00					4.00	8.00	12.00					0.00	0.00	0.00																9.00				9.00			0.30	0.13	0.00			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1607	015	0	1	04	01	H1607_015_0	5		Y	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	5		Y	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00	84.00	84.00																47.00				47.00			1.57	1.40	1.40			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1607	015	0	1	04	01	H1607_015_0	5		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	190.00	190.00																100.00				100.00			3.33	3.17	3.17			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1607	015	0	1	04	01	H1607_015_0	5		Y	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1607	015	0	1	04	01	H1607_015_0	5		Y	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1607	015	0	1	04	01	H1607_015_0	5		Y	Select Care Drugs	4	01	1	2	6	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				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	3		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					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	3		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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	3		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					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	001	0	1	04	01	H1608_001_0	3		N	Generic	4	01	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	001	0	1	04	01	H1608_001_0	3		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					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	3		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					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	3		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											889.77	33						603.44	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1608	012	0	1	04	01	H1608_012_0	3		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					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	3		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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	3		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					5.00	10.00	10.00											20.00	40.00	60.00				5.00	10.00	10.00					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	012	0	1	04	01	H1608_012_0	3		N	Generic	4	01	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	012	0	1	04	01	H1608_012_0	3		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					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	3		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					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	3		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											769.37	33						559.43	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1608	013	0	1	04	01	H1608_013_0	3			Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					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	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	013	0	1	04	01	H1608_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					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					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	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	013	0	1	04	01	H1608_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												
H1608	013	0	1	04	01	H1608_013_0	3			Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					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	3			Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											857.21	30						801.72	30												30						30						30		30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1608	016	0	1	04	01	H1608_016_0	3			Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	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	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		
H1608	016	0	1	04	01	H1608_016_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												
H1608	016	0	1	04	01	H1608_016_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		
H1608	016	0	1	04	01	H1608_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												
H1608	016	0	1	04	01	H1608_016_0	3			Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					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	3			Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											802.63	33						589.64	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1608	017	0	1	04	01	H1608_017_0	3			Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	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	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		
H1608	017	0	1	04	01	H1608_017_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												
H1608	017	0	1	04	01	H1608_017_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		
H1608	017	0	1	04	01	H1608_017_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	017	0	1	04	01	H1608_017_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	017	0	1	04	01	H1608_017_0	3			Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											781.70	33						570.50	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1608	018	0	1	04	01	H1608_018_0	3			Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	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	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		
H1608	018	0	1	04	01	H1608_018_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												
H1608	018	0	1	04	01	H1608_018_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		
H1608	018	0	1	04	01	H1608_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												
H1608	018	0	1	04	01	H1608_018_0	3			Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					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	3			Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											779.03	33						818.40	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1608	021	0	1	04	01	H1608_021_0	3			Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	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	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		
H1608	021	0	1	04	01	H1608_021_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												
H1608	021	0	1	04	01	H1608_021_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		
H1608	021	0	1	04	01	H1608_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					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					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	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	021	0	1	04	01	H1608_021_0	3			Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											938.21	33						958.85	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1608	024	0	1	04	01	H1608_024_0	3			Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	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	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		
H1608	024	0	1	04	01	H1608_024_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												
H1608	024	0	1	04	01	H1608_024_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		
H1608	024	0	1	04	01	H1608_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												
H1608	024	0	1	04	01	H1608_024_0	3			Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					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	3			Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											764.66	33						471.55	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1608	026	0	1	04	01	H1608_026_0	2		Y	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	2		Y	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	2		Y	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	2		Y	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	2		Y	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					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	2		Y	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					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	2		Y	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1215.93	33						528.52	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1608	027	0	1	04	01	H1608_027_0	2		Y	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	2		Y	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	2		Y	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	2		Y	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	2		Y	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1608	027	0	1	04	01	H1608_027_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1608	027	0	1	04	01	H1608_027_0	2		Y	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1077.32	33						628.50	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1608	028	0	1	04	01	H1608_028_0	2		Y	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	028	0	1	04	01	H1608_028_0	2		Y	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	028	0	1	04	01	H1608_028_0	2		Y	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												
H1608	028	0	1	04	01	H1608_028_0	2		Y	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		
H1608	028	0	1	04	01	H1608_028_0	2		Y	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					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	2		Y	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					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	2		Y	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											952.12	33						636.57	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1608	029	0	1	04	01	H1608_029_0	2		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					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	2		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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	2		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					10.00	20.00	20.00											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												
H1608	029	0	1	04	01	H1608_029_0	2		N	Generic	4	01	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	20.00											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										1		
H1608	029	0	1	04	01	H1608_029_0	2		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1608	029	0	1	04	01	H1608_029_0	2		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1608	029	0	1	04	01	H1608_029_0	2		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											939.12	33						620.21	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		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					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		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					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		N	Generic	4	01	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		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					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		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					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		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											865.24	30						586.33	30												30						30						30		30								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											981.52	30						605.41	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		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					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		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1608	037	0	1	04	01	H1608_037_0	2		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					10.00	20.00	20.00											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												
H1608	037	0	1	04	01	H1608_037_0	2		N	Generic	4	01	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	20.00											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										1		
H1608	037	0	1	04	01	H1608_037_0	2		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					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		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					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		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											818.13	33						505.67	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		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					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		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1608	038	0	1	04	01	H1608_038_0	2		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					10.00	20.00	20.00											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												
H1608	038	0	1	04	01	H1608_038_0	2		N	Generic	4	01	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	20.00											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										1		
H1608	038	0	1	04	01	H1608_038_0	2		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					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		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					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		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											832.89	33						525.17	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											879.37	33						510.82	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		N	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	040	0	1	04	01	H1608_040_0	2		N	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	040	0	1	04	01	H1608_040_0	2		N	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	040	0	1	04	01	H1608_040_0	2		N	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	040	0	1	04	01	H1608_040_0	2		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					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		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					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		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1045.06	33						681.67	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1608	041	0	1	04	01	H1608_041_0	3		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	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	041	0	1	04	01	H1608_041_0	3		N	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	041	0	1	04	01	H1608_041_0	3		N	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	041	0	1	04	01	H1608_041_0	3		N	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	041	0	1	04	01	H1608_041_0	3		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					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	3		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					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	3		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1024.30	33						719.49	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		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					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		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1608	043	0	1	04	01	H1608_043_0	2		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					10.00	20.00	20.00											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												
H1608	043	0	1	04	01	H1608_043_0	2		N	Generic	4	01	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	20.00											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										1		
H1608	043	0	1	04	01	H1608_043_0	2		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					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		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					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		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											741.25	33						535.02	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											849.09	33						559.94	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					10.00	20.00	20.00											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												
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					10.00	20.00	20.00											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										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											783.25	33						487.51	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											825.24	33						581.64	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1608	051	0	1	04	01	H1608_051_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	051	0	1	04	01	H1608_051_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	051	0	1	04	01	H1608_051_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	051	0	1	04	01	H1608_051_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	051	0	1	04	01	H1608_051_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	051	0	1	04	01	H1608_051_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	051	0	1	04	01	H1608_051_0	4			Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											678.73	30						386.05	30												30						30						30		30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1608	052	0	1	04	01	H1608_052_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												
H1608	052	0	1	04	01	H1608_052_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		
H1608	052	0	1	04	01	H1608_052_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												
H1608	052	0	1	04	01	H1608_052_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		
H1608	052	0	1	04	01	H1608_052_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	052	0	1	04	01	H1608_052_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	052	0	1	04	01	H1608_052_0	3			Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											725.39	33						427.67	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											759.79	33						489.27	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											723.67	33						631.23	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											796.48	30						466.97	30												30						30						30		30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1608	059	0	1	04	01	H1608_059_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												
H1608	059	0	1	04	01	H1608_059_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		
H1608	059	0	1	04	01	H1608_059_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												
H1608	059	0	1	04	01	H1608_059_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		
H1608	059	0	1	04	01	H1608_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					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					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	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	059	0	1	04	01	H1608_059_0	3			Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											786.27	33						558.68	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		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					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		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					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		N	Generic	4	01	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		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					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		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					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		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											760.60	33						466.39	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		Y	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		Y	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		Y	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		Y	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		Y	Preferred Brand	4	11	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		Y	Non-Preferred Drug	4	11	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		Y	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1081.54	33						890.52	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1609	017	0	1	01	01	H1609_017_0	4		N	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					10.00	20.00	30.00											15.00	30.00	45.00				10.00	20.00	30.00					15.00			15.00			0.50	0.33		0.50	0.33	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1609	017	0	1	01	01	H1609_017_0	4		N	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					15.00	30.00	45.00											20.00	40.00	60.00				15.00	30.00	45.00					20.00			20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1609	017	0	1	01	01	H1609_017_0	4		N	Preferred Brand	4	11	1	1	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31											64.63	25	25	25				62.69	25	25	25										25	25	25				25	25	25				25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1609	017	0	1	01	01	H1609_017_0	4		N	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31											99.29	37	37	37				72.76	37	37	37										37	37	37				37	37	37				37		37								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1609	017	0	1	01	01	H1609_017_0	4		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											629.19	25						663.53	25												25						25						25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1609	018	0	1	01	01	H1609_018_0	4		Y	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	4		Y	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	4		Y	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	4		Y	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	4		Y	Preferred Brand	4	11	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	4		Y	Non-Preferred Drug	4	11	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	4		Y	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1001.05	33						745.04	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		N	Preferred Generic	4	01	3	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								12.00	24.00	36.00					6.00	12.00	18.00											12.00	24.00	36.00				6.00	12.00	18.00					12.00			12.00			0.40	0.20		0.40	0.20	0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1609	019	0	1	01	01	H1609_019_0	4		N	Generic	4	11	3	2	2	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								16.00	32.00	48.00					11.00	22.00	33.00											16.00	32.00	48.00				11.00	22.00	33.00					16.00			16.00			0.53	0.37		0.53	0.37	0.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1609	019	0	1	01	01	H1609_019_0	4		N	Preferred Brand	4	11	1	1	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31											58.61	25	25	25				60.71	25	25	25										25	25	25				25	25	25				25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1609	019	0	1	01	01	H1609_019_0	4		N	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31											99.50	35	35	35				70.58	35	35	35										35	35	35				35	35	35				35		35								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1609	019	0	1	01	01	H1609_019_0	4		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											664.33	25						680.04	25												25						25						25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1609	020	0	1	01	01	H1609_020_0	4		Y	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	4		Y	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	4		Y	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	4		Y	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	4		Y	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					15.00	30.00	45.00											47.00	94.00	141.00				15.00	30.00	45.00					47.00			47.00			1.57	0.50		1.57	0.50	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1609	020	0	1	01	01	H1609_020_0	4		Y	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					70.00	140.00	210.00											100.00	200.00	300.00				70.00	140.00	210.00					100.00			100.00			3.33	2.33		3.33	2.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1609	020	0	1	01	01	H1609_020_0	4		Y	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											818.58	33						771.30	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1609	021	0	1	01	01	H1609_021_0	4		Y	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	4		Y	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	4		Y	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	021	0	1	01	01	H1609_021_0	4		Y	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	021	0	1	01	01	H1609_021_0	4		Y	Preferred Brand	4	11	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	4		Y	Non-Preferred Drug	4	11	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	4		Y	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1006.58	33						638.91	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1609	022	0	1	01	01	H1609_022_0	4		Y	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	4		Y	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	4		Y	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	4		Y	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	4		Y	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					10.00	20.00	30.00											47.00	94.00	141.00				10.00	20.00	30.00					47.00			47.00			1.57	0.33		1.57	0.33	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1609	022	0	1	01	01	H1609_022_0	4		Y	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	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	4		Y	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											862.87	33						664.06	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1609	025	0	1	01	01	H1609_025_0	4		Y	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	4		Y	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	4		Y	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	025	0	1	01	01	H1609_025_0	4		Y	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	025	0	1	01	01	H1609_025_0	4		Y	Preferred Brand	4	11	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	4		Y	Non-Preferred Drug	4	11	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	4		Y	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1236.57	33						851.39	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		N	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		N	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		N	Generic	4	01	3	2	2	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					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		N	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		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	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		N	Non-Preferred Drug	4	11	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		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1046.86	33						718.25	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		Y	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		Y	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		Y	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	027	0	1	01	01	H1609_027_0	3		Y	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	027	0	1	01	01	H1609_027_0	3		Y	Preferred Brand	4	11	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		Y	Non-Preferred Drug	4	11	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		Y	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											745.58	33						623.86	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		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					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		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					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		N	Generic	4	01	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		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					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		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					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		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											841.10	30						602.44	30												30						30						30		30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1609	034	0	1	01	01	H1609_034_0	3		Y	Preferred Generic	4	01	3	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					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	3		Y	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	3		Y	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	3		Y	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	3		Y	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					10.00	20.00	30.00											47.00	94.00	141.00				10.00	20.00	30.00					47.00			47.00			1.57	0.33		1.57	0.33	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1609	034	0	1	01	01	H1609_034_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	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	3		Y	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1170.45	33						749.24	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		Y	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		Y	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		Y	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	035	0	1	01	01	H1609_035_0	3		Y	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	035	0	1	01	01	H1609_035_0	3		Y	Preferred Brand	4	11	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		Y	Non-Preferred Drug	4	11	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		Y	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											998.55	33						757.68	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		Y	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		Y	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		Y	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	038	0	1	01	01	H1609_038_0	3		Y	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	038	0	1	01	01	H1609_038_0	3		Y	Preferred Brand	4	11	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		Y	Non-Preferred Drug	4	11	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		Y	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											986.44	33						738.67	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1609	041	0	1	01	01	H1609_041_0	3		Y	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		Y	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		Y	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		Y	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		Y	Preferred Brand	4	11	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		Y	Non-Preferred Drug	4	11	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		Y	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1064.66	33						685.11	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		Y	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		Y	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		Y	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		Y	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		Y	Preferred Brand	4	11	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		Y	Non-Preferred Drug	4	11	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		Y	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											900.85	33						675.02	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		N	Preferred Generic	4	01	3	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								12.00	24.00	36.00					6.00	12.00	18.00											12.00	24.00	36.00				6.00	12.00	18.00					12.00			12.00			0.40	0.20		0.40	0.20	0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1609	043	0	1	01	01	H1609_043_0	4		N	Generic	4	11	3	2	2	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								16.00	32.00	48.00					11.00	22.00	33.00											16.00	32.00	48.00				11.00	22.00	33.00					16.00			16.00			0.53	0.37		0.53	0.37	0.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1609	043	0	1	01	01	H1609_043_0	4		N	Preferred Brand	4	11	1	1	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31											61.11	25	25	25				57.49	25	25	25										25	25	25				25	25	25				25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1609	043	0	1	01	01	H1609_043_0	4		N	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31											87.07	35	35	35				58.80	35	35	35										35	35	35				35	35	35				35		35								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1609	043	0	1	01	01	H1609_043_0	4		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											648.61	25						517.61	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		N	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					10.00	20.00	30.00											15.00	30.00	45.00				10.00	20.00	30.00					15.00			15.00			0.50	0.33		0.50	0.33	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1609	044	0	1	01	01	H1609_044_0	4		N	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					15.00	30.00	45.00											20.00	40.00	60.00				15.00	30.00	45.00					20.00			20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1609	044	0	1	01	01	H1609_044_0	4		N	Preferred Brand	4	11	1	1	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31											60.53	25	25	25				57.74	25	25	25										25	25	25				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		N	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31											92.13	37	37	37				68.70	37	37	37										37	37	37				37	37	37				37		37								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1609	044	0	1	01	01	H1609_044_0	4		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											615.55	25						618.62	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		N	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					10.00	20.00	30.00											15.00	30.00	45.00				10.00	20.00	30.00					15.00			15.00			0.50	0.33		0.50	0.33	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1609	045	0	1	01	01	H1609_045_0	4		N	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					15.00	30.00	45.00											20.00	40.00	60.00				15.00	30.00	45.00					20.00			20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1609	045	0	1	01	01	H1609_045_0	4		N	Preferred Brand	4	11	1	1	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31											52.51	25	25	25				54.70	25	25	25										25	25	25				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		N	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31											93.92	37	37	37				71.14	37	37	37										37	37	37				37	37	37				37		37								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1609	045	0	1	01	01	H1609_045_0	4		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											627.85	25						612.47	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		N	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					10.00	20.00	30.00											15.00	30.00	45.00				10.00	20.00	30.00					15.00			15.00			0.50	0.33		0.50	0.33	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1609	046	0	1	01	01	H1609_046_0	4		N	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					15.00	30.00	45.00											20.00	40.00	60.00				15.00	30.00	45.00					20.00			20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1609	046	0	1	01	01	H1609_046_0	4		N	Preferred Brand	4	11	1	1	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31											58.97	25	25	25				58.13	25	25	25										25	25	25				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		N	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31											95.00	37	37	37				71.79	37	37	37										37	37	37				37	37	37				37		37								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1609	046	0	1	01	01	H1609_046_0	4		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											634.46	25						647.95	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		N	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					10.00	20.00	30.00											15.00	30.00	45.00				10.00	20.00	30.00					15.00			15.00			0.50	0.33		0.50	0.33	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1609	047	0	1	01	01	H1609_047_0	4		N	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					15.00	30.00	45.00											20.00	40.00	60.00				15.00	30.00	45.00					20.00			20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1609	047	0	1	01	01	H1609_047_0	4		N	Preferred Brand	4	11	1	1	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31											58.30	25	25	25				59.09	25	25	25										25	25	25				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		N	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31											96.25	37	37	37				66.89	37	37	37										37	37	37				37	37	37				37		37								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1609	047	0	1	01	01	H1609_047_0	4		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											675.32	25						730.96	25												25						25						25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1609	048	0	1	01	01	H1609_048_0	4		N	Preferred Generic	4	01	3	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	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			0.50	0.33		0.50	0.33	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1609	048	0	1	01	01	H1609_048_0	4		N	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					15.00	30.00	45.00											20.00	40.00	60.00				15.00	30.00	45.00					20.00			20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1609	048	0	1	01	01	H1609_048_0	4		N	Preferred Brand	4	11	1	1	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31											59.71	25	25	25				60.03	25	25	25										25	25	25				25	25	25				25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1609	048	0	1	01	01	H1609_048_0	4		N	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31											94.87	37	37	37				70.51	37	37	37										37	37	37				37	37	37				37		37								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1609	048	0	1	01	01	H1609_048_0	4		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											658.45	25						614.93	25												25						25						25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1609	049	0	1	01	01	H1609_049_0	5		N	Preferred Generic	4	01	3	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								12.00	24.00	36.00					6.00	12.00	18.00											12.00	24.00	36.00				6.00	12.00	18.00					12.00			12.00			0.40	0.20		0.40	0.20	0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1609	049	0	1	01	01	H1609_049_0	5		N	Generic	4	11	3	2	2	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								16.00	32.00	48.00					11.00	22.00	33.00											16.00	32.00	48.00				11.00	22.00	33.00					16.00			16.00			0.53	0.37		0.53	0.37	0.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1609	049	0	1	01	01	H1609_049_0	5		N	Preferred Brand	4	11	1	1	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31											57.66	25	25	25				56.04	25	25	25										25	25	25				25	25	25				25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1609	049	0	1	01	01	H1609_049_0	5		N	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31											86.94	35	35	35				62.64	35	35	35										35	35	35				35	35	35				35		35								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1609	049	0	1	01	01	H1609_049_0	5		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											627.46	25						596.46	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		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					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		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1609	053	0	1	01	01	H1609_053_0	3		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					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		N	Generic	4	01	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		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					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		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					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		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1055.27	33						515.48	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1609	055	0	1	01	01	H1609_055_0	5		N	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					10.00	20.00	30.00											15.00	30.00	45.00				10.00	20.00	30.00					15.00			15.00			0.50	0.33		0.50	0.33	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1609	055	0	1	01	01	H1609_055_0	5		N	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					15.00	30.00	45.00											20.00	40.00	60.00				15.00	30.00	45.00					20.00			20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1609	055	0	1	01	01	H1609_055_0	5		N	Preferred Brand	4	11	1	1	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31											61.36	25	25	25				60.24	25	25	25										25	25	25				25	25	25				25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1609	055	0	1	01	01	H1609_055_0	5		N	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31											97.20	37	37	37				70.04	37	37	37										37	37	37				37	37	37				37		37								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1609	055	0	1	01	01	H1609_055_0	5		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											645.25	25						617.91	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		N	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					10.00	20.00	30.00											15.00	30.00	45.00				10.00	20.00	30.00					15.00			15.00			0.50	0.33		0.50	0.33	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1609	056	0	1	01	01	H1609_056_0	4		N	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					15.00	30.00	45.00											20.00	40.00	60.00				15.00	30.00	45.00					20.00			20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1609	056	0	1	01	01	H1609_056_0	4		N	Preferred Brand	4	11	1	1	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31											61.36	25	25	25				60.24	25	25	25										25	25	25				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		N	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31											97.20	37	37	37				70.04	37	37	37										37	37	37				37	37	37				37		37								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1609	056	0	1	01	01	H1609_056_0	4		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											645.25	25						617.91	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		Y	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		Y	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		Y	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	059	0	1	01	01	H1609_059_0	3		Y	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	059	0	1	01	01	H1609_059_0	3		Y	Preferred Brand	4	11	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		Y	Non-Preferred Drug	4	11	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		Y	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											982.67	33						735.80	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		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					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		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					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		N	Generic	4	01	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		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					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		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					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		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1001.71	33						562.97	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1609	061	0	1	01	01	H1609_061_0	4		N	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					10.00	20.00	30.00											15.00	30.00	45.00				10.00	20.00	30.00					15.00			15.00			0.50	0.33		0.50	0.33	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1609	061	0	1	01	01	H1609_061_0	4		N	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					15.00	30.00	45.00											20.00	40.00	60.00				15.00	30.00	45.00					20.00			20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1609	061	0	1	01	01	H1609_061_0	4		N	Preferred Brand	4	11	1	1	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31											61.36	25	25	25				60.24	25	25	25										25	25	25				25	25	25				25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1609	061	0	1	01	01	H1609_061_0	4		N	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31											97.20	37	37	37				70.04	37	37	37										37	37	37				37	37	37				37		37								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1609	061	0	1	01	01	H1609_061_0	4		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											645.25	25						617.91	25												25						25						25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1609	062	0	1	01	01	H1609_062_0	4		N	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					10.00	20.00	30.00											15.00	30.00	45.00				10.00	20.00	30.00					15.00			15.00			0.50	0.33		0.50	0.33	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1609	062	0	1	01	01	H1609_062_0	4		N	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					15.00	30.00	45.00											20.00	40.00	60.00				15.00	30.00	45.00					20.00			20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1609	062	0	1	01	01	H1609_062_0	4		N	Preferred Brand	4	11	1	1	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31											61.36	25	25	25				60.24	25	25	25										25	25	25				25	25	25				25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1609	062	0	1	01	01	H1609_062_0	4		N	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31											97.20	37	37	37				70.04	37	37	37										37	37	37				37	37	37				37		37								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1609	062	0	1	01	01	H1609_062_0	4		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											645.25	25						617.91	25												25						25						25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1609	063	0	1	01	01	H1609_063_0	3		Y	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	063	0	1	01	01	H1609_063_0	3		Y	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	063	0	1	01	01	H1609_063_0	3		Y	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	063	0	1	01	01	H1609_063_0	3		Y	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	063	0	1	01	01	H1609_063_0	3		Y	Preferred Brand	4	11	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	063	0	1	01	01	H1609_063_0	3		Y	Non-Preferred Drug	4	11	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	063	0	1	01	01	H1609_063_0	3		Y	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											980.04	33						715.72	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1659	002	0	1	04	01	H1659_002_0	2		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1659	002	0	1	04	01	H1659_002_0	2		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1659	002	0	1	04	01	H1659_002_0	2		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1659	002	0	1	04	01	H1659_002_0	2		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H1659	002	0	1	04	01	H1659_002_0	2		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1659	002	0	1	04	01	H1659_002_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1659	002	0	1	04	01	H1659_002_0	2		Y	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												
H1659	003	0	1	04	01	H1659_003_0	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1659	003	0	1	04	01	H1659_003_0	3		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1659	003	0	1	04	01	H1659_003_0	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	14.00		42.00																											42.00						0.00				14.00				14.00		0.46						0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1659	003	0	1	04	01	H1659_003_0	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	14.00		42.00																											42.00						0.00				14.00				14.00		0.46						0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H1659	003	0	1	04	01	H1659_003_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1659	003	0	1	04	01	H1659_003_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1659	003	0	1	04	01	H1659_003_0	3		Y	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												
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											94.03	50	50	50				90.27	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											90.25	45	45	45				86.23	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	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											93.71	50	50	50				89.96	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	3	11	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								19.00	38.00	57.00					0.00	0.00	0.00											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												
H1664	007	0	1	01	01	H1664_007_0	4			Generic	3	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					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												
H1664	007	0	1	01	01	H1664_007_0	4			Preferred Brand	3	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	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, Select Care Drugs												
H1664	007	0	1	01	01	H1664_007_0	4			Non-Preferred Drug	3	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											99.36	46	46	46				99.36	46	46	46										46	46	46				46	46	46			46			46								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	3	11	1	1	5	1		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	007	0	1	01	01	H1664_007_0	4			Select Care Drugs	3	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1666	001	0	1	04	01	H1666_001_0	6			Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								10.00	20.00	30.00					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												
H1666	001	0	1	04	01	H1666_001_0	6			Preferred Generic	4	01	1	2	1	3		111	01		111	1				30	60	100	1	2				30	60	100	30		31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	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		
H1666	001	0	1	04	01	H1666_001_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											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												
H1666	001	0	1	04	01	H1666_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	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												
H1666	001	0	1	04	01	H1666_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	300.00				100.00	200.00	300.00				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	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												
H1666	002	0	1	04	01	H1666_002_0	6			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											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												
H1666	002	0	1	04	01	H1666_002_0	6			Preferred Generic	4	01	1	2	1	3		111	01		111	1				30	60	100	1	2				30	60	100	30		31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	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		
H1666	002	0	1	04	01	H1666_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					10.00	20.00	30.00											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												
H1666	002	0	1	04	01	H1666_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	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												
H1666	002	0	1	04	01	H1666_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	200.00	300.00				100.00	200.00	300.00				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	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												
H1666	003	0	1	04	01	H1666_003_0	6			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											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												
H1666	003	0	1	04	01	H1666_003_0	6			Preferred Generic	4	01	1	2	1	3		111	01		111	1				30	60	100	1	2				30	60	100	30		31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	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		
H1666	003	0	1	04	01	H1666_003_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											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												
H1666	003	0	1	04	01	H1666_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	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												
H1666	003	0	1	04	01	H1666_003_0	6			Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00				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	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												
H1666	004	0	1	04	01	H1666_004_0	6			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											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												
H1666	004	0	1	04	01	H1666_004_0	6			Preferred Generic	4	01	1	2	1	3		111	01		111	1				30	60	100	1	2				30	60	100	30		31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	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		
H1666	004	0	1	04	01	H1666_004_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											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												
H1666	004	0	1	04	01	H1666_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	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												
H1666	004	0	1	04	01	H1666_004_0	6			Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00				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	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												
H1666	005	0	1	04	01	H1666_005_0	6			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											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												
H1666	005	0	1	04	01	H1666_005_0	6			Preferred Generic	4	01	1	2	1	3		111	01		111	1				30	60	100	1	2				30	60	100	30		31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	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		
H1666	005	0	1	04	01	H1666_005_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											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												
H1666	005	0	1	04	01	H1666_005_0	6			Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	94.00				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												
H1666	005	0	1	04	01	H1666_005_0	6			Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00				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	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												
H1666	006	0	1	04	01	H1666_006_0	6			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											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												
H1666	006	0	1	04	01	H1666_006_0	6			Preferred Generic	4	01	1	2	1	3		111	01		111	1				30	60	100	1	2				30	60	100	30		31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	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		
H1666	006	0	1	04	01	H1666_006_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											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												
H1666	006	0	1	04	01	H1666_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	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												
H1666	006	0	1	04	01	H1666_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								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00				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	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												
H1666	008	0	1	04	01	H1666_008_0	6			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											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												
H1666	008	0	1	04	01	H1666_008_0	6			Preferred Generic	4	01	1	2	1	3		111	01		111	1				30	60	100	1	2				30	60	100	30		31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	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		
H1666	008	0	1	04	01	H1666_008_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											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												
H1666	008	0	1	04	01	H1666_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								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	94.00				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												
H1666	008	0	1	04	01	H1666_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								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00				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	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												
H1666	010	0	1	04	01	H1666_010_0	6			Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								10.00	20.00	30.00					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												
H1666	010	0	1	04	01	H1666_010_0	6			Preferred Generic	4	01	1	2	1	3		111	01		111	1				30	60	100	1	2				30	60	100	30		31								10.00	20.00	30.00					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		
H1666	010	0	1	04	01	H1666_010_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											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												
H1666	010	0	1	04	01	H1666_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								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	94.00				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												
H1666	010	0	1	04	01	H1666_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								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00				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	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												
H1666	012	0	1	04	01	H1666_012_0	7			Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	100	1	2				30	60	100	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												
H1666	012	0	1	04	01	H1666_012_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					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												
H1666	012	0	1	04	01	H1666_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	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												
H1666	012	0	1	04	01	H1666_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	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												
H1666	012	0	1	04	01	H1666_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												
H1666	013	0	1	04	01	H1666_013_0	6			Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	100	1	2				30	60	100	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												
H1666	013	0	1	04	01	H1666_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					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												
H1666	013	0	1	04	01	H1666_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					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												
H1666	013	0	1	04	01	H1666_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					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												
H1666	013	0	1	04	01	H1666_013_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												
H1666	014	0	1	04	01	H1666_014_0	7			Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	100	1	2				30	60	100	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												
H1666	014	0	1	04	01	H1666_014_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					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												
H1666	014	0	1	04	01	H1666_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	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												
H1666	014	0	1	04	01	H1666_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	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												
H1666	014	0	1	04	01	H1666_014_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												
H1666	015	0	1	04	01	H1666_015_0	7			Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	100	1	2				30	60	100	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												
H1666	015	0	1	04	01	H1666_015_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					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												
H1666	015	0	1	04	01	H1666_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	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												
H1666	015	0	1	04	01	H1666_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	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												
H1666	015	0	1	04	01	H1666_015_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												
H1666	016	0	1	04	01	H1666_016_0	7			Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	100	1	2				30	60	100	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												
H1666	016	0	1	04	01	H1666_016_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					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												
H1666	016	0	1	04	01	H1666_016_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					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												
H1666	016	0	1	04	01	H1666_016_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					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												
H1666	016	0	1	04	01	H1666_016_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												
H1666	018	0	1	04	01	H1666_018_0	5			Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	100	1	2				30	60	100	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												
H1666	018	0	1	04	01	H1666_018_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												
H1666	018	0	1	04	01	H1666_018_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					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												
H1666	018	0	1	04	01	H1666_018_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					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												
H1666	018	0	1	04	01	H1666_018_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												
H1692	002	0	1	02	01	H1692_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								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												
H1692	002	0	1	02	01	H1692_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								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		
H1692	002	0	1	02	01	H1692_002_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												
H1692	002	0	1	02	01	H1692_002_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		
H1692	002	0	1	02	01	H1692_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												
H1692	002	0	1	02	01	H1692_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												
H1692	002	0	1	02	01	H1692_002_0	3			Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											883.84	33						785.31	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1692	003	0	1	02	01	H1692_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								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												
H1692	003	0	1	02	01	H1692_003_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		
H1692	003	0	1	02	01	H1692_003_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												
H1692	003	0	1	02	01	H1692_003_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		
H1692	003	0	1	02	01	H1692_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	94.00	141.00				47.00	94.00	141.00					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	02	01	H1692_003_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												
H1692	003	0	1	02	01	H1692_003_0	3			Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											969.05	33						568.80	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1692	007	0	1	01	01	H1692_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								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												
H1692	007	0	1	01	01	H1692_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								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		
H1692	007	0	1	01	01	H1692_007_0	2			Generic	4	01	1	2	2	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								12.00	24.00	36.00					10.00	20.00	20.00											12.00	24.00	36.00				10.00	20.00	20.00					12.00			12.00			0.40	0.33		0.40	0.33	0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1692	007	0	1	01	01	H1692_007_0	2			Generic	4	01	1	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								12.00	24.00	36.00					10.00	20.00	20.00											12.00	24.00	36.00				10.00	20.00	20.00					12.00			12.00			0.40	0.33		0.40	0.33	0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1692	007	0	1	01	01	H1692_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												
H1692	007	0	1	01	01	H1692_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												
H1692	007	0	1	01	01	H1692_007_0	2			Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											990.88	33						568.14	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1722	002	0	1	01	01	H1722_002_0	10		Y	Preferred Generic	4	11	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	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	10		Y	Generic	4	11	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	10.00	20.00	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	10		Y	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	47.00	94.00	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	10		Y	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	100.00	200.00	300.00																			100.00	200.00	300.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Supplemental Drugs												
H1722	002	0	1	01	01	H1722_002_0	10		Y	Specialty Tier	4	11	1	1	5	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31					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	10		Y	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			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Supplemental Drugs												
H1722	002	0	1	01	01	H1722_002_0	10		Y	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			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Supplemental Drugs										1		
H1723	001	0	1	48	05	H1723_001_0	3			Generic Drugs	4	01			1	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31																																																					Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	1	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H1723	001	0	1	48	05	H1723_001_0	3			Brand Drugs	4	10			2	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31																																																					Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	1	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H1723	001	0	1	48	05	H1723_001_0	3			Non-Medicare Rx/OTC Drugs	4	11			3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31																																																					Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	2	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H1732	001	0	1	01	01	H1732_001_0	6		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								10.00	20.00	30.00					5.00	10.00	15.00					5.00	15.00	15.00																10.00				10.00			0.33	0.17	0.17			0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1732	001	0	1	01	01	H1732_001_0	6		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								20.00	40.00	60.00					15.00	30.00	45.00					15.00	45.00	45.00																20.00				20.00			0.67	0.50	0.50			0.59	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1732	001	0	1	01	01	H1732_001_0	6		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								47.00	94.00	141.00					47.00	94.00	141.00					47.00	141.00	141.00																47.00				47.00			1.57	1.57	1.57			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1732	001	0	1	01	01	H1732_001_0	6		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	285.00	285.00																100.00				100.00			3.33	3.17	3.17			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1732	001	0	1	01	01	H1732_001_0	6		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												25							25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1732	001	0	1	01	01	H1732_001_0	6		N	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								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												
H1732	003	0	1	01	01	H1732_003_0	5		N	Preferred Generic	4	01	3	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								10.00	20.00	30.00					5.00	10.00	15.00					5.00	15.00	15.00																10.00				10.00			0.33	0.17	0.17			0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1732	003	0	1	01	01	H1732_003_0	5		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								20.00	40.00	60.00					15.00	30.00	45.00					15.00	45.00	45.00																20.00				20.00			0.67	0.50	0.50			0.59	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1732	003	0	1	01	01	H1732_003_0	5		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								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	5		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	285.00	285.00																100.00				100.00			3.33	3.17	3.17			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1732	003	0	1	01	01	H1732_003_0	5		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												25							25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1732	003	0	1	01	01	H1732_003_0	5		N	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								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												
H1732	004	0	1	01	01	H1732_004_0	6		N	Preferred Generic	4	01	3	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								8.00	16.00	24.00					3.00	6.00	9.00					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		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								20.00	40.00	60.00					15.00	30.00	45.00					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		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00	126.00	126.00																47.00				47.00			1.57	1.40	1.40			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1732	004	0	1	01	01	H1732_004_0	6		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								99.00	198.00	297.00					94.00	188.00	282.00					94.00	282.00	282.00																99.00				99.00			3.30	3.13	3.13			2.91	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1732	004	0	1	01	01	H1732_004_0	6		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												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		N	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1732	004	0	1	01	01	H1732_004_0	6		N	Select Care Drugs	4	01	1	2	6	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H1732	005	0	1	01	01	H1732_005_0	5		Y	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	5		Y	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	5		Y	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	005	0	1	01	01	H1732_005_0	5		Y	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	005	0	1	01	01	H1732_005_0	5		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				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	5		Y	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	5		Y	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				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	5		Y	Select Care Drugs	4	01	1	2	6	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				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	5		Y	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	5		Y	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	5		Y	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	006	0	1	01	01	H1732_006_0	5		Y	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	006	0	1	01	01	H1732_006_0	5		Y	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	5		Y	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	5		Y	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				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	5		Y	Select Care Drugs	4	01	1	2	6	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				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	7		Y	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	7		Y	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	7		Y	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	7		Y	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	7		Y	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	7		Y	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	7		Y	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				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	7		Y	Select Care Drugs	4	01	1	2	6	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				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	4		Y	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	2.00	4.00	6.00																			2.00	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	4		Y	Preferred Generic	4	01	1	2	1	3	111		01	111		1	30	60	90				1	2	30	60	90				30		31	2.00	4.00	6.00																			2.00	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	4		Y	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	15.00	30.00	45.00																			15.00	30.00	30.00																15.00				15.00		0.50			0.50			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1737	001	0	1	01	01	H1737_001_0	4		Y	Preferred Brand	4	10	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	94.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1737	001	0	1	01	01	H1737_001_0	4		Y	Non-Preferred Drug	4	11	1	1	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31				67.79	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	4		Y	Specialty Tier	4	11	1	1	5	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31					33	33	33																		33	33	33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1748	001	0	1	01	01	H1748_001_0	6		Y	Preferred Generic	4	01	1	2	1	1	110		01	100		1	30		90				2	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1748	001	0	1	01	01	H1748_001_0	6		Y	Preferred Generic	4	01	1	2	1	3	110		01	100		1	30		90				2	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1748	001	0	1	01	01	H1748_001_0	6		Y	Generic	4	01	3	2	2	1	110		01	100		1	30		90				2	2			90				30		31	10.00		30.00																					30.00																10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1748	001	0	1	01	01	H1748_001_0	6		Y	Preferred Brand	4	10	1	2	3	1	110		01	100		1	30		90				2	2			90				30		31	44.00		132.00																					132.00																44.00				44.00		1.47						1.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1748	001	0	1	01	01	H1748_001_0	6		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01	100		1	30		90				2	2			90				30		31	95.00		285.00																					285.00																95.00				95.00		3.17						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1748	001	0	1	01	01	H1748_001_0	6		Y	Specialty Tier	4	11	1	1	5	1	110		01	100		1	30		90				2	2			90				30		31				1136.36	33		33																				33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1748	003	0	1	01	01	H1748_003_0	6		Y	Preferred Generic	4	01	1	2	1	1	110		01	100		1	30		90				2	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1748	003	0	1	01	01	H1748_003_0	6		Y	Generic	4	01	3	2	2	1	110		01	100		1	30		90				2	2			90				30		31	15.00		45.00																					45.00																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	6		Y	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	6		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01	100		1	30		90				2	2			90				30		31	100.00		300.00																					300.00																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	6		Y	Specialty Tier	4	11	1	1	5	1	110		01	100		1	30		90				2	2			90				30		31				1087.96	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	6		Y	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		Y	Preferred Generic	4	01	1	2	1	1	110		01	100		1	30		90				2	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1748	004	0	1	01	01	H1748_004_0	6		Y	Generic	4	01	3	2	2	1	110		01	100		1	30		90				2	2			90				30		31	15.00		45.00																					45.00																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		Y	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		Y	Non-Preferred 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		Y	Specialty Tier	4	11	1	1	5	1	110		01	100		1	30		90				2	2			90				30		31				1095.77	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		Y	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	6		N	Preferred Generic	4	01	1	2	1	1	110		01	100		1	30		90				2	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1748	005	0	1	01	01	H1748_005_0	6		N	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	6		N	Preferred Brand	4	10	1	2	3	1	110		01	100		1	30		90				2	2			90				30		31	47.00		141.00																					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	6		N	Non-Preferred Drug	4	11	1	2	4	1	110		01	100		1	30		90				2	2			90				30		31	95.00		285.00																					285.00																95.00				95.00		3.17						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1748	005	0	1	01	01	H1748_005_0	6		N	Specialty Tier	4	11	1	1	5	1	110		01	100		1	30		90				2	2			90				30		31				594.15	25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1774	001	0	1	04	01	H1774_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												
H1774	001	0	1	04	01	H1774_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												
H1774	001	0	1	04	01	H1774_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												
H1774	001	0	1	04	01	H1774_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												
H1774	001	0	1	04	01	H1774_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												
H1774	001	0	1	04	01	H1774_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												
H1774	002	0	1	04	01	H1774_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								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00				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	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												
H1774	002	0	1	04	01	H1774_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												
H1774	002	0	1	04	01	H1774_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												
H1774	002	0	1	04	01	H1774_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												
H1774	002	0	1	04	01	H1774_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												
H1787	002	0	1	01	01	H1787_002_0	5			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	5			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	5			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	5			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	5			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	8		N	Preferred Generic	4	11	1	2	1	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1799	001	0	1	01	01	H1799_001_0	8		N	Generic	4	11	1	2	2	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1799	001	0	1	01	01	H1799_001_0	8		N	Preferred Brand	4	11	1	2	3	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31	29.00	58.00	87.00																			29.00	58.00	87.00																29.00				29.00		0.94			0.94			0.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1799	001	0	1	01	01	H1799_001_0	8		N	Non-Preferred Drug	4	11	1	1	4	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31				93.29	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	8		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	31								31						31		31				740.53	25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1799	002	0	1	01	01	H1799_002_0	7		Y	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	7		Y	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	7		Y	Preferred Brand	4	11	1	2	3	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31	47.00	94.00	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	7		Y	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	7		Y	Specialty Tier	4	11	1	1	5	1	010		01	010		1	31								31						31		31				816.62	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	7		Y	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	2		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1821	001	0	1	04	01	H1821_001_0	2		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1821	001	0	1	04	01	H1821_001_0	2		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	8.00		24.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1821	001	0	1	04	01	H1821_001_0	2		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	8.00		24.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H1821	001	0	1	04	01	H1821_001_0	2		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1821	001	0	1	04	01	H1821_001_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1821	001	0	1	04	01	H1821_001_0	2		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				504.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1821	002	0	1	04	01	H1821_002_0	2		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1821	002	0	1	04	01	H1821_002_0	2		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1821	002	0	1	04	01	H1821_002_0	2		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1821	002	0	1	04	01	H1821_002_0	2		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H1821	002	0	1	04	01	H1821_002_0	2		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1821	002	0	1	04	01	H1821_002_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1821	002	0	1	04	01	H1821_002_0	2		Y	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												
H1821	003	0	1	04	01	H1821_003_0	2		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1821	003	0	1	04	01	H1821_003_0	2		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1821	003	0	1	04	01	H1821_003_0	2		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1821	003	0	1	04	01	H1821_003_0	2		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H1821	003	0	1	04	01	H1821_003_0	2		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1821	003	0	1	04	01	H1821_003_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1821	003	0	1	04	01	H1821_003_0	2		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				440.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1821	005	0	1	04	01	H1821_005_0	2		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1821	005	0	1	04	01	H1821_005_0	2		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1821	005	0	1	04	01	H1821_005_0	2		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1821	005	0	1	04	01	H1821_005_0	2		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H1821	005	0	1	04	01	H1821_005_0	2		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1821	005	0	1	04	01	H1821_005_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1821	005	0	1	04	01	H1821_005_0	2		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				456.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1822	001	0	1	01	01	H1822_001_0	8		Y	Preferred Generic	4	11	3	2	1	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								7.00	14.00	14.00					0.00	0.00	0.00											7.00	14.00	14.00				0.00	0.00	0.00				7.00				7.00			0.23	0.00		0.23	0.00	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1822	001	0	1	01	01	H1822_001_0	8		Y	Preferred Generic	4	11	3	2	1	3		111	01		111	1				30	60	100	1	2				30	60	100	30		31								7.00	14.00	14.00					0.00	0.00	0.00											7.00	14.00	14.00				0.00	0.00	0.00				7.00				7.00			0.23	0.00		0.23	0.00	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H1822	001	0	1	01	01	H1822_001_0	8		Y	Generic	4	11	1	2	2	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								15.00	30.00	30.00					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	8		Y	Generic	4	11	1	2	2	3		111	01		111	1				30	60	100	1	2				30	60	100	30		31								15.00	30.00	30.00					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	8		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								47.00	94.00	121.00					37.00	74.00	91.00											47.00	94.00	121.00				37.00	74.00	91.00				47.00				47.00			1.57	1.23		1.57	1.23	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1822	001	0	1	01	01	H1822_001_0	8		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								100.00	200.00	280.00					95.00	190.00	265.00											100.00	200.00	280.00				95.00	190.00	265.00				100.00				100.00			3.33	3.17		3.33	3.17	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1822	001	0	1	01	01	H1822_001_0	8		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1822	002	0	1	01	01	H1822_002_0	8		Y	Preferred Generic	4	11	1	2	1	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								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	8		Y	Preferred Generic	4	11	1	2	1	3		111	01		111	1				30	60	100	1	2				30	60	100	30		31								5.00	10.00	10.00					0.00	0.00	0.00											5.00	10.00	10.00				0.00	0.00	0.00				5.00				5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1822	002	0	1	01	01	H1822_002_0	8		Y	Generic	4	11	1	2	2	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								9.00	18.00	18.00					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	8		Y	Generic	4	11	1	2	2	3		111	01		111	1				30	60	100	1	2				30	60	100	30		31								9.00	18.00	18.00					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	8		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								47.00	94.00	121.00					37.00	74.00	91.00											47.00	94.00	121.00				37.00	74.00	91.00				47.00				47.00			1.57	1.23		1.57	1.23	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1822	002	0	1	01	01	H1822_002_0	8		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								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	8		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1822	003	0	1	01	01	H1822_003_0	8		Y	Preferred Generic	4	11	1	2	1	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								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	8		Y	Preferred Generic	4	11	1	2	1	3		111	01		111	1				30	60	100	1	2				30	60	100	30		31								5.00	10.00	10.00					0.00	0.00	0.00											5.00	10.00	10.00				0.00	0.00	0.00				5.00				5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1822	003	0	1	01	01	H1822_003_0	8		Y	Generic	4	11	1	2	2	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								9.00	18.00	18.00					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	8		Y	Generic	4	11	1	2	2	3		111	01		111	1				30	60	100	1	2				30	60	100	30		31								9.00	18.00	18.00					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	8		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								47.00	94.00	121.00					37.00	74.00	91.00											47.00	94.00	121.00				37.00	74.00	91.00				47.00				47.00			1.57	1.23		1.57	1.23	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1822	003	0	1	01	01	H1822_003_0	8		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								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	8		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1822	004	0	1	01	01	H1822_004_0	9		Y	Preferred Generic	4	11	3	2	1	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								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	9		Y	Preferred Generic	4	11	3	2	1	3		111	01		111	1				30	60	100	1	2				30	60	100	30		31								10.00	20.00	20.00					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	9		Y	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	9		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								47.00	94.00	121.00					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	9		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								100.00	200.00	280.00					95.00	190.00	265.00											100.00	200.00	280.00				95.00	190.00	265.00				100.00				100.00			3.33	3.17		3.33	3.17	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1822	004	0	1	01	01	H1822_004_0	9		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1822	005	0	1	01	01	H1822_005_0	9		Y	Preferred Generic	4	11	1	2	1	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1822	005	0	1	01	01	H1822_005_0	9		Y	Preferred Generic	4	11	1	2	1	3		111	01		111	1				30	60	100	1	2				30	60	100	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1822	005	0	1	01	01	H1822_005_0	9		Y	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												
H1822	005	0	1	01	01	H1822_005_0	9		Y	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		
H1822	005	0	1	01	01	H1822_005_0	9		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								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												
H1822	005	0	1	01	01	H1822_005_0	9		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								100.00	200.00	280.00					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												
H1822	005	0	1	01	01	H1822_005_0	9		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1846	004	0	1	04	01	H1846_004_0	5		Y	Preferred Generic	4	11	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	2.00	4.00	6.00																			0.00	0.00	0.00																2.00				2.00		0.07			0.00			0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1846	004	0	1	04	01	H1846_004_0	5		Y	Preferred Generic	4	11	1	2	1	3	111		01	111		1	30	60	90				1	2	30	60	90				30		31	2.00	4.00	6.00																			0.00	0.00	0.00																2.00				2.00		0.07			0.00			0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1846	004	0	1	04	01	H1846_004_0	5		Y	Generic	4	11	3	2	2	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31	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	004	0	1	04	01	H1846_004_0	5		Y	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	47.00	94.00	141.00																			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		Y	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	100.00	200.00	300.00																			100.00	200.00	200.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1846	004	0	1	04	01	H1846_004_0	5		Y	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	4		N	Preferred Generic	4	11	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1846	005	0	1	04	01	H1846_005_0	4		N	Preferred Generic	4	11	1	2	1	3	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1846	005	0	1	04	01	H1846_005_0	4		N	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	4		N	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	94.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1846	005	0	1	04	01	H1846_005_0	4		N	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	100.00	200.00	300.00																			100.00	200.00	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	4		N	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	4		N	Preferred Generic	4	11	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1846	006	0	1	04	01	H1846_006_0	4		N	Preferred Generic	4	11	1	2	1	3	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	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	4		N	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	4		N	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	45.00	90.00	135.00																			45.00	90.00	90.00																45.00				45.00		1.50			1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1846	006	0	1	04	01	H1846_006_0	4		N	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	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	4		N	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	4		Y	Preferred Generic	4	11	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1846	007	0	1	04	01	H1846_007_0	4		Y	Preferred Generic	4	11	1	2	1	3	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1846	007	0	1	04	01	H1846_007_0	4		Y	Generic	4	11	3	2	2	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31	5.00	10.00	15.00																			0.00	0.00	0.00																5.00				5.00		0.17			0.00			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1846	007	0	1	04	01	H1846_007_0	4		Y	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	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	4		Y	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	95.00	190.00	285.00																			95.00	190.00	190.00																95.00				95.00		3.17			3.17			3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1846	007	0	1	04	01	H1846_007_0	4		Y	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	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												
H1848	001	0	1	04	01	H1848_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												
H1848	001	0	1	04	01	H1848_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												
H1848	001	0	1	04	01	H1848_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	50	50	50				86.28	48	48	48										50	50	50				48	48	48			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1848	001	0	1	04	01	H1848_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												
H1848	001	0	1	04	01	H1848_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												
H1848	001	0	1	04	01	H1848_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	
H1848	002	0	1	04	01	H1848_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												
H1848	002	0	1	04	01	H1848_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					2.00	4.00	6.00											10.00	20.00	30.00				2.00	4.00	0.00				10.00				10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1848	002	0	1	04	01	H1848_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												
H1848	002	0	1	04	01	H1848_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											82.11	45	45	45				78.46	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	4			Specialty Tier	4	11	1	1	5	1		010	01		010	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	4			Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			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	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	
H1848	004	0	1	04	01	H1848_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												
H1848	004	0	1	04	01	H1848_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					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	4			Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											47.00	94.00	141.00				37.00	74.00	74.00				47.00				47.00			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	4			Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											81.86	45	45	45				78.22	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	4			Specialty Tier	4	11	1	1	5	1		010	01		010	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	4			Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			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	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	
H1862	001	0	1	01	01	H1862_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												
H1862	001	0	1	01	01	H1862_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												
H1862	001	0	1	01	01	H1862_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												
H1862	001	0	1	01	01	H1862_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											89.86	47	47	47				86.04	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	4			Specialty Tier	4	11	1	1	5	1		010	01		010	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	4			Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			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	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					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	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												
H1894	001	0	1	01	01	H1894_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	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	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												
H1894	001	0	1	01	01	H1894_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												
H1894	001	0	1	01	01	H1894_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												
H1894	001	0	1	01	01	H1894_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		
H1894	002	0	1	01	01	H1894_002_0	6		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								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		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								20.00	40.00	60.00					20.00	40.00	60.00					20.00	60.00	60.00																20.00				20.00			0.67	0.67	0.67			0.59	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1894	002	0	1	01	01	H1894_002_0	6		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								47.00	94.00	141.00					47.00	94.00	141.00					47.00	141.00	141.00																47.00				47.00			1.57	1.57	1.57			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1894	002	0	1	01	01	H1894_002_0	6		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	285.00	285.00																100.00				100.00			3.33	3.17	3.17			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1894	002	0	1	01	01	H1894_002_0	6		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												26							26						26																	26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1894	002	0	1	01	01	H1894_002_0	6		N	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								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	5			Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		34	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1894	007	0	1	01	01	H1894_007_0	5			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	5			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	5			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	5			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	5			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	5			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	5			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	5			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	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												
H1894	008	0	1	01	01	H1894_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												
H1894	008	0	1	01	01	H1894_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					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	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	008	0	1	01	01	H1894_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												
H1894	008	0	1	01	01	H1894_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												
H1894	008	0	1	01	01	H1894_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		
H1914	001	0	1	04	01	H1914_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												
H1914	001	0	1	04	01	H1914_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					1.00	2.00	3.00											10.00	20.00	30.00				1.00	2.00	0.00				10.00				10.00			0.33	0.03		0.33	0.03	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1914	001	0	1	04	01	H1914_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												
H1914	001	0	1	04	01	H1914_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											85.82	47	47	47				82.17	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	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												
H1914	001	0	1	04	01	H1914_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												
H1914	001	0	1	04	01	H1914_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	
H1914	002	0	1	04	01	H1914_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												
H1914	002	0	1	04	01	H1914_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												
H1914	002	0	1	04	01	H1914_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												
H1914	002	0	1	04	01	H1914_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											85.08	50	50	50				81.67	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	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												
H1914	002	0	1	04	01	H1914_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												
H1914	002	0	1	04	01	H1914_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	
H1914	004	0	1	04	01	H1914_004_0	4			Preferred Generic	4	11	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								19.00	38.00	57.00					0.00	0.00	0.00											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												
H1914	004	0	1	04	01	H1914_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	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												
H1914	004	0	1	04	01	H1914_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	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, Select Care Drugs												
H1914	004	0	1	04	01	H1914_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											99.48	45	45	45				99.48	45	45	45										45	45	45				45	45	45			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1914	004	0	1	04	01	H1914_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												
H1914	004	0	1	04	01	H1914_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												
H1944	001	0	1	02	01	H1944_001_0	2		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1944	001	0	1	02	01	H1944_001_0	2		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1944	001	0	1	02	01	H1944_001_0	2		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1944	001	0	1	02	01	H1944_001_0	2		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H1944	001	0	1	02	01	H1944_001_0	2		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1944	001	0	1	02	01	H1944_001_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1944	001	0	1	02	01	H1944_001_0	2		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				384.00	30																										30						30					30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1944	004	0	1	02	01	H1944_004_0	2		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1944	004	0	1	02	01	H1944_004_0	2		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1944	004	0	1	02	01	H1944_004_0	2		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1944	004	0	1	02	01	H1944_004_0	2		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H1944	004	0	1	02	01	H1944_004_0	2		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1944	004	0	1	02	01	H1944_004_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1944	004	0	1	02	01	H1944_004_0	2		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				397.00	28																										28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1944	005	0	1	02	01	H1944_005_0	2		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1944	005	0	1	02	01	H1944_005_0	2		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1944	005	0	1	02	01	H1944_005_0	2		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1944	005	0	1	02	01	H1944_005_0	2		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H1944	005	0	1	02	01	H1944_005_0	2		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1944	005	0	1	02	01	H1944_005_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1944	005	0	1	02	01	H1944_005_0	2		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				427.00	30																										30						30					30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1944	006	0	1	02	01	H1944_006_0	2		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1944	006	0	1	02	01	H1944_006_0	2		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1944	006	0	1	02	01	H1944_006_0	2		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1944	006	0	1	02	01	H1944_006_0	2		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H1944	006	0	1	02	01	H1944_006_0	2		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1944	006	0	1	02	01	H1944_006_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1944	006	0	1	02	01	H1944_006_0	2		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				355.00	30																										30						30					30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1944	009	0	1	02	01	H1944_009_0	2		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1944	009	0	1	02	01	H1944_009_0	2		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1944	009	0	1	02	01	H1944_009_0	2		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	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	02	01	H1944_009_0	2		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	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	02	01	H1944_009_0	2		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1944	009	0	1	02	01	H1944_009_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1944	009	0	1	02	01	H1944_009_0	2		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				416.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1944	010	0	1	02	01	H1944_010_0	2		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1944	010	0	1	02	01	H1944_010_0	2		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1944	010	0	1	02	01	H1944_010_0	2		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1944	010	0	1	02	01	H1944_010_0	2		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H1944	010	0	1	02	01	H1944_010_0	2		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1944	010	0	1	02	01	H1944_010_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1944	010	0	1	02	01	H1944_010_0	2		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				416.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1944	011	0	1	02	01	H1944_011_0	2		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1944	011	0	1	02	01	H1944_011_0	2		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1944	011	0	1	02	01	H1944_011_0	2		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1944	011	0	1	02	01	H1944_011_0	2		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H1944	011	0	1	02	01	H1944_011_0	2		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1944	011	0	1	02	01	H1944_011_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1944	011	0	1	02	01	H1944_011_0	2		Y	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												
H1944	014	0	1	02	01	H1944_014_0	2		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1944	014	0	1	02	01	H1944_014_0	2		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1944	014	0	1	02	01	H1944_014_0	2		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	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	2		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	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	2		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1944	014	0	1	02	01	H1944_014_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1944	014	0	1	02	01	H1944_014_0	2		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				397.00	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		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1944	016	0	1	02	01	H1944_016_0	3		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1944	016	0	1	02	01	H1944_016_0	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	9.00		18.00																											27.00						0.00				9.00				9.00		0.30						0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1944	016	0	1	02	01	H1944_016_0	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	9.00		18.00																											27.00						0.00				9.00				9.00		0.30						0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H1944	016	0	1	02	01	H1944_016_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		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												
H1944	016	0	1	02	01	H1944_016_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		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												
H1944	016	0	1	02	01	H1944_016_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				385.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1944	017	0	1	02	01	H1944_017_0	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1944	017	0	1	02	01	H1944_017_0	3		Y	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		
H1944	017	0	1	02	01	H1944_017_0	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1944	017	0	1	02	01	H1944_017_0	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H1944	017	0	1	02	01	H1944_017_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1944	017	0	1	02	01	H1944_017_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1944	017	0	1	02	01	H1944_017_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				321.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1944	018	0	1	02	01	H1944_018_0	2		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1944	018	0	1	02	01	H1944_018_0	2		Y	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		
H1944	018	0	1	02	01	H1944_018_0	2		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1944	018	0	1	02	01	H1944_018_0	2		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H1944	018	0	1	02	01	H1944_018_0	2		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1944	018	0	1	02	01	H1944_018_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1944	018	0	1	02	01	H1944_018_0	2		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				291.00	29																										29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1944	024	0	1	02	01	H1944_024_0	2		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1944	024	0	1	02	01	H1944_024_0	2		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1944	024	0	1	02	01	H1944_024_0	2		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1944	024	0	1	02	01	H1944_024_0	2		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H1944	024	0	1	02	01	H1944_024_0	2		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1944	024	0	1	02	01	H1944_024_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1944	024	0	1	02	01	H1944_024_0	2		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				447.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1944	028	0	1	02	01	H1944_028_0	2		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1944	028	0	1	02	01	H1944_028_0	2		Y	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		
H1944	028	0	1	02	01	H1944_028_0	2		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1944	028	0	1	02	01	H1944_028_0	2		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H1944	028	0	1	02	01	H1944_028_0	2		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1944	028	0	1	02	01	H1944_028_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1944	028	0	1	02	01	H1944_028_0	2		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				349.00	30																										30						30					30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1944	031	0	1	02	01	H1944_031_0	2		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1944	031	0	1	02	01	H1944_031_0	2		Y	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		
H1944	031	0	1	02	01	H1944_031_0	2		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1944	031	0	1	02	01	H1944_031_0	2		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H1944	031	0	1	02	01	H1944_031_0	2		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1944	031	0	1	02	01	H1944_031_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1944	031	0	1	02	01	H1944_031_0	2		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				417.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1944	032	0	1	02	01	H1944_032_0	2		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1944	032	0	1	02	01	H1944_032_0	2		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1944	032	0	1	02	01	H1944_032_0	2		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1944	032	0	1	02	01	H1944_032_0	2		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H1944	032	0	1	02	01	H1944_032_0	2		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1944	032	0	1	02	01	H1944_032_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1944	032	0	1	02	01	H1944_032_0	2		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				388.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1944	033	0	1	02	01	H1944_033_0	2		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1944	033	0	1	02	01	H1944_033_0	2		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1944	033	0	1	02	01	H1944_033_0	2		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	5.00		15.00																											15.00						0.00				5.00				5.00		0.16						0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1944	033	0	1	02	01	H1944_033_0	2		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	5.00		15.00																											15.00						0.00				5.00				5.00		0.16						0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H1944	033	0	1	02	01	H1944_033_0	2		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1944	033	0	1	02	01	H1944_033_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1944	033	0	1	02	01	H1944_033_0	2		Y	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												
H1944	034	0	1	02	01	H1944_034_0	2		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1944	034	0	1	02	01	H1944_034_0	2		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1944	034	0	1	02	01	H1944_034_0	2		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1944	034	0	1	02	01	H1944_034_0	2		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H1944	034	0	1	02	01	H1944_034_0	2		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1944	034	0	1	02	01	H1944_034_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1944	034	0	1	02	01	H1944_034_0	2		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				399.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1944	035	0	1	02	01	H1944_035_0	2		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1944	035	0	1	02	01	H1944_035_0	2		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1944	035	0	1	02	01	H1944_035_0	2		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1944	035	0	1	02	01	H1944_035_0	2		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H1944	035	0	1	02	01	H1944_035_0	2		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1944	035	0	1	02	01	H1944_035_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1944	035	0	1	02	01	H1944_035_0	2		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				416.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1947	001	0	1	01	01	H1947_001_0	6		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								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												
H1947	001	0	1	01	01	H1947_001_0	6		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								20.00	40.00	60.00					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												
H1947	001	0	1	01	01	H1947_001_0	6		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								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	6		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	285.00	285.00																100.00				100.00			3.33	3.17	3.17			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1947	001	0	1	01	01	H1947_001_0	6		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												25							25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1947	001	0	1	01	01	H1947_001_0	6		N	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								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												
H1947	003	0	1	01	01	H1947_003_0	7		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		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												
H1947	003	0	1	01	01	H1947_003_0	7		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								20.00	40.00	60.00					20.00	40.00	60.00					20.00	60.00	60.00																20.00				20.00			0.67	0.67	0.67			0.59	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1947	003	0	1	01	01	H1947_003_0	7		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		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												
H1947	003	0	1	01	01	H1947_003_0	7		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	285.00	285.00																100.00				100.00			3.33	3.17	3.17			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1947	003	0	1	01	01	H1947_003_0	7		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												25							25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1947	003	0	1	01	01	H1947_003_0	7		N	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								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												
H1951	013	0	1	01	01	H1951_013_0	3		Y	Preferred Generic	4	11	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1951	013	0	1	01	01	H1951_013_0	3		Y	Generic	4	11	1	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	5.00		15.00																									20.00		60.00				5.00		0.00				5.00				5.00		0.17				0.67	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1951	013	0	1	01	01	H1951_013_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1951	013	0	1	01	01	H1951_013_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	99.00		297.00																									100.00		300.00				99.00		287.00				99.00				99.00		3.30				3.33	3.30	3.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1951	013	0	1	01	01	H1951_013_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1951	024	0	1	01	01	H1951_024_0	5		Y	Preferred Generic	4	11	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1951	024	0	1	01	01	H1951_024_0	5		Y	Generic	4	11	1	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	5.00		15.00																									20.00		60.00				5.00		0.00				5.00				5.00		0.17				0.67	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1951	024	0	1	01	01	H1951_024_0	5		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		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		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	99.00		297.00																									100.00		300.00				99.00		287.00				99.00				99.00		3.30				3.33	3.30	3.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1951	024	0	1	01	01	H1951_024_0	5		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1951	028	0	1	01	01	H1951_028_0	5		Y	Preferred Generic	4	11	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1951	028	0	1	01	01	H1951_028_0	5		Y	Generic	4	11	1	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	5.00		15.00																									20.00		60.00				5.00		0.00				5.00				5.00		0.17				0.67	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1951	028	0	1	01	01	H1951_028_0	5		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		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		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	99.00		297.00																									100.00		300.00				99.00		287.00				99.00				99.00		3.30				3.33	3.30	3.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1951	028	0	1	01	01	H1951_028_0	5		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1951	038	0	1	01	01	H1951_038_0	5		Y	Preferred Generic	4	11	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1951	038	0	1	01	01	H1951_038_0	5		Y	Generic	4	11	1	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	10.00		30.00																									20.00		60.00				10.00		0.00				10.00				10.00		0.33				0.67	0.33	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1951	038	0	1	01	01	H1951_038_0	5		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		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	5		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	99.00		297.00																									100.00		300.00				99.00		287.00				99.00				99.00		3.30				3.33	3.30	3.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1951	038	0	1	01	01	H1951_038_0	5		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1951	039	0	1	01	01	H1951_039_0	5		Y	Preferred Generic	4	11	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1951	039	0	1	01	01	H1951_039_0	5		Y	Generic	4	11	1	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	10.00		30.00																									20.00		60.00				10.00		0.00				10.00				10.00		0.33				0.67	0.33	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1951	039	0	1	01	01	H1951_039_0	5		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		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	5		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	99.00		297.00																									100.00		300.00				99.00		287.00				99.00				99.00		3.30				3.33	3.30	3.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1951	039	0	1	01	01	H1951_039_0	5		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1951	044	0	1	01	01	H1951_044_0	7		Y	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1951	044	0	1	01	01	H1951_044_0	7		Y	Preferred Generic	4	11	3	2	1	3	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	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	7		Y	Generic	4	11	3	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	4.00		12.00																									20.00		60.00				4.00		0.00				4.00				4.00		0.13				0.67	0.13	0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1951	044	0	1	01	01	H1951_044_0	7		Y	Generic	4	11	3	2	2	3	110		01		110	1	30		90				2	2				30		90	30		31	4.00		12.00																									20.00		60.00				4.00		0.00				4.00				4.00		0.13				0.67	0.13	0.13	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	7		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1951	044	0	1	01	01	H1951_044_0	7		Y	Preferred Brand	4	11	1	2	3	3	110		01		110	1	30		90				2	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				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										2	3	
H1951	044	0	1	01	01	H1951_044_0	7		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	99.00		297.00																									100.00		300.00				99.00		287.00				99.00				99.00		3.30				3.33	3.30	3.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1951	044	0	1	01	01	H1951_044_0	7		Y	Non-Preferred Drug	4	11	1	2	4	3	110		01		110	1	30		90				2	2				30		90	30		31	99.00		297.00																									100.00		300.00				99.00		287.00				99.00				99.00		3.30				3.33	3.30	3.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	3	
H1951	044	0	1	01	01	H1951_044_0	7		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1951	044	0	1	01	01	H1951_044_0	7		Y	Specialty Tier	4	11	1	1	5	3	010		01		010	1	30											30			30		31					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	7		Y	Select Care Drugs	4	11	1	2	6	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0				0	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1951	044	0	1	01	01	H1951_044_0	7		Y	Select Care Drugs	4	11	1	2	6	3	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0				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		Y	Preferred Generic	4	11	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1951	047	1	1	01	01	H1951_047_1	5		Y	Generic	4	11	1	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	5.00		15.00																									20.00		60.00				5.00		0.00				5.00				5.00		0.17				0.67	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1951	047	1	1	01	01	H1951_047_1	5		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		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		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	99.00		297.00																									100.00		300.00				99.00		287.00				99.00				99.00		3.30				3.33	3.30	3.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1951	047	1	1	01	01	H1951_047_1	5		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1951	047	2	1	01	01	H1951_047_2	5		Y	Preferred Generic	4	11	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1951	047	2	1	01	01	H1951_047_2	5		Y	Generic	4	11	1	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	5.00		15.00																									20.00		60.00				5.00		0.00				5.00				5.00		0.17				0.67	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1951	047	2	1	01	01	H1951_047_2	5		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	47.00		141.00																									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												
H1951	047	2	1	01	01	H1951_047_2	5		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	99.00		297.00																									100.00		300.00				99.00		287.00				99.00				99.00		3.30				3.33	3.30	3.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1951	047	2	1	01	01	H1951_047_2	5		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1951	048	1	1	01	01	H1951_048_1	4		Y	Preferred Generic	4	11	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1951	048	1	1	01	01	H1951_048_1	4		Y	Generic	4	11	1	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	5.00		15.00																									20.00		60.00				5.00		0.00				5.00				5.00		0.17				0.67	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1951	048	1	1	01	01	H1951_048_1	4		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	47.00		141.00																									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												
H1951	048	1	1	01	01	H1951_048_1	4		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	99.00		297.00																									100.00		300.00				99.00		287.00				99.00				99.00		3.30				3.33	3.30	3.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1951	048	1	1	01	01	H1951_048_1	4		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1951	048	2	1	01	01	H1951_048_2	4		Y	Preferred Generic	4	11	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1951	048	2	1	01	01	H1951_048_2	4		Y	Generic	4	11	1	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	5.00		15.00																									20.00		60.00				5.00		0.00				5.00				5.00		0.17				0.67	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1951	048	2	1	01	01	H1951_048_2	4		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		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	4		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	99.00		297.00																									100.00		300.00				99.00		287.00				99.00				99.00		3.30				3.33	3.30	3.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1951	048	2	1	01	01	H1951_048_2	4		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1951	049	1	1	01	01	H1951_049_1	4		Y	Preferred Generic	4	11	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1951	049	1	1	01	01	H1951_049_1	4		Y	Generic	4	11	1	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	5.00		15.00																									20.00		60.00				5.00		0.00				5.00				5.00		0.17				0.67	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1951	049	1	1	01	01	H1951_049_1	4		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	47.00		141.00																									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												
H1951	049	1	1	01	01	H1951_049_1	4		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	99.00		297.00																									100.00		300.00				99.00		287.00				99.00				99.00		3.30				3.33	3.30	3.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1951	049	1	1	01	01	H1951_049_1	4		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1951	049	2	1	01	01	H1951_049_2	4		Y	Preferred Generic	4	11	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1951	049	2	1	01	01	H1951_049_2	4		Y	Generic	4	11	1	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	5.00		15.00																									20.00		60.00				5.00		0.00				5.00				5.00		0.17				0.67	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1951	049	2	1	01	01	H1951_049_2	4		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		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	4		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	99.00		297.00																									100.00		300.00				99.00		287.00				99.00				99.00		3.30				3.33	3.30	3.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1951	049	2	1	01	01	H1951_049_2	4		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1951	049	3	1	01	01	H1951_049_3	4		Y	Preferred Generic	4	11	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1951	049	3	1	01	01	H1951_049_3	4		Y	Generic	4	11	1	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	5.00		15.00																									20.00		60.00				5.00		0.00				5.00				5.00		0.17				0.67	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1951	049	3	1	01	01	H1951_049_3	4		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		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	4		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	99.00		297.00																									100.00		300.00				99.00		287.00				99.00				99.00		3.30				3.33	3.30	3.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1951	049	3	1	01	01	H1951_049_3	4		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1951	051	0	1	01	01	H1951_051_0	4		Y	Preferred Generic	4	11	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1951	051	0	1	01	01	H1951_051_0	4		Y	Generic	4	11	1	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	5.00		15.00																									20.00		60.00				5.00		0.00				5.00				5.00		0.17				0.67	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1951	051	0	1	01	01	H1951_051_0	4		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		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		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	99.00		297.00																									100.00		300.00				99.00		287.00				99.00				99.00		3.30				3.33	3.30	3.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1951	051	0	1	01	01	H1951_051_0	4		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1951	052	0	1	01	01	H1951_052_0	3		Y	Preferred Generic	4	11	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1951	052	0	1	01	01	H1951_052_0	3		Y	Generic	4	11	1	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	5.00		15.00																									20.00		60.00				5.00		0.00				5.00				5.00		0.17				0.67	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1951	052	0	1	01	01	H1951_052_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		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	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	99.00		297.00																									100.00		300.00				99.00		287.00				99.00				99.00		3.30				3.33	3.30	3.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1951	052	0	1	01	01	H1951_052_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1951	053	0	1	01	01	H1951_053_0	4		Y	Preferred Generic	4	11	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1951	053	0	1	01	01	H1951_053_0	4		Y	Generic	4	11	1	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	5.00		15.00																									20.00		60.00				5.00		0.00				5.00				5.00		0.17				0.67	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1951	053	0	1	01	01	H1951_053_0	4		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		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	4		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	99.00		297.00																									100.00		300.00				99.00		287.00				99.00				99.00		3.30				3.33	3.30	3.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1951	053	0	1	01	01	H1951_053_0	4		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1951	054	0	1	01	01	H1951_054_0	4		Y	Preferred Generic	4	11	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1951	054	0	1	01	01	H1951_054_0	4		Y	Generic	4	11	1	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	5.00		15.00																									20.00		60.00				5.00		0.00				5.00				5.00		0.17				0.67	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1951	054	0	1	01	01	H1951_054_0	4		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		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	4		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	99.00		297.00																									100.00		300.00				99.00		287.00				99.00				99.00		3.30				3.33	3.30	3.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1951	054	0	1	01	01	H1951_054_0	4		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1951	055	0	1	01	01	H1951_055_0	4		Y	Preferred Generic	4	11	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1951	055	0	1	01	01	H1951_055_0	4		Y	Generic	4	11	1	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	5.00		15.00																									20.00		60.00				5.00		0.00				5.00				5.00		0.17				0.67	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1951	055	0	1	01	01	H1951_055_0	4		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		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		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	99.00		297.00																									100.00		300.00				99.00		287.00				99.00				99.00		3.30				3.33	3.30	3.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1951	055	0	1	01	01	H1951_055_0	4		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1961	014	1	1	02	01	H1961_014_1	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1961	014	1	1	02	01	H1961_014_1	3		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1961	014	1	1	02	01	H1961_014_1	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1961	014	1	1	02	01	H1961_014_1	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H1961	014	1	1	02	01	H1961_014_1	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	45.00		135.00																											135.00						135.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1961	014	1	1	02	01	H1961_014_1	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						300.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1961	014	1	1	02	01	H1961_014_1	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				502.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1961	014	2	1	02	01	H1961_014_2	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1961	014	2	1	02	01	H1961_014_2	3		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1961	014	2	1	02	01	H1961_014_2	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1961	014	2	1	02	01	H1961_014_2	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H1961	014	2	1	02	01	H1961_014_2	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	45.00		135.00																											135.00						135.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1961	014	2	1	02	01	H1961_014_2	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						300.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1961	014	2	1	02	01	H1961_014_2	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				502.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1961	014	3	1	02	01	H1961_014_3	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1961	014	3	1	02	01	H1961_014_3	3		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1961	014	3	1	02	01	H1961_014_3	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1961	014	3	1	02	01	H1961_014_3	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H1961	014	3	1	02	01	H1961_014_3	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	45.00		135.00																											135.00						135.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1961	014	3	1	02	01	H1961_014_3	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						300.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1961	014	3	1	02	01	H1961_014_3	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				502.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1961	014	4	1	02	01	H1961_014_4	4		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1961	014	4	1	02	01	H1961_014_4	4		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1961	014	4	1	02	01	H1961_014_4	4		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1961	014	4	1	02	01	H1961_014_4	4		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H1961	014	4	1	02	01	H1961_014_4	4		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	45.00		135.00																											135.00						135.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1961	014	4	1	02	01	H1961_014_4	4		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						300.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1961	014	4	1	02	01	H1961_014_4	4		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				502.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1961	017	0	1	02	01	H1961_017_0	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1961	017	0	1	02	01	H1961_017_0	3		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1961	017	0	1	02	01	H1961_017_0	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1961	017	0	1	02	01	H1961_017_0	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H1961	017	0	1	02	01	H1961_017_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	45.00		135.00																											135.00						135.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1961	017	0	1	02	01	H1961_017_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						300.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1961	017	0	1	02	01	H1961_017_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				570.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1969	002	0	1	01	01	H1969_002_0	8		Y	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	8		Y	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	8		Y	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	100	1	2	30	60	100				30		31								47.00	94.00	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	8		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	100	1	2	30	60	100				30		31								100.00	200.00	300.00					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												
H1969	002	0	1	01	01	H1969_002_0	8		Y	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											1035.40	30						1035.40	30						30																	30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1969	007	3	1	01	01	H1969_007_3	9		Y	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	9		Y	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	9		Y	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	100	1	2	30	60	100				30		31								47.00	94.00	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	9		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	100	1	2	30	60	100				30		31								100.00	200.00	300.00					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												
H1969	007	3	1	01	01	H1969_007_3	9		Y	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											1069.92	31						1069.92	31						31																	31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1969	007	4	1	01	01	H1969_007_4	9		Y	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	9		Y	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	9		Y	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	100	1	2	30	60	100				30		31								47.00	94.00	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	9		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	100	1	2	30	60	100				30		31								100.00	200.00	300.00					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												
H1969	007	4	1	01	01	H1969_007_4	9		Y	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											1069.92	31						1069.92	31						31																	31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1977	001	0	1	48	05	H1977_001_0	4			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	4			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	11		Y	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1993	001	0	1	01	01	H1993_001_0	11		Y	Preferred Generic	4	01	1	2	1	3	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H1993	001	0	1	01	01	H1993_001_0	11		Y	Generic	4	01	3	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, Select Care Drugs												
H1993	001	0	1	01	01	H1993_001_0	11		Y	Generic	4	01	3	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				10.00		0.33			0.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		3
H1993	001	0	1	01	01	H1993_001_0	11		Y	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31	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, Select Care Drugs												
H1993	001	0	1	01	01	H1993_001_0	11		Y	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31	95.00	190.00	285.00																			95.00	190.00	285.00																95.00				95.00		3.17			3.17			3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1993	001	0	1	01	01	H1993_001_0	11		Y	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				1040.44	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1993	001	0	1	01	01	H1993_001_0	11		Y	Select Care Drugs	4	11	1	2	6	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, Select Care Drugs												
H1993	001	0	1	01	01	H1993_001_0	11		Y	Select Care Drugs	4	11	1	2	6	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, Select Care Drugs										1		
H1993	003	0	1	01	01	H1993_003_0	11		Y	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1993	003	0	1	01	01	H1993_003_0	11		Y	Preferred Generic	4	01	1	2	1	3	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H1993	003	0	1	01	01	H1993_003_0	11		Y	Generic	4	01	3	2	2	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31	4.00	8.00	12.00																			4.00	8.00	12.00																4.00				4.00		0.13			0.13			0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1993	003	0	1	01	01	H1993_003_0	11		Y	Generic	4	01	3	2	2	3	111		01	111		1	30	60	90				2	2	30	60	90				30		31	4.00	8.00	12.00																			4.00	8.00	12.00																4.00				4.00		0.13			0.13			0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		3
H1993	003	0	1	01	01	H1993_003_0	11		Y	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31	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, Select Care Drugs												
H1993	003	0	1	01	01	H1993_003_0	11		Y	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31	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												
H1993	003	0	1	01	01	H1993_003_0	11		Y	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				509.83	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1993	003	0	1	01	01	H1993_003_0	11		Y	Select Care Drugs	4	11	1	2	6	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, Select Care Drugs												
H1993	003	0	1	01	01	H1993_003_0	11		Y	Select Care Drugs	4	11	1	2	6	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, Select Care Drugs										1		
H1993	007	0	1	01	01	H1993_007_0	11		Y	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1993	007	0	1	01	01	H1993_007_0	11		Y	Preferred Generic	4	01	1	2	1	3	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H1993	007	0	1	01	01	H1993_007_0	11		Y	Generic	4	01	3	2	2	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31	4.00	8.00	12.00																			4.00	8.00	12.00																4.00				4.00		0.13			0.13			0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1993	007	0	1	01	01	H1993_007_0	11		Y	Generic	4	01	3	2	2	3	111		01	111		1	30	60	90				2	2	30	60	90				30		31	4.00	8.00	12.00																			4.00	8.00	12.00																4.00				4.00		0.13			0.13			0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		3
H1993	007	0	1	01	01	H1993_007_0	11		Y	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31	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, Select Care Drugs												
H1993	007	0	1	01	01	H1993_007_0	11		Y	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31	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												
H1993	007	0	1	01	01	H1993_007_0	11		Y	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				509.83	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1993	007	0	1	01	01	H1993_007_0	11		Y	Select Care Drugs	4	11	1	2	6	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, Select Care Drugs												
H1993	007	0	1	01	01	H1993_007_0	11		Y	Select Care Drugs	4	11	1	2	6	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, Select Care Drugs										1		
H1993	008	0	1	01	01	H1993_008_0	11		Y	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1993	008	0	1	01	01	H1993_008_0	11		Y	Preferred Generic	4	01	1	2	1	3	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H1993	008	0	1	01	01	H1993_008_0	11		Y	Generic	4	01	3	2	2	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31	4.00	8.00	12.00																			4.00	8.00	12.00																4.00				4.00		0.13			0.13			0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1993	008	0	1	01	01	H1993_008_0	11		Y	Generic	4	01	3	2	2	3	111		01	111		1	30	60	90				2	2	30	60	90				30		31	4.00	8.00	12.00																			4.00	8.00	12.00																4.00				4.00		0.13			0.13			0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		3
H1993	008	0	1	01	01	H1993_008_0	11		Y	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31	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, Select Care Drugs												
H1993	008	0	1	01	01	H1993_008_0	11		Y	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31	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												
H1993	008	0	1	01	01	H1993_008_0	11		Y	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				824.39	25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1993	008	0	1	01	01	H1993_008_0	11		Y	Select Care Drugs	4	11	1	2	6	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, Select Care Drugs												
H1993	008	0	1	01	01	H1993_008_0	11		Y	Select Care Drugs	4	11	1	2	6	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, Select Care Drugs										1		
H1994	001	0	1	01	01	H1994_001_0	9		Y	Preferred Generic	4	11	1	2	1	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1994	001	0	1	01	01	H1994_001_0	9		Y	Preferred Generic	4	11	1	2	1	3	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1994	001	0	1	01	01	H1994_001_0	9		Y	Generic	4	11	1	2	2	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				6.00		0.20			0.00			0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1994	001	0	1	01	01	H1994_001_0	9		Y	Generic	4	11	1	2	2	3	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				6.00		0.20			0.00			0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1994	001	0	1	01	01	H1994_001_0	9		Y	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	47.00	94.00	141.00																			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												
H1994	001	0	1	01	01	H1994_001_0	9		Y	Non-Preferred Brand	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 Brand, Specialty Tier												
H1994	001	0	1	01	01	H1994_001_0	9		Y	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				1420.00	31																				31																	31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1994	002	0	1	01	01	H1994_002_0	14		Y	Preferred Generic	4	11	1	2	1	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1994	002	0	1	01	01	H1994_002_0	14		Y	Preferred Generic	4	11	1	2	1	3	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1994	002	0	1	01	01	H1994_002_0	14		Y	Generic	4	11	1	2	2	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	10.00	20.00	30.00																			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												
H1994	002	0	1	01	01	H1994_002_0	14		Y	Generic	4	11	1	2	2	3	111		01	111		1	30	60	100				1	2	30	60	100				30		31	10.00	20.00	30.00																			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										2	3	
H1994	002	0	1	01	01	H1994_002_0	14		Y	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	47.00	94.00	141.00																			47.00	94.00	141.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1994	002	0	1	01	01	H1994_002_0	14		Y	Non-Preferred Brand	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 Brand, Specialty Tier												
H1994	002	0	1	01	01	H1994_002_0	14		Y	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				1345.00	29																				29																	29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1994	003	0	1	01	01	H1994_003_0	8		Y	Preferred Generic	4	11	1	2	1	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1994	003	0	1	01	01	H1994_003_0	8		Y	Preferred Generic	4	11	1	2	1	3	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1994	003	0	1	01	01	H1994_003_0	8		Y	Generic	4	11	1	2	2	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				6.00		0.20			0.00			0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1994	003	0	1	01	01	H1994_003_0	8		Y	Generic	4	11	1	2	2	3	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				6.00		0.20			0.00			0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1994	003	0	1	01	01	H1994_003_0	8		Y	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	47.00	94.00	141.00																			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												
H1994	003	0	1	01	01	H1994_003_0	8		Y	Non-Preferred Brand	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 Brand, Specialty Tier												
H1994	003	0	1	01	01	H1994_003_0	8		Y	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				1402.00	31																				31																	31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1994	004	0	1	01	01	H1994_004_0	8		Y	Preferred Generic	4	11	1	2	1	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1994	004	0	1	01	01	H1994_004_0	8		Y	Preferred Generic	4	11	1	2	1	3	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1994	004	0	1	01	01	H1994_004_0	8		Y	Generic	4	11	1	2	2	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				6.00		0.20			0.00			0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1994	004	0	1	01	01	H1994_004_0	8		Y	Generic	4	11	1	2	2	3	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				6.00		0.20			0.00			0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1994	004	0	1	01	01	H1994_004_0	8		Y	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	47.00	94.00	141.00																			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												
H1994	004	0	1	01	01	H1994_004_0	8		Y	Non-Preferred Brand	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 Brand, Specialty Tier												
H1994	004	0	1	01	01	H1994_004_0	8		Y	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				1415.00	31																				31																	31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1994	007	0	1	01	01	H1994_007_0	9		Y	Preferred Generic	4	11	1	2	1	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1994	007	0	1	01	01	H1994_007_0	9		Y	Preferred Generic	4	11	1	2	1	3	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H1994	007	0	1	01	01	H1994_007_0	9		Y	Generic	4	11	1	2	2	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				6.00		0.20			0.00			0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1994	007	0	1	01	01	H1994_007_0	9		Y	Generic	4	11	1	2	2	3	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				6.00		0.20			0.00			0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1994	007	0	1	01	01	H1994_007_0	9		Y	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	47.00	94.00	141.00																			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												
H1994	007	0	1	01	01	H1994_007_0	9		Y	Non-Preferred Brand	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 Brand, Specialty Tier												
H1994	007	0	1	01	01	H1994_007_0	9		Y	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				1656.00	32																				32																	32			32								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1994	008	0	1	01	01	H1994_008_0	9		Y	Preferred Generic	4	11	1	2	1	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1994	008	0	1	01	01	H1994_008_0	9		Y	Preferred Generic	4	11	1	2	1	3	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1994	008	0	1	01	01	H1994_008_0	9		Y	Generic	4	11	1	2	2	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				6.00		0.20			0.00			0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1994	008	0	1	01	01	H1994_008_0	9		Y	Generic	4	11	1	2	2	3	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				6.00		0.20			0.00			0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1994	008	0	1	01	01	H1994_008_0	9		Y	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	40.00	80.00	120.00																			40.00	80.00	120.00																40.00				40.00		1.33			1.33			1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1994	008	0	1	01	01	H1994_008_0	9		Y	Non-Preferred Brand	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 Brand, Specialty Tier												
H1994	008	0	1	01	01	H1994_008_0	9		Y	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				1239.00	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1994	012	0	1	01	01	H1994_012_0	9		Y	Preferred Generic	4	11	1	2	1	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1994	012	0	1	01	01	H1994_012_0	9		Y	Preferred Generic	4	11	1	2	1	3	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H1994	012	0	1	01	01	H1994_012_0	9		Y	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1994	012	0	1	01	01	H1994_012_0	9		Y	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1994	012	0	1	01	01	H1994_012_0	9		Y	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	47.00	94.00	141.00																			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												
H1994	012	0	1	01	01	H1994_012_0	9		Y	Non-Preferred Brand	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 Brand, Specialty Tier												
H1994	012	0	1	01	01	H1994_012_0	9		Y	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				2076.00	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1994	013	0	1	01	01	H1994_013_0	8		Y	Preferred Generic	4	11	1	2	1	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1994	013	0	1	01	01	H1994_013_0	8		Y	Preferred Generic	4	11	1	2	1	3	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1994	013	0	1	01	01	H1994_013_0	8		Y	Generic	4	11	1	2	2	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				6.00		0.20			0.00			0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1994	013	0	1	01	01	H1994_013_0	8		Y	Generic	4	11	1	2	2	3	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				6.00		0.20			0.00			0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1994	013	0	1	01	01	H1994_013_0	8		Y	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	47.00	94.00	141.00																			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												
H1994	013	0	1	01	01	H1994_013_0	8		Y	Non-Preferred Brand	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 Brand, Specialty Tier												
H1994	013	0	1	01	01	H1994_013_0	8		Y	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				1998.00	29																				29																	29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1994	014	0	1	01	01	H1994_014_0	9		Y	Preferred Generic	4	11	1	2	1	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1994	014	0	1	01	01	H1994_014_0	9		Y	Preferred Generic	4	11	1	2	1	3	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1994	014	0	1	01	01	H1994_014_0	9		Y	Generic	4	11	1	2	2	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				6.00		0.20			0.00			0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1994	014	0	1	01	01	H1994_014_0	9		Y	Generic	4	11	1	2	2	3	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				6.00		0.20			0.00			0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1994	014	0	1	01	01	H1994_014_0	9		Y	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	47.00	94.00	141.00																			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												
H1994	014	0	1	01	01	H1994_014_0	9		Y	Non-Preferred Brand	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 Brand, Specialty Tier												
H1994	014	0	1	01	01	H1994_014_0	9		Y	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				1998.00	29																				29																	29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1994	017	0	1	01	01	H1994_017_0	9		Y	Preferred Generic	4	11	1	2	1	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1994	017	0	1	01	01	H1994_017_0	9		Y	Preferred Generic	4	11	1	2	1	3	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1994	017	0	1	01	01	H1994_017_0	9		Y	Generic	4	11	1	2	2	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	15.00	30.00	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 Brand, Specialty Tier												
H1994	017	0	1	01	01	H1994_017_0	9		Y	Generic	4	11	1	2	2	3	111		01	111		1	30	60	100				1	2	30	60	100				30		31	15.00	30.00	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 Brand, Specialty Tier										2	3	
H1994	017	0	1	01	01	H1994_017_0	9		Y	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	47.00	94.00	141.00																			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												
H1994	017	0	1	01	01	H1994_017_0	9		Y	Non-Preferred Brand	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 Brand, Specialty Tier												
H1994	017	0	1	01	01	H1994_017_0	9		Y	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				1345.00	29																				29																	29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1997	002	0	1	01	01	H1997_002_0	8		Y	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	8		Y	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	8		Y	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	100	1	2	30	60	100				30		31								47.00	94.00	117.50					40.00	80.00	100.00					40.00	80.00	100.00																47.00				47.00			1.57	1.33	1.33			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1997	002	0	1	01	01	H1997_002_0	8		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	100	1	2	30	60	100				30		31								100.00	200.00	250.00					100.00	200.00	250.00					100.00	200.00	250.00																100.00				100.00			3.33	3.33	3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1997	002	0	1	01	01	H1997_002_0	8		Y	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											1069.92	31						1069.92	31						31																	31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1997	009	0	1	01	01	H1997_009_0	10		Y	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	10		Y	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	10		Y	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	100	1	2	30	60	100				30		31								47.00	94.00	141.00					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	10		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	100	1	2	30	60	100				30		31								100.00	200.00	300.00					100.00	200.00	300.00					100.00	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												
H1997	009	0	1	01	01	H1997_009_0	10		Y	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											966.38	28						966.38	28						28																	28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2001	001	0	1	04	01	H2001_001_0	2		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2001	001	0	1	04	01	H2001_001_0	2		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H2001	001	0	1	04	01	H2001_001_0	2		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2001	001	0	1	04	01	H2001_001_0	2		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H2001	001	0	1	04	01	H2001_001_0	2		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2001	001	0	1	04	01	H2001_001_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2001	001	0	1	04	01	H2001_001_0	2		Y	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												
H2001	010	0	1	04	01	H2001_010_0	2		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2001	010	0	1	04	01	H2001_010_0	2		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H2001	010	0	1	04	01	H2001_010_0	2		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2001	010	0	1	04	01	H2001_010_0	2		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H2001	010	0	1	04	01	H2001_010_0	2		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2001	010	0	1	04	01	H2001_010_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2001	010	0	1	04	01	H2001_010_0	2		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				288.00	30																										30						30					30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2001	017	0	1	04	01	H2001_017_0	2		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2001	017	0	1	04	01	H2001_017_0	2		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H2001	017	0	1	04	01	H2001_017_0	2		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2001	017	0	1	04	01	H2001_017_0	2		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H2001	017	0	1	04	01	H2001_017_0	2		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2001	017	0	1	04	01	H2001_017_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2001	017	0	1	04	01	H2001_017_0	2		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				427.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2001	018	0	1	04	01	H2001_018_0	2		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2001	018	0	1	04	01	H2001_018_0	2		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H2001	018	0	1	04	01	H2001_018_0	2		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2001	018	0	1	04	01	H2001_018_0	2		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H2001	018	0	1	04	01	H2001_018_0	2		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2001	018	0	1	04	01	H2001_018_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2001	018	0	1	04	01	H2001_018_0	2		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				222.00	30																										30						30					30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2001	019	0	1	04	01	H2001_019_0	2		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2001	019	0	1	04	01	H2001_019_0	2		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H2001	019	0	1	04	01	H2001_019_0	2		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2001	019	0	1	04	01	H2001_019_0	2		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H2001	019	0	1	04	01	H2001_019_0	2		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2001	019	0	1	04	01	H2001_019_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2001	019	0	1	04	01	H2001_019_0	2		Y	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												
H2001	023	0	1	04	01	H2001_023_0	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2001	023	0	1	04	01	H2001_023_0	3		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H2001	023	0	1	04	01	H2001_023_0	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	14.00		42.00																											42.00						0.00				14.00				14.00		0.46						0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2001	023	0	1	04	01	H2001_023_0	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	14.00		42.00																											42.00						0.00				14.00				14.00		0.46						0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H2001	023	0	1	04	01	H2001_023_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2001	023	0	1	04	01	H2001_023_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2001	023	0	1	04	01	H2001_023_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				488.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2029	001	0	1	04	01	H2029_001_0	4		Y	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				2	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0				0	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2029	001	0	1	04	01	H2029_001_0	4		Y	Generic	4	11	1	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0				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	4		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	25.00		75.00																									26.00		75.00				25.00		65.00				25.00				25.00		0.83				0.87	0.83	0.81	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2029	001	0	1	04	01	H2029_001_0	4		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	40.00		120.00																									40.00		120.00				40.00		110.00				40.00				40.00		1.33				1.33	1.33	1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2029	001	0	1	04	01	H2029_001_0	4		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2029	001	0	1	04	01	H2029_001_0	4		Y	Select Care Drugs	4	11	1	2	6	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0				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	7		Y	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31	4.00	8.00	8.00																			0.00	0.00	0.00																4.00				4.00		0.13			0.00			0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2032	001	0	1	04	01	H2032_001_0	7		Y	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31	14.00	28.00	28.00																			0.00	0.00	0.00																14.00				14.00		0.47			0.00			0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2032	001	0	1	04	01	H2032_001_0	7		Y	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31	47.00	94.00	94.00																			47.00	94.00	94.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2032	001	0	1	04	01	H2032_001_0	7		Y	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31	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	7		Y	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31					27																				27																	27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2032	002	0	1	04	01	H2032_002_0	6		Y	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31	3.00	6.00	6.00																			0.00	0.00	0.00																3.00				3.00		0.10			0.00			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2032	002	0	1	04	01	H2032_002_0	6		Y	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31	14.00	28.00	28.00																			0.00	0.00	0.00																14.00				14.00		0.47			0.00			0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2032	002	0	1	04	01	H2032_002_0	6		Y	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31	47.00	94.00	94.00																			47.00	94.00	94.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2032	002	0	1	04	01	H2032_002_0	6		Y	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31	99.00	198.00	198.00																			99.00	198.00	198.00																99.00				99.00		3.30			3.30			3.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2032	002	0	1	04	01	H2032_002_0	6		Y	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31					28																				28																	28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2032	003	0	1	04	01	H2032_003_0	7		Y	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31	2.00	4.00	4.00																			0.00	0.00	0.00																2.00				2.00		0.07			0.00			0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2032	003	0	1	04	01	H2032_003_0	7		Y	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31	12.00	24.00	24.00																			0.00	0.00	0.00																12.00				12.00		0.40			0.00			0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2032	003	0	1	04	01	H2032_003_0	7		Y	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31	45.00	90.00	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	7		Y	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31	95.00	190.00	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	7		Y	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31					32																				32																	32			32								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2056	001	0	1	02	01	H2056_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												
H2056	001	0	1	02	01	H2056_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								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00					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		
H2056	001	0	1	02	01	H2056_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	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												
H2056	001	0	1	02	01	H2056_001_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		
H2056	001	0	1	02	01	H2056_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												
H2056	001	0	1	02	01	H2056_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												
H2056	001	0	1	02	01	H2056_001_0	4			Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											749.03	33						443.69	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2056	002	0	1	02	01	H2056_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												
H2056	002	0	1	02	01	H2056_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		
H2056	002	0	1	02	01	H2056_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	20.00											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												
H2056	002	0	1	02	01	H2056_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	20.00											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										1		
H2056	002	0	1	02	01	H2056_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												
H2056	002	0	1	02	01	H2056_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												
H2056	002	0	1	02	01	H2056_002_0	3			Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											818.28	33						499.85	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2056	003	0	1	02	01	H2056_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								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00					5.00			5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2056	003	0	1	02	01	H2056_003_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		
H2056	003	0	1	02	01	H2056_003_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												
H2056	003	0	1	02	01	H2056_003_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		
H2056	003	0	1	02	01	H2056_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	94.00	141.00				47.00	94.00	141.00					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	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	003	0	1	02	01	H2056_003_0	3			Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											678.77	33						591.38	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2056	004	0	1	02	01	H2056_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												
H2056	004	0	1	02	01	H2056_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		
H2056	004	0	1	02	01	H2056_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	20.00											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												
H2056	004	0	1	02	01	H2056_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	20.00											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										1		
H2056	004	0	1	02	01	H2056_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												
H2056	004	0	1	02	01	H2056_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												
H2056	004	0	1	02	01	H2056_004_0	3			Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											959.01	33						731.74	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					10.00	20.00	20.00											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												
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					10.00	20.00	20.00											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										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											1333.25	33						816.91	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2108	022	0	1	01	01	H2108_022_0	4		Y	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								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	4		Y	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	40.00					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	4		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2108	022	0	1	01	01	H2108_022_0	4		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								100.00	200.00	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	4		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											916.12	33						758.23	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2108	028	0	1	01	01	H2108_028_0	4		Y	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								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	4		Y	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	4		Y	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	40.00					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	4		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2108	028	0	1	01	01	H2108_028_0	4		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								100.00	200.00	300.00					95.00	190.00	285.00											100.00	200.00	300.00				95.00	190.00	285.00				100.00				100.00			3.33	3.17		3.33	3.17	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2108	028	0	1	01	01	H2108_028_0	4		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											760.44	33						773.62	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2108	029	0	1	01	01	H2108_029_0	5			Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								9.00	18.00	18.00					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	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					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	5			Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs												
H2108	029	0	1	01	01	H2108_029_0	5			Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	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	5			Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											763.20	33						672.85	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	5			Select Diabetic Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								6.00	12.00	12.00					5.00	10.00	10.00											6.00	12.00	12.00				5.00	10.00	10.00				6.00				6.00			0.20	0.17		0.20	0.17	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs												
H2108	030	0	1	01	01	H2108_030_0	4			Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								9.00	18.00	18.00					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	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, Select Diabetic Drugs												
H2108	030	0	1	01	01	H2108_030_0	4			Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs												
H2108	030	0	1	01	01	H2108_030_0	4			Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								100.00	200.00	300.00					95.00	190.00	285.00											100.00	200.00	300.00				95.00	190.00	285.00				100.00				100.00			3.33	3.17		3.33	3.17	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs												
H2108	030	0	1	01	01	H2108_030_0	4			Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											855.72	33						674.55	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	4			Select Diabetic Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								11.00	22.00	22.00					10.00	20.00	20.00											11.00	22.00	22.00				10.00	20.00	20.00				11.00				11.00			0.37	0.33		0.37	0.33	0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs												
H2108	036	0	1	01	01	H2108_036_0	4		Y	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								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	4		Y	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	40.00					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	4		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2108	036	0	1	01	01	H2108_036_0	4		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								100.00	200.00	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	4		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											790.60	33						828.53	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2117	001	0	1	04	01	H2117_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												
H2117	001	0	1	04	01	H2117_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								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00				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
H2117	001	0	1	04	01	H2117_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	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	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												
H2117	001	0	1	04	01	H2117_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											77.79	45	45	45				74.33	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	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												
H2117	001	0	1	04	01	H2117_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												
H2117	001	0	1	04	01	H2117_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	
H2117	004	0	1	04	01	H2117_004_0	6			Preferred Generic	3	11	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								19.00	38.00	57.00					0.00	0.00	0.00											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	6			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					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00				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	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					37.00	74.00	111.00											47.00	94.00	141.00				37.00	74.00	74.00				47.00				47.00			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	6			Non-Preferred Drug	3	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											92.73	45	45	45				92.73	45	45	45										45	45	45				45	45	45			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2117	004	0	1	04	01	H2117_004_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												
H2117	004	0	1	04	01	H2117_004_0	6			Select Care Drugs	3	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			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	3	11	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								19.00	38.00	57.00					0.00	0.00	0.00											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												
H2128	001	0	1	04	01	H2128_001_0	4			Generic	3	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					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												
H2128	001	0	1	04	01	H2128_001_0	4			Preferred Brand	3	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	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, Select Care Drugs												
H2128	001	0	1	04	01	H2128_001_0	4			Non-Preferred Drug	3	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											98.54	46	46	46				98.54	46	46	46										46	46	46				46	46	46			46			46								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	3	11	1	1	5	1		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												
H2128	001	0	1	04	01	H2128_001_0	4			Select Care Drugs	3	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			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								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00				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												
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											78.49	45	45	45				75.00	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											78.78	45	45	45				75.28	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								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00				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												
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											93.03	50	50	50				89.31	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	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								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00				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												
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								20.00	40.00	60.00					9.00	18.00	27.00											20.00	40.00	60.00				9.00	18.00	0.00				20.00				20.00			0.67	0.3		0.67	0.3	0.65	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	004	0	1	01	01	H2134_004_0	4			Preferred Generic	4	11	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								19.00	38.00	57.00					0.00	0.00	0.00											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												
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	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												
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	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, 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											99.05	44	44	44				99.05	44	44	44										44	44	44				44	44	44			44			44								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			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	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								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00				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												
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								20.00	40.00	60.00					9.00	18.00	27.00											20.00	40.00	60.00				9.00	18.00	0.00				20.00				20.00			0.67	0.3		0.67	0.3	0.65	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												
H2162	001	0	1	01	01	H2162_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												
H2162	001	0	1	01	01	H2162_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												
H2162	001	0	1	01	01	H2162_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												
H2162	001	0	1	01	01	H2162_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											95.96	45	45	45				91.70	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	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												
H2162	001	0	1	01	01	H2162_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												
H2171	001	0	1	01	01	H2171_001_0	5		Y	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												
H2171	001	0	1	01	01	H2171_001_0	5		Y	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		
H2171	001	0	1	01	01	H2171_001_0	5		Y	Generic	4	11	1	2	2	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	14.00	28.00	28.00																			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												
H2171	001	0	1	01	01	H2171_001_0	5		Y	Generic	4	11	1	2	2	3	111		01	111		1	30	60	100				1	2	30	60	100				30		31	14.00	28.00	28.00																			14.00	28.00	28.00																14.00				14.00		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	5		Y	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	47.00	94.00	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												
H2171	001	0	1	01	01	H2171_001_0	5		Y	Preferred Brand	4	11	1	2	3	3	111		01	111		1	30	60	100				1	2	30	60	100				30		31	47.00	94.00	94.00																			47.00	94.00	94.00																47.00				47.00		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	5		Y	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	100.00	200.00	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	5		Y	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				1128.17	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2171	003	0	1	01	01	H2171_003_0	5		Y	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												
H2171	003	0	1	01	01	H2171_003_0	5		Y	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		
H2171	003	0	1	01	01	H2171_003_0	5		Y	Generic	4	11	1	2	2	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	10.00	20.00	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	5		Y	Generic	4	11	1	2	2	3	111		01	111		1	30	60	100				1	2	30	60	100				30		31	10.00	20.00	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	5		Y	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	40.00	80.00	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	5		Y	Preferred Brand	4	11	1	2	3	3	111		01	111		1	30	60	100				1	2	30	60	100				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	5		Y	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	100.00	200.00	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	5		Y	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				1131.08	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2172	001	0	1	02	01	H2172_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								10.00	20.00	30.00					0.00	0.00	0.00					0.00	0.00	0.00																10.00				10.00			0.33	0.00	0.00			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H2172	001	0	1	02	01	H2172_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								10.00	20.00	30.00					0.00	0.00	0.00					0.00	0.00	0.00																10.00				10.00			0.33	0.00	0.00			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H2172	001	0	1	02	01	H2172_001_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					12.00	0.00	0.00																20.00				20.00			0.66	0.40	0.40			0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H2172	001	0	1	02	01	H2172_001_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					12.00	0.00	0.00																20.00				20.00			0.66	0.40	0.40			0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H2172	001	0	1	02	01	H2172_001_0	8			Preferred Brand	4	10	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		31								47.00	94.00	141.00					42.00	84.00	126.00					42.00	84.00	84.00																47.00				47.00			1.56	1.40	1.40			1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H2172	001	0	1	02	01	H2172_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								100.00	200.00	300.00					80.00	160.00	240.00					80.00	160.00	160.00																100.00				100.00			3.33	2.66	2.66			3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H2172	001	0	1	02	01	H2172_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	33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H2172	001	0	1	02	01	H2172_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	0.00				0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H2172	001	0	1	02	01	H2172_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	0.00				0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H2172	002	0	1	02	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					0.00	0.00	0.00					0.00	0.00	0.00																10.00				10.00			0.33	0.00	0.00			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H2172	002	0	1	02	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					0.00	0.00	0.00					0.00	0.00	0.00																10.00				10.00			0.33	0.00	0.00			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H2172	002	0	1	02	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					12.00	24.00	36.00					12.00	0.00	0.00																20.00				20.00			0.66	0.40	0.40			0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H2172	002	0	1	02	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					12.00	24.00	36.00					12.00	0.00	0.00																20.00				20.00			0.66	0.40	0.40			0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H2172	002	0	1	02	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					42.00	84.00	84.00																47.00				47.00			1.56	1.40	1.40			1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H2172	002	0	1	02	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					80.00	160.00	160.00																100.00				100.00			3.33	2.66	2.66			3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H2172	002	0	1	02	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								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H2172	002	0	1	02	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	02	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	02	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					0.00	0.00	0.00					0.00	0.00	0.00																10.00				10.00			0.33	0.00	0.00			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H2172	003	0	1	02	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					12.00	24.00	36.00					12.00	0.00	0.00																20.00				20.00			0.66	0.40	0.40			0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H2172	003	0	1	02	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					45.00	90.00	90.00																47.00				47.00			1.56	1.50	1.50			1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H2172	003	0	1	02	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	200.00																100.00				100.00			3.33	3.33	3.33			3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H2172	003	0	1	02	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								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H2172	003	0	1	02	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	02	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	02	01	H2172_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								10.00	20.00	30.00					0.00	0.00	0.00					0.00	0.00	0.00																10.00				10.00			0.33	0.00	0.00			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H2172	004	0	1	02	01	H2172_004_0	7			Generic	4	11	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		31								20.00	40.00	60.00					12.00	24.00	36.00					12.00	0.00	0.00																20.00				20.00			0.66	0.40	0.40			0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H2172	004	0	1	02	01	H2172_004_0	7			Preferred Brand	4	10	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		31								47.00	94.00	141.00					45.00	90.00	135.00					45.00	90.00	90.00																47.00				47.00			1.56	1.50	1.50			1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H2172	004	0	1	02	01	H2172_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								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			3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H2172	004	0	1	02	01	H2172_004_0	7			Specialty Tier	4	11	1	1	5	1		111	01	111		1				30	60	90	2	2	30	60	90				30		31												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	02	01	H2172_004_0	7			Vaccines	4	10	1	2	6	1		010	01			1				30											30		31								0.00							0.00																									0.00				0.00			0.00	0.00				0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H2172	004	0	1	02	01	H2172_004_0	7			Vaccines	4	10	1	2	6	3		010	01			1				30											30		31								0.00							0.00																									0.00				0.00			0.00	0.00				0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H2172	006	0	1	01	01	H2172_006_0	6			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					5.00	0.00	0.00																10.00				10.00			0.33	0.16	0.16			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H2172	006	0	1	01	01	H2172_006_0	6			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					15.00	0.00	0.00																20.00				20.00			0.66	0.50	0.50			0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H2172	006	0	1	01	01	H2172_006_0	6			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					45.00	90.00	90.00																47.00				47.00			1.56	1.50	1.50			1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H2172	006	0	1	01	01	H2172_006_0	6			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	200.00																100.00				100.00			3.33	3.33	3.33			3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H2172	006	0	1	01	01	H2172_006_0	6			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								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H2172	006	0	1	01	01	H2172_006_0	6			Vaccines	4	10	1	2	6	1		010	01			1				30											30		31								0.00							0.00																									0.00				0.00			0.00	0.00				0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H2172	006	0	1	01	01	H2172_006_0	6			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	02	01	H2172_008_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					0.00	0.00	0.00					0.00	0.00	0.00																10.00				10.00			0.33	0.00	0.00			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H2172	008	0	1	02	01	H2172_008_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					0.00	0.00	0.00					0.00	0.00	0.00																10.00				10.00			0.33	0.00	0.00			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H2172	008	0	1	02	01	H2172_008_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					10.00	20.00	30.00					10.00	0.00	0.00																20.00				20.00			0.66	0.33	0.33			0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H2172	008	0	1	02	01	H2172_008_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					10.00	20.00	30.00					10.00	0.00	0.00																20.00				20.00			0.66	0.33	0.33			0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H2172	008	0	1	02	01	H2172_008_0	7			Preferred Brand	4	10	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		31								47.00	94.00	141.00					42.00	84.00	126.00					42.00	84.00	84.00																47.00				47.00			1.56	1.40	1.40			1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H2172	008	0	1	02	01	H2172_008_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					80.00	160.00	160.00																100.00				100.00			3.33	2.66	2.66			3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H2172	008	0	1	02	01	H2172_008_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								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H2172	008	0	1	02	01	H2172_008_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	008	0	1	02	01	H2172_008_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	009	0	1	02	01	H2172_009_0	6			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					0.00	0.00	0.00					0.00	0.00	0.00																10.00				10.00			0.33	0.00	0.00			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H2172	009	0	1	02	01	H2172_009_0	6			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					10.00	0.00	0.00																20.00				20.00			0.66	0.33	0.33			0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H2172	009	0	1	02	01	H2172_009_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					45.00	90.00	135.00					45.00	90.00	90.00																47.00				47.00			1.56	1.50	1.50			1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H2172	009	0	1	02	01	H2172_009_0	6			Non-Preferred Brand	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		31								100.00	200.00	300.00					100.00	200.00	300.00					100.00	200.00	200.00																100.00				100.00			3.33	3.33	3.33			3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H2172	009	0	1	02	01	H2172_009_0	6			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								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H2172	009	0	1	02	01	H2172_009_0	6			Vaccines	4	10	1	2	6	1		010	01			1				30											30		31								0.00							0.00																									0.00				0.00			0.00	0.00				0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H2172	009	0	1	02	01	H2172_009_0	6			Vaccines	4	10	1	2	6	3		010	01			1				30											30		31								0.00							0.00																									0.00				0.00			0.00	0.00				0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H2172	010	0	1	02	01	H2172_010_0	6			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					0.00	0.00	0.00					0.00	0.00	0.00																10.00				10.00			0.33	0.00	0.00			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H2172	010	0	1	02	01	H2172_010_0	6			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					12.00	0.00	0.00																20.00				20.00			0.66	0.40	0.40			0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H2172	010	0	1	02	01	H2172_010_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					45.00	90.00	135.00					45.00	90.00	90.00																47.00				47.00			1.56	1.50	1.50			1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H2172	010	0	1	02	01	H2172_010_0	6			Non-Preferred Brand	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		31								100.00	200.00	300.00					100.00	200.00	300.00					100.00	200.00	200.00																100.00				100.00			3.33	3.33	3.33			3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H2172	010	0	1	02	01	H2172_010_0	6			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								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H2172	010	0	1	02	01	H2172_010_0	6			Vaccines	4	10	1	2	6	1		010	01			1				30											30		31								0.00							0.00																									0.00				0.00			0.00	0.00				0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H2172	010	0	1	02	01	H2172_010_0	6			Vaccines	4	10	1	2	6	3		010	01			1				30											30		31								0.00							0.00																									0.00				0.00			0.00	0.00				0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H2172	011	0	1	01	01	H2172_011_0	6			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					5.00	0.00	0.00																10.00				10.00			0.33	0.16	0.16			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H2172	011	0	1	01	01	H2172_011_0	6			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					15.00	0.00	0.00																20.00				20.00			0.66	0.50	0.50			0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H2172	011	0	1	01	01	H2172_011_0	6			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					45.00	90.00	90.00																47.00				47.00			1.56	1.50	1.50			1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H2172	011	0	1	01	01	H2172_011_0	6			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	200.00																100.00				100.00			3.33	3.33	3.33			3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H2172	011	0	1	01	01	H2172_011_0	6			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								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H2172	011	0	1	01	01	H2172_011_0	6			Vaccines	4	10	1	2	6	1		010	01			1				30											30		31								0.00							0.00																									0.00				0.00			0.00	0.00				0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H2172	011	0	1	01	01	H2172_011_0	6			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	02	01	H2172_012_0	6			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					0.00	0.00	0.00					0.00	0.00	0.00																10.00				10.00			0.33	0.00	0.00			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H2172	012	0	1	02	01	H2172_012_0	6			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					12.00	0.00	0.00																20.00				20.00			0.66	0.40	0.40			0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H2172	012	0	1	02	01	H2172_012_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					45.00	90.00	135.00					45.00	90.00	90.00																47.00				47.00			1.56	1.50	1.50			1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H2172	012	0	1	02	01	H2172_012_0	6			Non-Preferred Brand	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		31								100.00	200.00	300.00					100.00	200.00	300.00					100.00	200.00	200.00																100.00				100.00			3.33	3.33	3.33			3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H2172	012	0	1	02	01	H2172_012_0	6			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								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H2172	012	0	1	02	01	H2172_012_0	6			Vaccines	4	10	1	2	6	1		010	01			1				30											30		31								0.00							0.00																									0.00				0.00			0.00	0.00				0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H2172	012	0	1	02	01	H2172_012_0	6			Vaccines	4	10	1	2	6	3		010	01			1				30											30		31								0.00							0.00																									0.00				0.00			0.00	0.00				0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H2172	013	0	1	02	01	H2172_013_0	6			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					3.00	0.00	0.00																10.00				10.00			0.33	0.10	0.10			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H2172	013	0	1	02	01	H2172_013_0	6			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					12.00	0.00	0.00																20.00				20.00			0.66	0.40	0.40			0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H2172	013	0	1	02	01	H2172_013_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					45.00	90.00	135.00					45.00	90.00	90.00																47.00				47.00			1.56	1.50	1.50			1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H2172	013	0	1	02	01	H2172_013_0	6			Non-Preferred Brand	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		31								100.00	200.00	300.00					100.00	200.00	300.00					100.00	200.00	200.00																100.00				100.00			3.33	3.33	3.33			3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H2172	013	0	1	02	01	H2172_013_0	6			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								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H2172	013	0	1	02	01	H2172_013_0	6			Vaccines	4	10	1	2	6	1		010	01			1				30											30		31								0.00							0.00																									0.00				0.00			0.00	0.00				0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H2172	013	0	1	02	01	H2172_013_0	6			Vaccines	4	10	1	2	6	3		010	01			1				30											30		31								0.00							0.00																									0.00				0.00			0.00	0.00				0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H2185	003	0	1	01	01	H2185_003_0	8			Preferred Generic	4	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 Brand, Specialty Tier												
H2185	003	0	1	01	01	H2185_003_0	8			Generic	4	01	1	2	2	1	111		01			1	30	60	90				2	2							30		31	15.00	30.00	45.00																																					15.00				15.00		0.50						0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2185	003	0	1	01	01	H2185_003_0	8			Preferred Brand	4	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 Brand, Specialty Tier												
H2185	003	0	1	01	01	H2185_003_0	8			Non-Preferred Brand	4	10	1	2	4	1	111		01			1	30	60	90				2	2							30		31	95.00	190.00	285.00																																					95.00				95.00		3.17						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2185	003	0	1	01	01	H2185_003_0	8			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												
H2196	001	0	1	02	01	H2196_001_0	2		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2196	001	0	1	02	01	H2196_001_0	2		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H2196	001	0	1	02	01	H2196_001_0	2		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2196	001	0	1	02	01	H2196_001_0	2		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H2196	001	0	1	02	01	H2196_001_0	2		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2196	001	0	1	02	01	H2196_001_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2196	001	0	1	02	01	H2196_001_0	2		Y	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												
H2225	001	0	1	01	01	H2225_001_0	6		N	Preferred Generic	2	01	1	1	1	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31					25	25	25																		25	25	25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2225	001	0	1	01	01	H2225_001_0	6		N	Generic	2	01	1	1	2	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31					25	25	25																		25	25	25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2225	001	0	1	01	01	H2225_001_0	6		N	Preferred Brand	2	10	1	1	3	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31					25	25	25																		25	25	25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2225	001	0	1	01	01	H2225_001_0	6		N	Non-Preferred Brand	2	11	1	1	4	1	111		01	111		1	31	60	90				2	2	31	60	90				31		31					25	25	25																		25	25	25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2225	001	0	1	01	01	H2225_001_0	6		N	Specialty Tier	2	11	1	1	5	1	010		01	010		1	31								31						31		31					25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2228	011	0	1	04	01	H2228_011_0	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		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	011	0	1	04	01	H2228_011_0	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	011	0	1	04	01	H2228_011_0	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H2228	011	0	1	04	01	H2228_011_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	011	0	1	04	01	H2228_011_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		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	011	0	1	04	01	H2228_011_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				272.00	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		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	017	0	1	04	01	H2228_017_0	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	017	0	1	04	01	H2228_017_0	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H2228	017	0	1	04	01	H2228_017_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	017	0	1	04	01	H2228_017_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	017	0	1	04	01	H2228_017_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				221.00	29																										29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	018	0	1	04	01	H2228_018_0	2		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	018	0	1	04	01	H2228_018_0	2		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H2228	018	0	1	04	01	H2228_018_0	2		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	8.00		16.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	018	0	1	04	01	H2228_018_0	2		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	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	2		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	018	0	1	04	01	H2228_018_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	018	0	1	04	01	H2228_018_0	2		Y	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												
H2228	019	0	1	04	01	H2228_019_0	2		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	019	0	1	04	01	H2228_019_0	2		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H2228	019	0	1	04	01	H2228_019_0	2		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	8.00		24.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	019	0	1	04	01	H2228_019_0	2		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	8.00		24.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H2228	019	0	1	04	01	H2228_019_0	2		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	019	0	1	04	01	H2228_019_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	019	0	1	04	01	H2228_019_0	2		Y	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												
H2228	020	0	1	04	01	H2228_020_0	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	020	0	1	04	01	H2228_020_0	3		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H2228	020	0	1	04	01	H2228_020_0	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	8.00		24.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	020	0	1	04	01	H2228_020_0	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	8.00		24.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H2228	020	0	1	04	01	H2228_020_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	020	0	1	04	01	H2228_020_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		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	020	0	1	04	01	H2228_020_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				403.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	021	0	1	04	01	H2228_021_0	2		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	021	0	1	04	01	H2228_021_0	2		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H2228	021	0	1	04	01	H2228_021_0	2		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	8.00		24.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	021	0	1	04	01	H2228_021_0	2		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	8.00		24.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H2228	021	0	1	04	01	H2228_021_0	2		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	021	0	1	04	01	H2228_021_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	021	0	1	04	01	H2228_021_0	2		Y	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												
H2228	022	0	1	04	01	H2228_022_0	2		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	022	0	1	04	01	H2228_022_0	2		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H2228	022	0	1	04	01	H2228_022_0	2		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	8.00		24.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	022	0	1	04	01	H2228_022_0	2		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	8.00		24.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H2228	022	0	1	04	01	H2228_022_0	2		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	022	0	1	04	01	H2228_022_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	022	0	1	04	01	H2228_022_0	2		Y	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												
H2228	023	0	1	04	01	H2228_023_0	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	023	0	1	04	01	H2228_023_0	3		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H2228	023	0	1	04	01	H2228_023_0	3		Y	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		Y	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										1		3
H2228	023	0	1	04	01	H2228_023_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	023	0	1	04	01	H2228_023_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	023	0	1	04	01	H2228_023_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				391.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	024	0	1	04	01	H2228_024_0	2		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	024	0	1	04	01	H2228_024_0	2		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H2228	024	0	1	04	01	H2228_024_0	2		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	024	0	1	04	01	H2228_024_0	2		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H2228	024	0	1	04	01	H2228_024_0	2		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	024	0	1	04	01	H2228_024_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	024	0	1	04	01	H2228_024_0	2		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				482.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	029	0	1	04	01	H2228_029_0	2		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	029	0	1	04	01	H2228_029_0	2		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H2228	029	0	1	04	01	H2228_029_0	2		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	029	0	1	04	01	H2228_029_0	2		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H2228	029	0	1	04	01	H2228_029_0	2		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	029	0	1	04	01	H2228_029_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	029	0	1	04	01	H2228_029_0	2		Y	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												
H2228	030	0	1	04	01	H2228_030_0	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	030	0	1	04	01	H2228_030_0	3		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H2228	030	0	1	04	01	H2228_030_0	3		Y	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		Y	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		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	030	0	1	04	01	H2228_030_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	030	0	1	04	01	H2228_030_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				403.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	031	0	1	04	01	H2228_031_0	2		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	031	0	1	04	01	H2228_031_0	2		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H2228	031	0	1	04	01	H2228_031_0	2		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	8.00		24.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	031	0	1	04	01	H2228_031_0	2		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	8.00		24.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H2228	031	0	1	04	01	H2228_031_0	2		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	031	0	1	04	01	H2228_031_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	031	0	1	04	01	H2228_031_0	2		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				406.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	032	0	1	04	01	H2228_032_0	2		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	032	0	1	04	01	H2228_032_0	2		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H2228	032	0	1	04	01	H2228_032_0	2		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	8.00		24.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	032	0	1	04	01	H2228_032_0	2		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	8.00		24.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H2228	032	0	1	04	01	H2228_032_0	2		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	032	0	1	04	01	H2228_032_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	032	0	1	04	01	H2228_032_0	2		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				454.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	035	0	1	04	01	H2228_035_0	2		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	035	0	1	04	01	H2228_035_0	2		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H2228	035	0	1	04	01	H2228_035_0	2		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	035	0	1	04	01	H2228_035_0	2		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H2228	035	0	1	04	01	H2228_035_0	2		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	035	0	1	04	01	H2228_035_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	035	0	1	04	01	H2228_035_0	2		Y	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												
H2228	036	0	1	04	01	H2228_036_0	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	036	0	1	04	01	H2228_036_0	3		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H2228	036	0	1	04	01	H2228_036_0	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	036	0	1	04	01	H2228_036_0	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H2228	036	0	1	04	01	H2228_036_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	036	0	1	04	01	H2228_036_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		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	036	0	1	04	01	H2228_036_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				504.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	037	0	1	04	01	H2228_037_0	2		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	037	0	1	04	01	H2228_037_0	2		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H2228	037	0	1	04	01	H2228_037_0	2		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	037	0	1	04	01	H2228_037_0	2		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H2228	037	0	1	04	01	H2228_037_0	2		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	037	0	1	04	01	H2228_037_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	037	0	1	04	01	H2228_037_0	2		Y	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												
H2228	039	0	1	04	01	H2228_039_0	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	039	0	1	04	01	H2228_039_0	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	039	0	1	04	01	H2228_039_0	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H2228	039	0	1	04	01	H2228_039_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	039	0	1	04	01	H2228_039_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		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	039	0	1	04	01	H2228_039_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				220.00	29																										29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	047	0	1	04	01	H2228_047_0	2		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	047	0	1	04	01	H2228_047_0	2		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H2228	047	0	1	04	01	H2228_047_0	2		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	047	0	1	04	01	H2228_047_0	2		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H2228	047	0	1	04	01	H2228_047_0	2		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	047	0	1	04	01	H2228_047_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	047	0	1	04	01	H2228_047_0	2		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				461.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	049	0	1	04	01	H2228_049_0	2		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	049	0	1	04	01	H2228_049_0	2		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H2228	049	0	1	04	01	H2228_049_0	2		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	049	0	1	04	01	H2228_049_0	2		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H2228	049	0	1	04	01	H2228_049_0	2		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	049	0	1	04	01	H2228_049_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	049	0	1	04	01	H2228_049_0	2		Y	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												
H2228	064	0	1	04	01	H2228_064_0	2		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	064	0	1	04	01	H2228_064_0	2		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H2228	064	0	1	04	01	H2228_064_0	2		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	064	0	1	04	01	H2228_064_0	2		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H2228	064	0	1	04	01	H2228_064_0	2		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	064	0	1	04	01	H2228_064_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	064	0	1	04	01	H2228_064_0	2		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				399.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	065	0	1	04	01	H2228_065_0	2		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	065	0	1	04	01	H2228_065_0	2		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H2228	065	0	1	04	01	H2228_065_0	2		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	065	0	1	04	01	H2228_065_0	2		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H2228	065	0	1	04	01	H2228_065_0	2		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	065	0	1	04	01	H2228_065_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	065	0	1	04	01	H2228_065_0	2		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				416.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	067	0	1	04	01	H2228_067_0	2		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	067	0	1	04	01	H2228_067_0	2		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H2228	067	0	1	04	01	H2228_067_0	2		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	067	0	1	04	01	H2228_067_0	2		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H2228	067	0	1	04	01	H2228_067_0	2		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	067	0	1	04	01	H2228_067_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	067	0	1	04	01	H2228_067_0	2		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				528.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	068	0	1	04	01	H2228_068_0	2		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	068	0	1	04	01	H2228_068_0	2		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H2228	068	0	1	04	01	H2228_068_0	2		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	068	0	1	04	01	H2228_068_0	2		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H2228	068	0	1	04	01	H2228_068_0	2		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	068	0	1	04	01	H2228_068_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	068	0	1	04	01	H2228_068_0	2		Y	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												
H2228	071	0	1	04	01	H2228_071_0	3		Y	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		Y	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		Y	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		Y	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		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	071	0	1	04	01	H2228_071_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	071	0	1	04	01	H2228_071_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				447.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	074	0	1	04	01	H2228_074_0	2		Y	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		100	2	2						100	30		31								10.00		30.00					0.00		0.00													30.00						0.00				10.00				10.00			0.33	0.00				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	074	0	1	04	01	H2228_074_0	2		Y	Preferred Generic	4	01	1	2	1	3		110	01		100	1				30		100	2	2						100	30		31								10.00		30.00					0.00		0.00													30.00						0.00				10.00				10.00			0.33	0.00				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H2228	074	0	1	04	01	H2228_074_0	2		Y	Generic	4	01	3	2	2	1		110	01		100	1				30		100	2	2						100	30		31								20.00		60.00					0.00		0.00													60.00						0.00				20.00				20.00			0.66	0.00				0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	074	0	1	04	01	H2228_074_0	2		Y	Generic	4	01	3	2	2	3		110	01		100	1				30		100	2	2						100	30		31								20.00		60.00					0.00		0.00													60.00						0.00				20.00				20.00			0.66	0.00				0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H2228	074	0	1	04	01	H2228_074_0	2		Y	Preferred Brand	4	11	1	2	3	1		110	01		100	1				30		100	2	2						100	30		31								47.00		141.00					47.00		131.00													141.00						131.00				47.00				47.00			1.56	1.56				1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	074	0	1	04	01	H2228_074_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1		110	01		100	1				30		100	2	2						100	30		31								100.00		300.00					100.00		290.00													300.00						290.00				100.00				100.00			3.33	3.33				3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	074	0	1	04	01	H2228_074_0	2		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											533.00	33						389.00	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	075	0	1	04	01	H2228_075_0	2		Y	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		100	2	2						100	30		31								10.00		30.00					0.00		0.00													30.00						0.00				10.00				10.00			0.33	0.00				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	075	0	1	04	01	H2228_075_0	2		Y	Preferred Generic	4	01	1	2	1	3		110	01		100	1				30		100	2	2						100	30		31								10.00		30.00					0.00		0.00													30.00						0.00				10.00				10.00			0.33	0.00				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H2228	075	0	1	04	01	H2228_075_0	2		Y	Generic	4	01	3	2	2	1		110	01		100	1				30		100	2	2						100	30		31								20.00		60.00					0.00		0.00													60.00						0.00				20.00				20.00			0.66	0.00				0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	075	0	1	04	01	H2228_075_0	2		Y	Generic	4	01	3	2	2	3		110	01		100	1				30		100	2	2						100	30		31								20.00		60.00					0.00		0.00													60.00						0.00				20.00				20.00			0.66	0.00				0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H2228	075	0	1	04	01	H2228_075_0	2		Y	Preferred Brand	4	11	1	2	3	1		110	01		100	1				30		100	2	2						100	30		31								47.00		141.00					47.00		131.00													141.00						131.00				47.00				47.00			1.56	1.56				1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	075	0	1	04	01	H2228_075_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1		110	01		100	1				30		100	2	2						100	30		31								100.00		300.00					100.00		290.00													300.00						290.00				100.00				100.00			3.33	3.33				3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	075	0	1	04	01	H2228_075_0	2		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											602.00	33						426.00	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	076	0	1	04	01	H2228_076_0	2		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	076	0	1	04	01	H2228_076_0	2		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H2228	076	0	1	04	01	H2228_076_0	2		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	076	0	1	04	01	H2228_076_0	2		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H2228	076	0	1	04	01	H2228_076_0	2		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	076	0	1	04	01	H2228_076_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	076	0	1	04	01	H2228_076_0	2		Y	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												
H2228	077	0	1	04	01	H2228_077_0	2		Y	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		100	2	2						100	30		31								10.00		30.00					0.00		0.00													30.00						0.00				10.00				10.00			0.33	0.00				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	077	0	1	04	01	H2228_077_0	2		Y	Preferred Generic	4	01	1	2	1	3		110	01		100	1				30		100	2	2						100	30		31								10.00		30.00					0.00		0.00													30.00						0.00				10.00				10.00			0.33	0.00				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H2228	077	0	1	04	01	H2228_077_0	2		Y	Generic	4	01	3	2	2	1		110	01		100	1				30		100	2	2						100	30		31								20.00		60.00					0.00		0.00													60.00						0.00				20.00				20.00			0.66	0.00				0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	077	0	1	04	01	H2228_077_0	2		Y	Generic	4	01	3	2	2	3		110	01		100	1				30		100	2	2						100	30		31								20.00		60.00					0.00		0.00													60.00						0.00				20.00				20.00			0.66	0.00				0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H2228	077	0	1	04	01	H2228_077_0	2		Y	Preferred Brand	4	11	1	2	3	1		110	01		100	1				30		100	2	2						100	30		31								47.00		141.00					47.00		131.00													141.00						131.00				47.00				47.00			1.56	1.56				1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	077	0	1	04	01	H2228_077_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1		110	01		100	1				30		100	2	2						100	30		31								100.00		300.00					100.00		290.00													300.00						290.00				100.00				100.00			3.33	3.33				3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	077	0	1	04	01	H2228_077_0	2		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											377.00	33						431.00	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	079	0	1	04	01	H2228_079_0	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		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	079	0	1	04	01	H2228_079_0	3		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H2228	079	0	1	04	01	H2228_079_0	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	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												
H2228	079	0	1	04	01	H2228_079_0	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	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
H2228	079	0	1	04	01	H2228_079_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	45.00		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	079	0	1	04	01	H2228_079_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	95.00		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	079	0	1	04	01	H2228_079_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				357.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	080	0	1	04	01	H2228_080_0	2		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	080	0	1	04	01	H2228_080_0	2		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H2228	080	0	1	04	01	H2228_080_0	2		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	8.00		24.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	080	0	1	04	01	H2228_080_0	2		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	8.00		24.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H2228	080	0	1	04	01	H2228_080_0	2		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	080	0	1	04	01	H2228_080_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	080	0	1	04	01	H2228_080_0	2		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				405.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	081	0	1	04	01	H2228_081_0	2		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	081	0	1	04	01	H2228_081_0	2		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H2228	081	0	1	04	01	H2228_081_0	2		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	081	0	1	04	01	H2228_081_0	2		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H2228	081	0	1	04	01	H2228_081_0	2		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	081	0	1	04	01	H2228_081_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	081	0	1	04	01	H2228_081_0	2		Y	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												
H2228	082	0	1	04	01	H2228_082_0	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	082	0	1	04	01	H2228_082_0	3		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H2228	082	0	1	04	01	H2228_082_0	3		Y	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		Y	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		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	082	0	1	04	01	H2228_082_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	082	0	1	04	01	H2228_082_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				427.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	083	0	1	04	01	H2228_083_0	3		Y	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		100	2	2						100	30		31								10.00		30.00					0.00		0.00													30.00						0.00				10.00				10.00			0.33	0.00				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	083	0	1	04	01	H2228_083_0	3		Y	Preferred Generic	4	01	1	2	1	3		110	01		100	1				30		100	2	2						100	30		31								10.00		30.00					0.00		0.00													30.00						0.00				10.00				10.00			0.33	0.00				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H2228	083	0	1	04	01	H2228_083_0	3		Y	Generic	4	01	3	2	2	1		110	01		100	1				30		100	2	2						100	30		31								20.00		60.00					0.00		0.00													60.00						0.00				20.00				20.00			0.66	0.00				0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	083	0	1	04	01	H2228_083_0	3		Y	Generic	4	01	3	2	2	3		110	01		100	1				30		100	2	2						100	30		31								20.00		60.00					0.00		0.00													60.00						0.00				20.00				20.00			0.66	0.00				0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H2228	083	0	1	04	01	H2228_083_0	3		Y	Preferred Brand	4	11	1	2	3	1		110	01		100	1				30		100	2	2						100	30		31								47.00		141.00					47.00		131.00													141.00						131.00				47.00				47.00			1.56	1.56				1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	083	0	1	04	01	H2228_083_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1		110	01		100	1				30		100	2	2						100	30		31								100.00		300.00					100.00		290.00													300.00						290.00				100.00				100.00			3.33	3.33				3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	083	0	1	04	01	H2228_083_0	3		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											381.00	33						374.00	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	084	0	1	04	01	H2228_084_0	2		Y	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		100	2	2						100	30		31								10.00		30.00					0.00		0.00													30.00						0.00				10.00				10.00			0.33	0.00				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	084	0	1	04	01	H2228_084_0	2		Y	Preferred Generic	4	01	1	2	1	3		110	01		100	1				30		100	2	2						100	30		31								10.00		30.00					0.00		0.00													30.00						0.00				10.00				10.00			0.33	0.00				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H2228	084	0	1	04	01	H2228_084_0	2		Y	Generic	4	01	3	2	2	1		110	01		100	1				30		100	2	2						100	30		31								20.00		60.00					0.00		0.00													60.00						0.00				20.00				20.00			0.66	0.00				0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	084	0	1	04	01	H2228_084_0	2		Y	Generic	4	01	3	2	2	3		110	01		100	1				30		100	2	2						100	30		31								20.00		60.00					0.00		0.00													60.00						0.00				20.00				20.00			0.66	0.00				0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H2228	084	0	1	04	01	H2228_084_0	2		Y	Preferred Brand	4	11	1	2	3	1		110	01		100	1				30		100	2	2						100	30		31								47.00		141.00					47.00		131.00													141.00						131.00				47.00				47.00			1.56	1.56				1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	084	0	1	04	01	H2228_084_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1		110	01		100	1				30		100	2	2						100	30		31								100.00		300.00					100.00		290.00													300.00						290.00				100.00				100.00			3.33	3.33				3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	084	0	1	04	01	H2228_084_0	2		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											359.00	33						356.00	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	085	0	1	04	01	H2228_085_0	2		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	085	0	1	04	01	H2228_085_0	2		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H2228	085	0	1	04	01	H2228_085_0	2		Y	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	085	0	1	04	01	H2228_085_0	2		Y	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										1		3
H2228	085	0	1	04	01	H2228_085_0	2		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	085	0	1	04	01	H2228_085_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	085	0	1	04	01	H2228_085_0	2		Y	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		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	086	0	1	04	01	H2228_086_0	3		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H2228	086	0	1	04	01	H2228_086_0	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	086	0	1	04	01	H2228_086_0	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H2228	086	0	1	04	01	H2228_086_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	086	0	1	04	01	H2228_086_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		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	086	0	1	04	01	H2228_086_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				410.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	093	0	1	04	01	H2228_093_0	2		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	093	0	1	04	01	H2228_093_0	2		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H2228	093	0	1	04	01	H2228_093_0	2		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	093	0	1	04	01	H2228_093_0	2		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H2228	093	0	1	04	01	H2228_093_0	2		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	093	0	1	04	01	H2228_093_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	093	0	1	04	01	H2228_093_0	2		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				454.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	094	0	1	04	01	H2228_094_0	2		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	094	0	1	04	01	H2228_094_0	2		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H2228	094	0	1	04	01	H2228_094_0	2		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	094	0	1	04	01	H2228_094_0	2		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H2228	094	0	1	04	01	H2228_094_0	2		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	094	0	1	04	01	H2228_094_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	094	0	1	04	01	H2228_094_0	2		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				364.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	096	0	1	04	01	H2228_096_0	2		Y	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		100	2	2						100	30		31								10.00		30.00					0.00		0.00													30.00						0.00				10.00				10.00			0.33	0.00				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	096	0	1	04	01	H2228_096_0	2		Y	Preferred Generic	4	01	1	2	1	3		110	01		100	1				30		100	2	2						100	30		31								10.00		30.00					0.00		0.00													30.00						0.00				10.00				10.00			0.33	0.00				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H2228	096	0	1	04	01	H2228_096_0	2		Y	Generic	4	01	3	2	2	1		110	01		100	1				30		100	2	2						100	30		31								20.00		60.00					0.00		0.00													60.00						0.00				20.00				20.00			0.66	0.00				0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	096	0	1	04	01	H2228_096_0	2		Y	Generic	4	01	3	2	2	3		110	01		100	1				30		100	2	2						100	30		31								20.00		60.00					0.00		0.00													60.00						0.00				20.00				20.00			0.66	0.00				0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H2228	096	0	1	04	01	H2228_096_0	2		Y	Preferred Brand	4	11	1	2	3	1		110	01		100	1				30		100	2	2						100	30		31								47.00		141.00					47.00		131.00													141.00						131.00				47.00				47.00			1.56	1.56				1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	096	0	1	04	01	H2228_096_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1		110	01		100	1				30		100	2	2						100	30		31								100.00		300.00					100.00		290.00													300.00						290.00				100.00				100.00			3.33	3.33				3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	096	0	1	04	01	H2228_096_0	2		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											377.00	33						315.00	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	097	0	1	04	01	H2228_097_0	2		Y	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		100	2	2						100	30		31								10.00		30.00					0.00		0.00													30.00						0.00				10.00				10.00			0.33	0.00				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	097	0	1	04	01	H2228_097_0	2		Y	Preferred Generic	4	01	1	2	1	3		110	01		100	1				30		100	2	2						100	30		31								10.00		30.00					0.00		0.00													30.00						0.00				10.00				10.00			0.33	0.00				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H2228	097	0	1	04	01	H2228_097_0	2		Y	Generic	4	01	3	2	2	1		110	01		100	1				30		100	2	2						100	30		31								20.00		60.00					0.00		0.00													60.00						0.00				20.00				20.00			0.66	0.00				0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	097	0	1	04	01	H2228_097_0	2		Y	Generic	4	01	3	2	2	3		110	01		100	1				30		100	2	2						100	30		31								20.00		60.00					0.00		0.00													60.00						0.00				20.00				20.00			0.66	0.00				0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H2228	097	0	1	04	01	H2228_097_0	2		Y	Preferred Brand	4	11	1	2	3	1		110	01		100	1				30		100	2	2						100	30		31								47.00		141.00					47.00		131.00													141.00						131.00				47.00				47.00			1.56	1.56				1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	097	0	1	04	01	H2228_097_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1		110	01		100	1				30		100	2	2						100	30		31								100.00		300.00					100.00		290.00													300.00						290.00				100.00				100.00			3.33	3.33				3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	097	0	1	04	01	H2228_097_0	2		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											442.00	33						311.00	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	099	0	1	04	01	H2228_099_0	2		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	099	0	1	04	01	H2228_099_0	2		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H2228	099	0	1	04	01	H2228_099_0	2		Y	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	099	0	1	04	01	H2228_099_0	2		Y	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	099	0	1	04	01	H2228_099_0	2		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	099	0	1	04	01	H2228_099_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	099	0	1	04	01	H2228_099_0	2		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				643.00	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		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	100	0	1	04	01	H2228_100_0	3		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H2228	100	0	1	04	01	H2228_100_0	3		Y	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	100	0	1	04	01	H2228_100_0	3		Y	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	100	0	1	04	01	H2228_100_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	100	0	1	04	01	H2228_100_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	100	0	1	04	01	H2228_100_0	3		Y	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	101	0	1	04	01	H2228_101_0	2		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	101	0	1	04	01	H2228_101_0	2		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H2228	101	0	1	04	01	H2228_101_0	2		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	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	2		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	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	2		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	101	0	1	04	01	H2228_101_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	101	0	1	04	01	H2228_101_0	2		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				332.00	28																										28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	102	0	1	04	01	H2228_102_0	2		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	102	0	1	04	01	H2228_102_0	2		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H2228	102	0	1	04	01	H2228_102_0	2		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	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	2		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	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	2		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	102	0	1	04	01	H2228_102_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	102	0	1	04	01	H2228_102_0	2		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				294.00	30																										30						30					30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	110	0	1	04	01	H2228_110_0	2		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	110	0	1	04	01	H2228_110_0	2		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H2228	110	0	1	04	01	H2228_110_0	2		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	110	0	1	04	01	H2228_110_0	2		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H2228	110	0	1	04	01	H2228_110_0	2		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	110	0	1	04	01	H2228_110_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	110	0	1	04	01	H2228_110_0	2		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				399.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	111	0	1	04	01	H2228_111_0	2		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	111	0	1	04	01	H2228_111_0	2		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H2228	111	0	1	04	01	H2228_111_0	2		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	111	0	1	04	01	H2228_111_0	2		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H2228	111	0	1	04	01	H2228_111_0	2		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	111	0	1	04	01	H2228_111_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	111	0	1	04	01	H2228_111_0	2		Y	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												
H2228	115	0	1	04	01	H2228_115_0	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	115	0	1	04	01	H2228_115_0	3		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H2228	115	0	1	04	01	H2228_115_0	3		Y	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		Y	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		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	115	0	1	04	01	H2228_115_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	115	0	1	04	01	H2228_115_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				321.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	116	0	1	04	01	H2228_116_0	2		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	116	0	1	04	01	H2228_116_0	2		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H2228	116	0	1	04	01	H2228_116_0	2		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	116	0	1	04	01	H2228_116_0	2		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H2228	116	0	1	04	01	H2228_116_0	2		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	116	0	1	04	01	H2228_116_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	116	0	1	04	01	H2228_116_0	2		Y	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												
H2228	117	0	1	04	01	H2228_117_0	2		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	117	0	1	04	01	H2228_117_0	2		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H2228	117	0	1	04	01	H2228_117_0	2		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	117	0	1	04	01	H2228_117_0	2		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H2228	117	0	1	04	01	H2228_117_0	2		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	117	0	1	04	01	H2228_117_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	117	0	1	04	01	H2228_117_0	2		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				368.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	118	0	1	04	01	H2228_118_0	2		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	118	0	1	04	01	H2228_118_0	2		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H2228	118	0	1	04	01	H2228_118_0	2		Y	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	2		Y	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	2		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	118	0	1	04	01	H2228_118_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	118	0	1	04	01	H2228_118_0	2		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				305.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	120	0	1	04	01	H2228_120_0	2		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	120	0	1	04	01	H2228_120_0	2		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H2228	120	0	1	04	01	H2228_120_0	2		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	120	0	1	04	01	H2228_120_0	2		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H2228	120	0	1	04	01	H2228_120_0	2		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	120	0	1	04	01	H2228_120_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	120	0	1	04	01	H2228_120_0	2		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				485.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	124	0	1	04	01	H2228_124_0	2		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	124	0	1	04	01	H2228_124_0	2		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H2228	124	0	1	04	01	H2228_124_0	2		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	14.00		42.00																											42.00						0.00				14.00				14.00		0.46						0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	124	0	1	04	01	H2228_124_0	2		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	14.00		42.00																											42.00						0.00				14.00				14.00		0.46						0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H2228	124	0	1	04	01	H2228_124_0	2		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	124	0	1	04	01	H2228_124_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	124	0	1	04	01	H2228_124_0	2		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				256.00	28																										28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	125	0	1	04	01	H2228_125_0	2		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	125	0	1	04	01	H2228_125_0	2		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H2228	125	0	1	04	01	H2228_125_0	2		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	125	0	1	04	01	H2228_125_0	2		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H2228	125	0	1	04	01	H2228_125_0	2		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	125	0	1	04	01	H2228_125_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	125	0	1	04	01	H2228_125_0	2		Y	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												
H2228	126	0	1	04	01	H2228_126_0	2		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	126	0	1	04	01	H2228_126_0	2		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H2228	126	0	1	04	01	H2228_126_0	2		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	126	0	1	04	01	H2228_126_0	2		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H2228	126	0	1	04	01	H2228_126_0	2		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	126	0	1	04	01	H2228_126_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	126	0	1	04	01	H2228_126_0	2		Y	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												
H2228	127	0	1	04	01	H2228_127_0	4		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	127	0	1	04	01	H2228_127_0	4		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H2228	127	0	1	04	01	H2228_127_0	4		Y	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	127	0	1	04	01	H2228_127_0	4		Y	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	127	0	1	04	01	H2228_127_0	4		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	127	0	1	04	01	H2228_127_0	4		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	127	0	1	04	01	H2228_127_0	4		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				500.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	129	0	1	04	01	H2228_129_0	2		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	129	0	1	04	01	H2228_129_0	2		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H2228	129	0	1	04	01	H2228_129_0	2		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	5.00		15.00																											15.00						0.00				5.00				5.00		0.16						0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	129	0	1	04	01	H2228_129_0	2		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	5.00		15.00																											15.00						0.00				5.00				5.00		0.16						0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H2228	129	0	1	04	01	H2228_129_0	2		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	129	0	1	04	01	H2228_129_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	129	0	1	04	01	H2228_129_0	2		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				489.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	130	0	1	04	01	H2228_130_0	2		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	130	0	1	04	01	H2228_130_0	2		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H2228	130	0	1	04	01	H2228_130_0	2		Y	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	130	0	1	04	01	H2228_130_0	2		Y	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	130	0	1	04	01	H2228_130_0	2		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	130	0	1	04	01	H2228_130_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	130	0	1	04	01	H2228_130_0	2		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				232.00	28																										28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	131	0	1	04	01	H2228_131_0	2		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	131	0	1	04	01	H2228_131_0	2		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H2228	131	0	1	04	01	H2228_131_0	2		Y	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	131	0	1	04	01	H2228_131_0	2		Y	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	131	0	1	04	01	H2228_131_0	2		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	131	0	1	04	01	H2228_131_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	131	0	1	04	01	H2228_131_0	2		Y	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												
H2230	002	0	1	04	01	H2230_002_0	8		Y	Preferred Generic	4	11	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								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 Drug, Specialty Tier												
H2230	002	0	1	04	01	H2230_002_0	8		Y	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					5.00	10.00	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 Drug, Specialty Tier												
H2230	002	0	1	04	01	H2230_002_0	8		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											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 Drug, Specialty Tier												
H2230	002	0	1	04	01	H2230_002_0	8		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	300.00					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 Drug, Specialty Tier												
H2230	002	0	1	04	01	H2230_002_0	8		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												29							29												29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2230	017	0	1	04	01	H2230_017_0	8		Y	Preferred Generic	4	11	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								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 Drug, Specialty Tier												
H2230	017	0	1	04	01	H2230_017_0	8		Y	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					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 Drug, Specialty Tier												
H2230	017	0	1	04	01	H2230_017_0	8		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											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 Drug, Specialty Tier												
H2230	017	0	1	04	01	H2230_017_0	8		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	300.00					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 Drug, Specialty Tier												
H2230	017	0	1	04	01	H2230_017_0	8		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												30							30												30						30					30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2230	018	1	1	04	01	H2230_018_1	8		Y	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 Drug, Specialty Tier												
H2230	018	1	1	04	01	H2230_018_1	8		Y	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 Drug, Specialty Tier												
H2230	018	1	1	04	01	H2230_018_1	8		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					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 Drug, Specialty Tier												
H2230	018	1	1	04	01	H2230_018_1	8		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	300.00					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 Drug, Specialty Tier												
H2230	018	1	1	04	01	H2230_018_1	8		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												28							28												28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2230	018	2	1	04	01	H2230_018_2	8		Y	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 Drug, Specialty Tier												
H2230	018	2	1	04	01	H2230_018_2	8		Y	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 Drug, Specialty Tier												
H2230	018	2	1	04	01	H2230_018_2	8		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					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 Drug, Specialty Tier												
H2230	018	2	1	04	01	H2230_018_2	8		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								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 Drug, Specialty Tier												
H2230	018	2	1	04	01	H2230_018_2	8		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												28							28												28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2235	001	0	1	01	01	H2235_001_0	4		Y	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	4		Y	Generic	4	01	3	2	2	1	111		01	100		1	30	60	90				1	2			90				30		31	3.00	6.00	9.00																					0.00																3.00				3.00		0.10						0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2235	001	0	1	01	01	H2235_001_0	4		Y	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	4		Y	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	4		Y	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				770.10	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2235	002	0	1	01	01	H2235_002_0	4		N	Preferred Generic	4	01	1	2	1	1	111		01	100		1	30	60	90				1	2			90				30		31	0.00	0.00	0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2235	002	0	1	01	01	H2235_002_0	4		N	Generic	4	01	3	2	2	1	111		01	100		1	30	60	90				1	2			90				30		31	10.00	20.00	30.00																					0.00																10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2235	002	0	1	01	01	H2235_002_0	4		N	Preferred Brand	4	10	1	2	3	1	111		01	100		1	30	60	90				1	2			90				30		31	47.00	94.00	141.00																					125.00																47.00				47.00		1.57						1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2235	002	0	1	01	01	H2235_002_0	4		N	Non-Preferred Brand	4	10	1	2	4	1	111		01	100		1	30	60	90				1	2			90				30		31	100.00	200.00	300.00																					275.00																100.00				100.00		3.33						3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2235	002	0	1	01	01	H2235_002_0	4		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				839.12	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2235	003	0	1	01	01	H2235_003_0	4		Y	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	4		Y	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	4		Y	Preferred Brand	4	10	1	2	3	1	111		01	100		1	30	60	90				1	2			90				30		31	30.00	60.00	90.00																					80.00																30.00				30.00		1.00						0.97	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2235	003	0	1	01	01	H2235_003_0	4		Y	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	4		Y	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				846.91	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2237	001	0	1	01	01	H2237_001_0	6		N	Preferred Generic	4	01	3	2	1	1	110		01	110		1	30		90				1	2	30		90				30		31	7.00		21.00																			7.00		0.00																7.00				7.00		0.23			0.23			0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2237	001	0	1	01	01	H2237_001_0	6		N	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		0.00																14.00				14.00		0.47			0.47			0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2237	001	0	1	01	01	H2237_001_0	6		N	Preferred Brand	4	11	1	2	3	1	110		01	110		1	30		90				1	2	30		90				30		31	33.00		99.00																			33.00		89.00																33.00				33.00		1.10			1.10			1.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2237	001	0	1	01	01	H2237_001_0	6		N	Non-Preferred Brand	4	11	1	2	4	1	110		01	110		1	30		90				1	2	30		90				30		31	100.00		300.00																			100.00		290.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2237	001	0	1	01	01	H2237_001_0	6		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31					25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2237	007	0	1	01	01	H2237_007_0	5		N	Preferred Generic	4	01	3	2	1	1	110		01	110		1	30		90				1	2	30		90				30		31	5.00		15.00																			5.00		0.00																5.00				5.00		0.17			0.17			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2237	007	0	1	01	01	H2237_007_0	5		N	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		0.00																10.00				10.00		0.33			0.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2237	007	0	1	01	01	H2237_007_0	5		N	Preferred Brand	4	11	1	2	3	1	110		01	110		1	30		90				1	2	30		90				30		31	15.00		45.00																			15.00		35.00																15.00				15.00		0.50			0.50			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2237	007	0	1	01	01	H2237_007_0	5		N	Non-Preferred Brand	4	11	1	2	4	1	110		01	110		1	30		90				1	2	30		90				30		31	100.00		300.00																			100.00		290.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2237	007	0	1	01	01	H2237_007_0	5		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31					25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2246	018	0	1	04	01	H2246_018_0	12		Y	Preferred Generic	4	11	1	2	1	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2246	018	0	1	04	01	H2246_018_0	12		Y	Preferred Generic	4	11	1	2	1	3	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2246	018	0	1	04	01	H2246_018_0	12		Y	Generic	4	11	1	2	2	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				6.00		0.20			0.00			0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2246	018	0	1	04	01	H2246_018_0	12		Y	Generic	4	11	1	2	2	3	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				6.00		0.20			0.00			0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2246	018	0	1	04	01	H2246_018_0	12		Y	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	47.00	94.00	141.00																			47.00	94.00	141.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2246	018	0	1	04	01	H2246_018_0	12		Y	Non-Preferred Brand	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 Brand, Specialty Tier												
H2246	018	0	1	04	01	H2246_018_0	12		Y	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				1420.00	31																				31																	31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2246	019	0	1	04	01	H2246_019_0	12		Y	Preferred Generic	4	11	1	2	1	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2246	019	0	1	04	01	H2246_019_0	12		Y	Preferred Generic	4	11	1	2	1	3	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H2246	019	0	1	04	01	H2246_019_0	12		Y	Generic	4	11	1	2	2	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	8.00	16.00	24.00																			8.00	16.00	16.00																8.00				8.00		0.27			0.27			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2246	019	0	1	04	01	H2246_019_0	12		Y	Generic	4	11	1	2	2	3	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										2	3	
H2246	019	0	1	04	01	H2246_019_0	12		Y	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	47.00	94.00	141.00																			47.00	94.00	141.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2246	019	0	1	04	01	H2246_019_0	12		Y	Non-Preferred Brand	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 Brand, Specialty Tier												
H2246	019	0	1	04	01	H2246_019_0	12		Y	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												
H2256	001	1	1	01	01	H2256_001_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	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	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, Vaccines										1		
H2256	001	1	1	01	01	H2256_001_1	8			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	8			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	8			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	8			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	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	001	1	1	01	01	H2256_001_1	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	001	1	1	01	01	H2256_001_1	8			Vaccines	4	11	1	2	6	3	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										1		
H2256	001	2	1	01	01	H2256_001_2	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, Vaccines												
H2256	001	2	1	01	01	H2256_001_2	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, Vaccines										1		
H2256	001	2	1	01	01	H2256_001_2	8			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	8			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	8			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	8			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	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	001	2	1	01	01	H2256_001_2	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	001	2	1	01	01	H2256_001_2	8			Vaccines	4	11	1	2	6	3	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										1		
H2256	001	6	1	01	01	H2256_001_6	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, Vaccines												
H2256	001	6	1	01	01	H2256_001_6	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, Vaccines										1		
H2256	001	6	1	01	01	H2256_001_6	8			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	8			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	8			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	8			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	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	001	6	1	01	01	H2256_001_6	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	001	6	1	01	01	H2256_001_6	8			Vaccines	4	11	1	2	6	3	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										1		
H2256	015	1	1	01	01	H2256_015_1	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	015	1	1	01	01	H2256_015_1	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	015	1	1	01	01	H2256_015_1	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	015	1	1	01	01	H2256_015_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	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	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	015	1	1	01	01	H2256_015_1	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	015	1	1	01	01	H2256_015_1	8			Vaccines	4	11	1	2	6	3	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										1		
H2256	015	2	1	01	01	H2256_015_2	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	015	2	1	01	01	H2256_015_2	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	015	2	1	01	01	H2256_015_2	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	015	2	1	01	01	H2256_015_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	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	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	015	2	1	01	01	H2256_015_2	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	015	2	1	01	01	H2256_015_2	8			Vaccines	4	11	1	2	6	3	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										1		
H2256	015	6	1	01	01	H2256_015_6	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	015	6	1	01	01	H2256_015_6	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	015	6	1	01	01	H2256_015_6	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	015	6	1	01	01	H2256_015_6	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	015	6	1	01	01	H2256_015_6	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	015	6	1	01	01	H2256_015_6	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	015	6	1	01	01	H2256_015_6	8			Vaccines	4	11	1	2	6	3	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										1		
H2256	018	1	1	01	01	H2256_018_1	8			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	8			Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								19.00	38.00	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	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, Vaccines												
H2256	018	1	1	01	01	H2256_018_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	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	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, Vaccines												
H2256	018	1	1	01	01	H2256_018_1	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				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	8			Vaccines	4	11	1	2	6	3		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										1		
H2256	018	7	1	01	01	H2256_018_7	8			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	8			Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								19.00	38.00	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	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, Vaccines												
H2256	018	7	1	01	01	H2256_018_7	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, Vaccines												
H2256	018	7	1	01	01	H2256_018_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, Vaccines												
H2256	018	7	1	01	01	H2256_018_7	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				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	8			Vaccines	4	11	1	2	6	3		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										1		
H2256	018	8	1	01	01	H2256_018_8	8			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	8			Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								19.00	38.00	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	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, Vaccines												
H2256	018	8	1	01	01	H2256_018_8	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, Vaccines												
H2256	018	8	1	01	01	H2256_018_8	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, Vaccines												
H2256	018	8	1	01	01	H2256_018_8	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				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	8			Vaccines	4	11	1	2	6	3		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										1		
H2256	026	1	1	01	01	H2256_026_1	8			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	8			Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								19.00	38.00	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	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, Vaccines												
H2256	026	1	1	01	01	H2256_026_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	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	8			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	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				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	8			Vaccines	4	11	1	2	6	3		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										1		
H2256	026	2	1	01	01	H2256_026_2	8			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	8			Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								19.00	38.00	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	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, Vaccines												
H2256	026	2	1	01	01	H2256_026_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	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	8			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	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				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	8			Vaccines	4	11	1	2	6	3		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										1		
H2256	026	3	1	01	01	H2256_026_3	8			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	8			Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								19.00	38.00	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	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, Vaccines												
H2256	026	3	1	01	01	H2256_026_3	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, Vaccines												
H2256	026	3	1	01	01	H2256_026_3	8			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	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				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	8			Vaccines	4	11	1	2	6	3		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										1		
H2256	028	0	1	01	01	H2256_028_0	8			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	8			Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								19.00	38.00	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	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, Vaccines												
H2256	028	0	1	01	01	H2256_028_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, Vaccines												
H2256	028	0	1	01	01	H2256_028_0	8			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	028	0	1	01	01	H2256_028_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				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	8			Vaccines	4	11	1	2	6	3		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										1		
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	033	0	1	01	01	H2256_033_0	8			Vaccines	4	11	1	2	6	3	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										1		
H2256	034	0	1	01	01	H2256_034_0	8			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	8			Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								19.00	38.00	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	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, Vaccines												
H2256	034	0	1	01	01	H2256_034_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, Vaccines												
H2256	034	0	1	01	01	H2256_034_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, Vaccines												
H2256	034	0	1	01	01	H2256_034_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				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	8			Vaccines	4	11	1	2	6	3		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										1		
H2256	036	0	1	01	01	H2256_036_0	8			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	8			Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								19.00	38.00	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	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, Vaccines												
H2256	036	0	1	01	01	H2256_036_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, Vaccines												
H2256	036	0	1	01	01	H2256_036_0	8			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	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				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	8			Vaccines	4	11	1	2	6	3		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										1		
H2256	046	0	1	01	01	H2256_046_0	8			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	8			Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								19.00	38.00	57.00					2.00	4.00	6.00					2.00	4.00	4.00																19.00				2.00			0.63	0.07	0.07			0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H2256	046	0	1	01	01	H2256_046_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, Vaccines												
H2256	046	0	1	01	01	H2256_046_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, Vaccines												
H2256	046	0	1	01	01	H2256_046_0	8			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, Vaccines												
H2256	046	0	1	01	01	H2256_046_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				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	8			Vaccines	4	11	1	2	6	3		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										1		
H2261	005	0	1	01	01	H2261_005_0	8		Y	Preferred Generic	4	11	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								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 Drug, Specialty Tier												
H2261	005	0	1	01	01	H2261_005_0	8		Y	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					5.00	10.00	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 Drug, Specialty Tier												
H2261	005	0	1	01	01	H2261_005_0	8		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											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 Drug, Specialty Tier												
H2261	005	0	1	01	01	H2261_005_0	8		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	300.00					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 Drug, Specialty Tier												
H2261	005	0	1	01	01	H2261_005_0	8		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												29							29												29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2261	022	1	1	01	01	H2261_022_1	8		Y	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 Drug, Specialty Tier												
H2261	022	1	1	01	01	H2261_022_1	8		Y	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 Drug, Specialty Tier												
H2261	022	1	1	01	01	H2261_022_1	8		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					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 Drug, Specialty Tier												
H2261	022	1	1	01	01	H2261_022_1	8		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	300.00					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 Drug, Specialty Tier												
H2261	022	1	1	01	01	H2261_022_1	8		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												27							27												27						27					27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2261	022	2	1	01	01	H2261_022_2	8		Y	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 Drug, Specialty Tier												
H2261	022	2	1	01	01	H2261_022_2	8		Y	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 Drug, Specialty Tier												
H2261	022	2	1	01	01	H2261_022_2	8		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					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 Drug, Specialty Tier												
H2261	022	2	1	01	01	H2261_022_2	8		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								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 Drug, Specialty Tier												
H2261	022	2	1	01	01	H2261_022_2	8		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												27							27												27						27					27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2261	023	1	1	02	01	H2261_023_1	8		Y	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 Drug, Specialty Tier												
H2261	023	1	1	02	01	H2261_023_1	8		Y	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					5.00	10.00	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 Drug, Specialty Tier												
H2261	023	1	1	02	01	H2261_023_1	8		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					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 Drug, Specialty Tier												
H2261	023	1	1	02	01	H2261_023_1	8		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	300.00					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 Drug, Specialty Tier												
H2261	023	1	1	02	01	H2261_023_1	8		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												28							28												28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2261	023	2	1	02	01	H2261_023_2	8		Y	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 Drug, Specialty Tier												
H2261	023	2	1	02	01	H2261_023_2	8		Y	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					5.00	10.00	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 Drug, Specialty Tier												
H2261	023	2	1	02	01	H2261_023_2	8		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					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 Drug, Specialty Tier												
H2261	023	2	1	02	01	H2261_023_2	8		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								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 Drug, Specialty Tier												
H2261	023	2	1	02	01	H2261_023_2	8		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												28							28												28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2261	024	0	1	01	01	H2261_024_0	8		Y	Preferred Generic	4	11	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								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 Drug, Specialty Tier												
H2261	024	0	1	01	01	H2261_024_0	8		Y	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					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 Drug, Specialty Tier												
H2261	024	0	1	01	01	H2261_024_0	8		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											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 Drug, Specialty Tier												
H2261	024	0	1	01	01	H2261_024_0	8		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	300.00					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 Drug, Specialty Tier												
H2261	024	0	1	01	01	H2261_024_0	8		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												28							28												28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2292	003	0	1	04	01	H2292_003_0	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2292	003	0	1	04	01	H2292_003_0	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2292	003	0	1	04	01	H2292_003_0	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H2292	003	0	1	04	01	H2292_003_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2292	003	0	1	04	01	H2292_003_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		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												
H2292	003	0	1	04	01	H2292_003_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				455.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2292	004	0	1	04	01	H2292_004_0	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2292	004	0	1	04	01	H2292_004_0	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2292	004	0	1	04	01	H2292_004_0	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H2292	004	0	1	04	01	H2292_004_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2292	004	0	1	04	01	H2292_004_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2292	004	0	1	04	01	H2292_004_0	3		Y	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												
H2293	001	0	1	04	01	H2293_001_0	2		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2293	001	0	1	04	01	H2293_001_0	2		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					10.00	20.00	0.00											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												
H2293	001	0	1	04	01	H2293_001_0	2		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2293	001	0	1	04	01	H2293_001_0	2		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2293	001	0	1	04	01	H2293_001_0	2		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											766.73	25						446.56	25												25						25						25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2293	006	0	1	04	01	H2293_006_0	3		Y	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												
H2293	006	0	1	04	01	H2293_006_0	3		Y	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		
H2293	006	0	1	04	01	H2293_006_0	3		Y	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												
H2293	006	0	1	04	01	H2293_006_0	3		Y	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		
H2293	006	0	1	04	01	H2293_006_0	3		Y	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2293	006	0	1	04	01	H2293_006_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2293	006	0	1	04	01	H2293_006_0	3		Y	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											994.86	33						566.17	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2293	007	0	1	04	01	H2293_007_0	3		Y	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												
H2293	007	0	1	04	01	H2293_007_0	3		Y	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		
H2293	007	0	1	04	01	H2293_007_0	3		Y	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												
H2293	007	0	1	04	01	H2293_007_0	3		Y	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		
H2293	007	0	1	04	01	H2293_007_0	3		Y	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2293	007	0	1	04	01	H2293_007_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2293	007	0	1	04	01	H2293_007_0	3		Y	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											983.15	33						565.70	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2293	008	0	1	04	01	H2293_008_0	3		Y	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												
H2293	008	0	1	04	01	H2293_008_0	3		Y	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		
H2293	008	0	1	04	01	H2293_008_0	3		Y	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												
H2293	008	0	1	04	01	H2293_008_0	3		Y	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		
H2293	008	0	1	04	01	H2293_008_0	3		Y	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2293	008	0	1	04	01	H2293_008_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2293	008	0	1	04	01	H2293_008_0	3		Y	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											983.15	33						565.70	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2293	010	0	1	04	01	H2293_010_0	3		N	Preferred Generic	4	01	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												
H2293	010	0	1	04	01	H2293_010_0	3		N	Preferred Generic	4	01	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		
H2293	010	0	1	04	01	H2293_010_0	3		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					10.00	20.00	0.00											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												
H2293	010	0	1	04	01	H2293_010_0	3		N	Generic	4	01	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	0.00											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		
H2293	010	0	1	04	01	H2293_010_0	3		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2293	010	0	1	04	01	H2293_010_0	3		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2293	010	0	1	04	01	H2293_010_0	3		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1128.38	25						627.93	25												25						25						25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2293	011	0	1	04	01	H2293_011_0	3		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2293	011	0	1	04	01	H2293_011_0	3		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					10.00	20.00	0.00											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												
H2293	011	0	1	04	01	H2293_011_0	3		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2293	011	0	1	04	01	H2293_011_0	3		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2293	011	0	1	04	01	H2293_011_0	3		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											776.82	25						447.00	25												25						25						25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2293	013	0	1	04	01	H2293_013_0	3		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2293	013	0	1	04	01	H2293_013_0	3		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H2293	013	0	1	04	01	H2293_013_0	3		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					10.00	20.00	20.00											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												
H2293	013	0	1	04	01	H2293_013_0	3		N	Generic	4	01	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	20.00											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										1		
H2293	013	0	1	04	01	H2293_013_0	3		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2293	013	0	1	04	01	H2293_013_0	3		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2293	013	0	1	04	01	H2293_013_0	3		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											879.04	29						508.27	29												29						29						29		29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2293	014	0	1	04	01	H2293_014_0	3		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2293	014	0	1	04	01	H2293_014_0	3		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H2293	014	0	1	04	01	H2293_014_0	3		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					10.00	20.00	20.00											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												
H2293	014	0	1	04	01	H2293_014_0	3		N	Generic	4	01	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	20.00											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										1		
H2293	014	0	1	04	01	H2293_014_0	3		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2293	014	0	1	04	01	H2293_014_0	3		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2293	014	0	1	04	01	H2293_014_0	3		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											899.97	30						532.31	30												30						30						30		30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2293	016	0	1	04	01	H2293_016_0	3		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2293	016	0	1	04	01	H2293_016_0	3		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H2293	016	0	1	04	01	H2293_016_0	3		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					10.00	20.00	20.00											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												
H2293	016	0	1	04	01	H2293_016_0	3		N	Generic	4	01	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	20.00											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										1		
H2293	016	0	1	04	01	H2293_016_0	3		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2293	016	0	1	04	01	H2293_016_0	3		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2293	016	0	1	04	01	H2293_016_0	3		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											890.25	29						522.99	29												29						29						29		29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2293	017	0	1	04	01	H2293_017_0	3		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2293	017	0	1	04	01	H2293_017_0	3		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H2293	017	0	1	04	01	H2293_017_0	3		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					10.00	20.00	20.00											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												
H2293	017	0	1	04	01	H2293_017_0	3		N	Generic	4	01	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	20.00											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										1		
H2293	017	0	1	04	01	H2293_017_0	3		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2293	017	0	1	04	01	H2293_017_0	3		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2293	017	0	1	04	01	H2293_017_0	3		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											871.12	29						520.21	29												29						29						29		29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2293	018	0	1	04	01	H2293_018_0	3		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2293	018	0	1	04	01	H2293_018_0	3		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H2293	018	0	1	04	01	H2293_018_0	3		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					10.00	20.00	20.00											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												
H2293	018	0	1	04	01	H2293_018_0	3		N	Generic	4	01	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	20.00											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										1		
H2293	018	0	1	04	01	H2293_018_0	3		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2293	018	0	1	04	01	H2293_018_0	3		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2293	018	0	1	04	01	H2293_018_0	3		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											880.22	29						508.31	29												29						29						29		29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2293	019	0	1	04	01	H2293_019_0	3		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2293	019	0	1	04	01	H2293_019_0	3		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H2293	019	0	1	04	01	H2293_019_0	3		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					10.00	20.00	20.00											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												
H2293	019	0	1	04	01	H2293_019_0	3		N	Generic	4	01	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	20.00											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										1		
H2293	019	0	1	04	01	H2293_019_0	3		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2293	019	0	1	04	01	H2293_019_0	3		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2293	019	0	1	04	01	H2293_019_0	3		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											885.60	29						522.32	29												29						29						29		29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2320	022	1	1	02	01	H2320_022_1	16		Y	Preferred Generic	4	01	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	0.00											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	16		Y	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					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	16		Y	Preferred Brand	4	10	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											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	16		Y	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											23.63	50	50	50				25.57	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	16		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											99.00	33						99.00	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2320	022	2	1	02	01	H2320_022_2	14		Y	Preferred Generic	4	01	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	0.00											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	14		Y	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					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	14		Y	Preferred Brand	4	10	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					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	14		Y	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											23.63	50	50	50				25.57	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	14		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											99.00	33						99.00	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2320	022	3	1	02	01	H2320_022_3	14		Y	Preferred Generic	4	01	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	0.00											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	14		Y	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					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	14		Y	Preferred Brand	4	10	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					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	14		Y	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											23.63	50	50	50				25.57	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	14		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											99.00	33						99.00	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2320	022	4	1	02	01	H2320_022_4	14		Y	Preferred Generic	4	01	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	0.00											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	14		Y	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					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	14		Y	Preferred Brand	4	10	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					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	14		Y	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											23.63	50	50	50				25.57	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	14		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											99.00	33						99.00	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2320	022	5	1	02	01	H2320_022_5	14		Y	Preferred Generic	4	01	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	0.00											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	14		Y	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					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	14		Y	Preferred Brand	4	10	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					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	14		Y	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											23.63	50	50	50				25.57	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	14		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											99.00	33						99.00	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2320	028	1	1	02	01	H2320_028_1	11			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	0.00											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												
H2320	028	1	1	02	01	H2320_028_1	11			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	11			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	11			Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											23.30	45	45	45				27.11	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	11			Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											99.00	33						99.00	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2320	028	2	1	02	01	H2320_028_2	11			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	0.00											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												
H2320	028	2	1	02	01	H2320_028_2	11			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	11			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	11			Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											23.30	45	45	45				27.11	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	11			Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											99.00	33						99.00	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2320	028	3	1	02	01	H2320_028_3	11			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	0.00											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												
H2320	028	3	1	02	01	H2320_028_3	11			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	11			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	11			Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											23.30	45	45	45				27.11	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	11			Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											99.00	33						99.00	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2320	028	4	1	02	01	H2320_028_4	11			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	0.00											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												
H2320	028	4	1	02	01	H2320_028_4	11			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	11			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	11			Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											23.30	45	45	45				27.11	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	11			Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											99.00	33						99.00	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2320	028	5	1	02	01	H2320_028_5	11			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	0.00											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												
H2320	028	5	1	02	01	H2320_028_5	11			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	11			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	11			Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											23.30	45	45	45				27.11	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	11			Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											99.00	33						99.00	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2320	029	1	1	02	01	H2320_029_1	12		Y	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								7.00	14.00	21.00					2.00	4.00	0.00											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	12		Y	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					10.00	20.00	30.00											15.00	30.00	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	12		Y	Preferred Brand	4	10	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					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	12		Y	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											38.76	50	50	50				46.90	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	12		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											99.00	31						99.00	31												31						31					31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2320	029	2	1	02	01	H2320_029_2	12		Y	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								7.00	14.00	21.00					2.00	4.00	0.00											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	12		Y	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					10.00	20.00	30.00											15.00	30.00	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	12		Y	Preferred Brand	4	10	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					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	12		Y	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											38.76	50	50	50				46.90	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	12		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											99.00	31						99.00	31												31						31					31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2320	029	3	1	02	01	H2320_029_3	12		Y	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								7.00	14.00	21.00					2.00	4.00	0.00											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	12		Y	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					10.00	20.00	30.00											15.00	30.00	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	12		Y	Preferred Brand	4	10	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					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	12		Y	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											38.76	50	50	50				46.90	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	12		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											99.00	31						99.00	31												31						31					31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2320	029	4	1	02	01	H2320_029_4	12		Y	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								7.00	14.00	21.00					2.00	4.00	0.00											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	12		Y	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					10.00	20.00	30.00											15.00	30.00	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	12		Y	Preferred Brand	4	10	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					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	12		Y	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											38.76	50	50	50				46.90	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	12		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											99.00	31						99.00	31												31						31					31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2320	029	5	1	02	01	H2320_029_5	12		Y	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								7.00	14.00	21.00					2.00	4.00	0.00											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	12		Y	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					10.00	20.00	30.00											15.00	30.00	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	12		Y	Preferred Brand	4	10	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					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	12		Y	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											38.76	50	50	50				46.90	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	12		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											99.00	31						99.00	31												31						31					31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2320	030	1	1	02	01	H2320_030_1	12		Y	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								6.00	12.00	18.00					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												
H2320	030	1	1	02	01	H2320_030_1	12		Y	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					10.00	20.00	30.00											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												
H2320	030	1	1	02	01	H2320_030_1	12		Y	Preferred Brand	4	10	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					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	030	1	1	02	01	H2320_030_1	12		Y	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											25.42	50	50	50				26.13	45	45	45										50	50	50				45	45	45			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2320	030	1	1	02	01	H2320_030_1	12		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											99.00	33						99.00	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2320	030	2	1	02	01	H2320_030_2	12		Y	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								6.00	12.00	18.00					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												
H2320	030	2	1	02	01	H2320_030_2	12		Y	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					10.00	20.00	30.00											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												
H2320	030	2	1	02	01	H2320_030_2	12		Y	Preferred Brand	4	10	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					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	030	2	1	02	01	H2320_030_2	12		Y	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											25.42	50	50	50				26.13	45	45	45										50	50	50				45	45	45			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2320	030	2	1	02	01	H2320_030_2	12		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											99.00	33						99.00	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2322	004	0	1	04	01	H2322_004_0	8		Y	Preferred Generic	4	01	3	2	1	1		111	01		111	1				30	60	90	2	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				0.00			0.30	0.00		0.30	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	8		Y	Generic	4	11	3	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	36.00											17.00	34.00	51.00				12.00	24.00	0.00				17.00				12.00			0.57	0.40		0.57	0.40	0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2322	004	0	1	04	01	H2322_004_0	8		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	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	8		Y	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											63.56	50	50	50				70.34	48	48	48										50	50	50				48	48	48			48			48								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2322	004	0	1	04	01	H2322_004_0	8		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2322	004	0	1	04	01	H2322_004_0	8		Y	Select Care Drugs	4	11	1	2	6	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	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	8		Y	Select Care Drugs	4	11	1	2	6	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	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	8		Y	Preferred Generic	4	01	3	2	1	1		111	01		111	1				30	60	90	2	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				0.00			0.30	0.00		0.30	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	8		Y	Generic	4	11	3	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	36.00											17.00	34.00	51.00				12.00	24.00	0.00				17.00				12.00			0.57	0.40		0.57	0.40	0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2322	008	0	1	04	01	H2322_008_0	8		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	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	8		Y	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											68.15	50	50	50				64.89	48	48	48										50	50	50				48	48	48			48			48								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2322	008	0	1	04	01	H2322_008_0	8		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2322	008	0	1	04	01	H2322_008_0	8		Y	Select Care Drugs	4	11	1	2	6	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	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	8		Y	Select Care Drugs	4	11	1	2	6	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	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	8		Y	Preferred Generic	4	01	3	2	1	1		111	01		111	1				30	60	90	2	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				0.00			0.30	0.00		0.30	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	8		Y	Generic	4	11	3	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	36.00											17.00	34.00	51.00				12.00	24.00	0.00				17.00				12.00			0.57	0.40		0.57	0.40	0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2322	011	0	1	04	01	H2322_011_0	8		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	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	8		Y	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											71.14	50	50	50				67.56	48	48	48										50	50	50				48	48	48			48			48								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2322	011	0	1	04	01	H2322_011_0	8		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2322	011	0	1	04	01	H2322_011_0	8		Y	Select Care Drugs	4	11	1	2	6	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	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	8		Y	Select Care Drugs	4	11	1	2	6	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	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	9		Y	Preferred Generic	4	01	3	2	1	1		111	01		111	1				30	60	90	2	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				0.00			0.30	0.00		0.30	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	9		Y	Generic	4	11	3	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	36.00											17.00	34.00	51.00				12.00	24.00	0.00				17.00				12.00			0.57	0.40		0.57	0.40	0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2322	012	0	1	04	01	H2322_012_0	9		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								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	9		Y	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											70.29	50	50	50				66.87	48	48	48										50	50	50				48	48	48			48			48								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2322	012	0	1	04	01	H2322_012_0	9		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2322	012	0	1	04	01	H2322_012_0	9		Y	Select Care Drugs	4	11	1	2	6	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	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	9		Y	Select Care Drugs	4	11	1	2	6	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	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H2322	014	0	1	04	01	H2322_014_0	10			Preferred Generic	4	01	3	2	1	1		111	01		111	1				30	60	90	2	2				30	60	90	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				0.00			0.40	0.00		0.40	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2322	014	0	1	04	01	H2322_014_0	10			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					15.00	30.00	45.00											20.00	40.00	60.00				15.00	30.00	0.00				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												
H2322	014	0	1	04	01	H2322_014_0	10			Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	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	014	0	1	04	01	H2322_014_0	10			Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											96.36	50	50	50				87.98	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	014	0	1	04	01	H2322_014_0	10			Specialty Tier	4	11	1	1	5	1		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												
H2322	014	0	1	04	01	H2322_014_0	10			Select Care Drugs	4	11	1	2	6	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	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2322	014	0	1	04	01	H2322_014_0	10			Select Care Drugs	4	11	1	2	6	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	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H2334	005	0	1	04	01	H2334_005_0	5		Y	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	5		Y	Generic	4	01	3	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	5		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	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	5		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								100.00	200.00	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	5		Y	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		Y	Preferred Generic	4	01	3	2	1	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								7.00	14.00	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												
H2354	015	0	1	01	01	H2354_015_0	7		Y	Generic	4	11	3	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								16.00	32.00	48.00					10.00	20.00	30.00											16.00	32.00	48.00				10.00	20.00	0.00				16.00				10.00			0.53	0.33		0.53	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		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	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		Y	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											66.64	50	50	50				65.66	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		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2354	015	0	1	01	01	H2354_015_0	7		Y	Select Care Drugs	4	11	1	2	6	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	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		Y	Select Care Drugs	4	11	1	2	6	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	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		Y	Preferred Generic	4	01	3	2	1	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								7.00	14.00	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												
H2354	018	0	1	01	01	H2354_018_0	7		Y	Generic	4	11	3	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								16.00	32.00	48.00					10.00	20.00	30.00											16.00	32.00	48.00				10.00	20.00	0.00				16.00				10.00			0.53	0.33		0.53	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		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	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		Y	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											55.67	50	50	50				61.79	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		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2354	018	0	1	01	01	H2354_018_0	7		Y	Select Care Drugs	4	11	1	2	6	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	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		Y	Select Care Drugs	4	11	1	2	6	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	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		Y	Preferred Generic	4	01	3	2	1	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								7.00	14.00	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												
H2354	021	0	1	02	01	H2354_021_0	7		Y	Generic	4	11	3	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								16.00	32.00	48.00					10.00	20.00	30.00											16.00	32.00	48.00				10.00	20.00	0.00				16.00				10.00			0.53	0.33		0.53	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		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	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		Y	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											67.22	50	50	50				68.08	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		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2354	021	0	1	02	01	H2354_021_0	7		Y	Select Care Drugs	4	11	1	2	6	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	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		Y	Select Care Drugs	4	11	1	2	6	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	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		Y	Preferred Generic	4	01	3	2	1	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								7.00	14.00	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												
H2354	022	0	1	02	01	H2354_022_0	7		Y	Generic	4	11	3	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								16.00	32.00	48.00					10.00	20.00	30.00											16.00	32.00	48.00				10.00	20.00	0.00				16.00				10.00			0.53	0.33		0.53	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		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	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		Y	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											74.73	50	50	50				72.26	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		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2354	022	0	1	02	01	H2354_022_0	7		Y	Select Care Drugs	4	11	1	2	6	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	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		Y	Select Care Drugs	4	11	1	2	6	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	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		Y	Preferred Generic	4	01	3	2	1	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								7.00	14.00	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												
H2354	024	0	1	01	01	H2354_024_0	7		Y	Generic	4	11	3	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								16.00	32.00	48.00					10.00	20.00	30.00											16.00	32.00	48.00				10.00	20.00	0.00				16.00				10.00			0.53	0.33		0.53	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		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	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		Y	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											73.62	50	50	50				77.23	48	48	48										50	50	50				48	48	48			50			48								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2354	024	0	1	01	01	H2354_024_0	7		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2354	024	0	1	01	01	H2354_024_0	7		Y	Select Care Drugs	4	11	1	2	6	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	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		Y	Select Care Drugs	4	11	1	2	6	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	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	7		N	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	7		N	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					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	7		N	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					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	7		N	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								100.00	200.00	300.00					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	7		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2354	025	0	1	01	01	H2354_025_0	7		N	Select Care Drugs	4	11	1	2	6	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	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	7		N	Select Care Drugs	4	11	1	2	6	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	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		Y	Preferred Generic	4	01	3	2	1	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								7.00	14.00	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												
H2354	026	0	1	01	01	H2354_026_0	7		Y	Generic	4	11	3	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								16.00	32.00	48.00					10.00	20.00	30.00											16.00	32.00	48.00				10.00	20.00	0.00				16.00				10.00			0.53	0.33		0.53	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		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	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		Y	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											70.46	50	50	50				70.09	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		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2354	026	0	1	01	01	H2354_026_0	7		Y	Select Care Drugs	4	11	1	2	6	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	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		Y	Select Care Drugs	4	11	1	2	6	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	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		Y	Preferred Generic	4	01	3	2	1	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								7.00	14.00	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												
H2354	027	0	1	01	01	H2354_027_0	7		Y	Generic	4	11	3	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								16.00	32.00	48.00					10.00	20.00	30.00											16.00	32.00	48.00				10.00	20.00	0.00				16.00				10.00			0.53	0.33		0.53	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		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	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		Y	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											75.21	50	50	50				67.17	48	48	48										50	50	50				48	48	48			50			48								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2354	027	0	1	01	01	H2354_027_0	7		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2354	027	0	1	01	01	H2354_027_0	7		Y	Select Care Drugs	4	11	1	2	6	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	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		Y	Select Care Drugs	4	11	1	2	6	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	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H2354	028	0	1	01	01	H2354_028_0	11		Y	Preferred Generic	4	01	3	2	1	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								7.00	14.00	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												
H2354	028	0	1	01	01	H2354_028_0	11		Y	Generic	4	11	3	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								16.00	32.00	48.00					10.00	20.00	30.00											16.00	32.00	48.00				10.00	20.00	0.00				16.00				10.00			0.53	0.33		0.53	0.33	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2354	028	0	1	01	01	H2354_028_0	11		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	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	028	0	1	01	01	H2354_028_0	11		Y	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											67.75	50	50	50				62.82	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	028	0	1	01	01	H2354_028_0	11		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2354	028	0	1	01	01	H2354_028_0	11		Y	Select Care Drugs	4	11	1	2	6	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	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2354	028	0	1	01	01	H2354_028_0	11		Y	Select Care Drugs	4	11	1	2	6	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	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H2406	008	0	1	04	01	H2406_008_0	2		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2406	008	0	1	04	01	H2406_008_0	2		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H2406	008	0	1	04	01	H2406_008_0	2		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2406	008	0	1	04	01	H2406_008_0	2		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H2406	008	0	1	04	01	H2406_008_0	2		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2406	008	0	1	04	01	H2406_008_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2406	008	0	1	04	01	H2406_008_0	2		Y	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												
H2406	009	0	1	04	01	H2406_009_0	2		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2406	009	0	1	04	01	H2406_009_0	2		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H2406	009	0	1	04	01	H2406_009_0	2		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2406	009	0	1	04	01	H2406_009_0	2		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H2406	009	0	1	04	01	H2406_009_0	2		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2406	009	0	1	04	01	H2406_009_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2406	009	0	1	04	01	H2406_009_0	2		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				505.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2406	010	0	1	04	01	H2406_010_0	2		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2406	010	0	1	04	01	H2406_010_0	2		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H2406	010	0	1	04	01	H2406_010_0	2		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2406	010	0	1	04	01	H2406_010_0	2		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H2406	010	0	1	04	01	H2406_010_0	2		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2406	010	0	1	04	01	H2406_010_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2406	010	0	1	04	01	H2406_010_0	2		Y	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												
H2406	011	0	1	04	01	H2406_011_0	2		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2406	011	0	1	04	01	H2406_011_0	2		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H2406	011	0	1	04	01	H2406_011_0	2		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2406	011	0	1	04	01	H2406_011_0	2		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H2406	011	0	1	04	01	H2406_011_0	2		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2406	011	0	1	04	01	H2406_011_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2406	011	0	1	04	01	H2406_011_0	2		Y	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												
H2406	012	0	1	04	01	H2406_012_0	2		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2406	012	0	1	04	01	H2406_012_0	2		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H2406	012	0	1	04	01	H2406_012_0	2		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2406	012	0	1	04	01	H2406_012_0	2		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H2406	012	0	1	04	01	H2406_012_0	2		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2406	012	0	1	04	01	H2406_012_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2406	012	0	1	04	01	H2406_012_0	2		Y	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												
H2406	013	0	1	04	01	H2406_013_0	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2406	013	0	1	04	01	H2406_013_0	3		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H2406	013	0	1	04	01	H2406_013_0	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2406	013	0	1	04	01	H2406_013_0	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H2406	013	0	1	04	01	H2406_013_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2406	013	0	1	04	01	H2406_013_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2406	013	0	1	04	01	H2406_013_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				529.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2406	014	0	1	04	01	H2406_014_0	2		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2406	014	0	1	04	01	H2406_014_0	2		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H2406	014	0	1	04	01	H2406_014_0	2		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	5.00		15.00																											15.00						0.00				5.00				5.00		0.16						0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2406	014	0	1	04	01	H2406_014_0	2		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	5.00		15.00																											15.00						0.00				5.00				5.00		0.16						0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H2406	014	0	1	04	01	H2406_014_0	2		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2406	014	0	1	04	01	H2406_014_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2406	014	0	1	04	01	H2406_014_0	2		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				388.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2406	015	0	1	04	01	H2406_015_0	2		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2406	015	0	1	04	01	H2406_015_0	2		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H2406	015	0	1	04	01	H2406_015_0	2		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	5.00		15.00																											15.00						0.00				5.00				5.00		0.16						0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2406	015	0	1	04	01	H2406_015_0	2		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	5.00		15.00																											15.00						0.00				5.00				5.00		0.16						0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H2406	015	0	1	04	01	H2406_015_0	2		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2406	015	0	1	04	01	H2406_015_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2406	015	0	1	04	01	H2406_015_0	2		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				371.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2406	016	0	1	04	01	H2406_016_0	2		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2406	016	0	1	04	01	H2406_016_0	2		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H2406	016	0	1	04	01	H2406_016_0	2		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2406	016	0	1	04	01	H2406_016_0	2		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H2406	016	0	1	04	01	H2406_016_0	2		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2406	016	0	1	04	01	H2406_016_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2406	016	0	1	04	01	H2406_016_0	2		Y	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												
H2406	017	0	1	04	01	H2406_017_0	2		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2406	017	0	1	04	01	H2406_017_0	2		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H2406	017	0	1	04	01	H2406_017_0	2		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2406	017	0	1	04	01	H2406_017_0	2		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H2406	017	0	1	04	01	H2406_017_0	2		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2406	017	0	1	04	01	H2406_017_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2406	017	0	1	04	01	H2406_017_0	2		Y	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												
H2406	018	0	1	04	01	H2406_018_0	2		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2406	018	0	1	04	01	H2406_018_0	2		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H2406	018	0	1	04	01	H2406_018_0	2		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2406	018	0	1	04	01	H2406_018_0	2		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H2406	018	0	1	04	01	H2406_018_0	2		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2406	018	0	1	04	01	H2406_018_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2406	018	0	1	04	01	H2406_018_0	2		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				553.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2406	019	0	1	04	01	H2406_019_0	2		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2406	019	0	1	04	01	H2406_019_0	2		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H2406	019	0	1	04	01	H2406_019_0	2		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	5.00		15.00																											15.00						0.00				5.00				5.00		0.16						0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2406	019	0	1	04	01	H2406_019_0	2		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	5.00		15.00																											15.00						0.00				5.00				5.00		0.16						0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H2406	019	0	1	04	01	H2406_019_0	2		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2406	019	0	1	04	01	H2406_019_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2406	019	0	1	04	01	H2406_019_0	2		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				440.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2450	001	0	1	18	06	H2450_001_0	3			Preferred Generic	4	01	1	2	1	1		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	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					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	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					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	3			Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											68.28	50	50	50				65.46	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	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												
H2450	002	0	1	18	06	H2450_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								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	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					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	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					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	3			Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											60.66	50	50	50				61.78	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	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												
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					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	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											88.33	50	50	50				81.88	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	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				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	3			Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	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	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					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	3			Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											89.81	50	50	50				98.91	50	50	50										50	50	50				50	50	50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2450	016	0	1	18	06	H2450_016_0	3			Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2450	035	0	1	18	06	H2450_035_0	3			Preferred Generic	4	01	1	2	1	1		111	01		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	3			Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	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	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					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	3			Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											103.35	50	50	50				90.79	50	50	50										50	50	50				50	50	50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2450	035	0	1	18	06	H2450_035_0	3			Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2450	037	0	1	18	06	H2450_037_0	3			Preferred Generic	4	01	1	2	1	1		111	01		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	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					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	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					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	3			Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											94.50	50	50	50				85.04	50	50	50										50	50	50				50	50	50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2450	037	0	1	18	06	H2450_037_0	3			Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2450	039	0	1	18	06	H2450_039_0	3			Preferred Generic	4	01	1	2	1	1		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	3			Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	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	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	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	3			Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											81.55	50	50	50				101.67	50	50	50										50	50	50				50	50	50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2450	039	0	1	18	06	H2450_039_0	3			Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2450	041	0	1	18	06	H2450_041_0	3			Preferred Generic	4	01	1	2	1	1		111	01		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	3			Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	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	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	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	3			Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											84.74	50	50	50				87.56	50	50	50										50	50	50				50	50	50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2450	041	0	1	18	06	H2450_041_0	3			Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2450	049	0	1	18	06	H2450_049_0	3			Preferred Generic	4	01	1	2	1	1		111	01		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	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	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	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	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	3			Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											90.76	50	50	50				96.52	50	50	50										50	50	50				50	50	50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2450	049	0	1	18	06	H2450_049_0	3			Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2459	020	0	1	02	01	H2459_020_0	5		Y	Preferred Generic	4	11	1	2	1	1		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	5		Y	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	5		Y	Preferred Brand	4	11	1	1	3	1		111	10		111	1				30	60	90	1	2				30	60	90		29	31											77.00	25	25	25				53.00	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	5		Y	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		29	31											89.00	50	50	50				89.00	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	5		Y	Specialty Tier	4	11	1	1	5	1		111	10		111	1				30	60	90	1	2				30	60	90		29	31											2129.00	25	25	25				2129.00	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	4		Y	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	4		Y	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	4		Y	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	4		Y	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	4		Y	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	4		Y	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		29	31											95.00	45	45	45				95.00	45	45	45										45	45	45				45	45	45				45		45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2459	021	1	1	02	01	H2459_021_1	4		Y	Specialty Tier	4	11	1	1	5	1		111	10		111	1				30	60	90	1	2				30	60	90		29	31											3301.00	33	33	33				3301.00	33	33	33										33	33	33				33	33	33				33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2459	021	2	1	02	01	H2459_021_2	4		Y	Preferred Generic	4	11	1	2	1	1		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	4		Y	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	4		Y	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	4		Y	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	4		Y	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	4		Y	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		29	31											95.00	45	45	45				95.00	45	45	45										45	45	45				45	45	45				45		45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2459	021	2	1	02	01	H2459_021_2	4		Y	Specialty Tier	4	11	1	1	5	1		111	10		111	1				30	60	90	1	2				30	60	90		29	31											3301.00	33	33	33				3301.00	33	33	33										33	33	33				33	33	33				33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2459	021	3	1	02	01	H2459_021_3	4		Y	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	4		Y	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	4		Y	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	4		Y	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	4		Y	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	4		Y	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		29	31											95.00	45	45	45				95.00	45	45	45										45	45	45				45	45	45				45		45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2459	021	3	1	02	01	H2459_021_3	4		Y	Specialty Tier	4	11	1	1	5	1		111	10		111	1				30	60	90	1	2				30	60	90		29	31											3301.00	33	33	33				3301.00	33	33	33										33	33	33				33	33	33				33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2459	023	1	1	02	01	H2459_023_1	4		Y	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	4		Y	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	4		Y	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		29	31								47.00	94.00	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	4		Y	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		29	31											88.00	50	50	50				88.00	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	4		Y	Specialty Tier	4	11	1	1	5	1		111	10		111	1				30	60	90	1	2				30	60	90		29	31											2538.00	27	27	27				2538.00	27	27	27										27	27	27				27	27	27				27		27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2459	023	2	1	02	01	H2459_023_2	4		Y	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	4		Y	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	4		Y	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		29	31								47.00	94.00	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	4		Y	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		29	31											88.00	50	50	50				88.00	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	4		Y	Specialty Tier	4	11	1	1	5	1		111	10		111	1				30	60	90	1	2				30	60	90		29	31											2538.00	27	27	27				2538.00	27	27	27										27	27	27				27	27	27				27		27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2459	024	0	1	02	01	H2459_024_0	4		Y	Preferred Generic	4	11	1	2	1	1		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	4		Y	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	4		Y	Preferred Brand	4	11	1	1	3	1		111	10		111	1				30	60	90	1	2				30	60	90		29	31											76.00	25	25	25				51.00	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	4		Y	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		29	31											63.00	50	50	50				63.00	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	4		Y	Specialty Tier	4	11	1	1	5	1		111	10		111	1				30	60	90	1	2				30	60	90		29	31											2082.00	25	25	25				2082.00	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	3		Y	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	3		Y	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	3		Y	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		29	31								47.00	94.00	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	3		Y	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		29	31											81.00	50	50	50				81.00	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	3		Y	Specialty Tier	4	11	1	1	5	1		111	10		111	1				30	60	90	1	2				30	60	90		29	31											1753.00	29	29	29				1753.00	29	29	29										29	29	29				29	29	29				29		29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2459	026	3	1	02	01	H2459_026_3	4		Y	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	4		Y	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	4		Y	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		29	31								47.00	94.00	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	4		Y	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		29	31											81.00	50	50	50				81.00	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	4		Y	Specialty Tier	4	11	1	1	5	1		111	10		111	1				30	60	90	1	2				30	60	90		29	31											1753.00	29	29	29				1753.00	29	29	29										29	29	29				29	29	29				29		29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2459	026	4	1	02	01	H2459_026_4	5		Y	Preferred Generic	4	11	1	2	1	1		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		Y	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		Y	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		29	31								47.00	94.00	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		Y	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		29	31											81.00	50	50	50				81.00	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		Y	Specialty Tier	4	11	1	1	5	1		111	10		111	1				30	60	90	1	2				30	60	90		29	31											1753.00	29	29	29				1753.00	29	29	29										29	29	29				29	29	29				29		29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2459	028	0	1	02	01	H2459_028_0	4		Y	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	4		Y	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				6.00	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	4		Y	Preferred Brand	4	11	1	1	3	1		111	10		111	1				30	60	90	1	2				30	60	90		29	31											76.00	25	25	25				61.00	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	4		Y	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		29	31											78.00	50	50	50				78.00	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	4		Y	Specialty Tier	4	11	1	1	5	1		111	10		111	1				30	60	90	1	2				30	60	90		29	31											1574.00	25	25	25				1574.00	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	4		Y	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	4		Y	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	4		Y	Preferred Brand	4	11	1	1	3	1		111	10		111	1				30	60	90	1	2				30	60	90		29	31											73.00	25	25	25				49.00	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	4		Y	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		29	31											75.00	50	50	50				75.00	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	4		Y	Specialty Tier	4	11	1	1	5	1		111	10		111	1				30	60	90	1	2				30	60	90		29	31											1927.00	27	27	27				1927.00	27	27	27										27	27	27				27	27	27				27		27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2459	031	0	1	01	01	H2459_031_0	5		Y	Preferred Generic	4	11	1	2	1	1	111		10	111		1	30	60	90				1	1	30	60	90					29	31	8.00	16.00	24.00																			8.00	16.00	24.00																	8.00			8.00		0.27			0.27			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2459	031	0	1	01	01	H2459_031_0	5		Y	Generic	4	11	1	2	2	1	111		10	111		1	30	60	90				1	1	30	60	90					29	31	16.00	32.00	48.00																			16.00	32.00	48.00																	16.00			16.00		0.53			0.53			0.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2459	031	0	1	01	01	H2459_031_0	5		Y	Preferred Brand	4	11	1	2	3	1	111		10	111		1	30	60	90				1	1	30	60	90					29	31	45.00	90.00	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	031	0	1	01	01	H2459_031_0	5		Y	Non-Preferred Drug	4	11	1	1	4	1	111		10	111		1	30	60	90				1	1	30	60	90					29	31				87.00	40	40	40																		40	40	40																40		40								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2459	031	0	1	01	01	H2459_031_0	5		Y	Specialty Tier	4	11	1	1	5	1	111		10	111		1	30	60	90				1	1	30	60	90					29	31				2008.00	29	29	29																		29	29	29																29		29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2459	032	0	1	01	01	H2459_032_0	5		Y	Preferred Generic	4	11	1	2	1	1	111		10	111		1	30	60	90				1	1	30	60	90					29	31	7.00	14.00	21.00																			7.00	14.00	21.00																	7.00			7.00		0.23			0.23			0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2459	032	0	1	01	01	H2459_032_0	5		Y	Generic	4	11	1	2	2	1	111		10	111		1	30	60	90				1	1	30	60	90					29	31	15.00	30.00	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												
H2459	032	0	1	01	01	H2459_032_0	5		Y	Preferred Brand	4	11	1	2	3	1	111		10	111		1	30	60	90				1	1	30	60	90					29	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												
H2459	032	0	1	01	01	H2459_032_0	5		Y	Non-Preferred Drug	4	11	1	1	4	1	111		10	111		1	30	60	90				1	1	30	60	90					29	31				84.00	40	40	40																		40	40	40																40		40								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2459	032	0	1	01	01	H2459_032_0	5		Y	Specialty Tier	4	11	1	1	5	1	111		10	111		1	30	60	90				1	1	30	60	90					29	31				2285.00	33	33	33																		33	33	33																33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2461	008	0	1	18	06	H2461_008_0	4			Preferred Generic	2	01	1	2	1	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31	0.00	0.00	0.00																			0.00	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	4			Generic	2	01	1	2	2	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31	11.00	22.00	22.00																			11.00	22.00	22.00																11.00				11.00		0.35			0.35			0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2461	008	0	1	18	06	H2461_008_0	4			Preferred Brand	2	11	1	1	3	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31				47.46	22	22	22																		22	22	22															22			22								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2461	008	0	1	18	06	H2461_008_0	4			Non-Preferred Drug	2	11	1	1	4	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31				98.83	44	44	44																		44	44	44															44			44								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2461	008	0	1	18	06	H2461_008_0	4			Specialty Tier	2	11	1	1	5	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31					25	25	25																		25	25	25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2461	009	0	1	18	06	H2461_009_0	5			Preferred Generic	4	01	1	2	1	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31	0.00	0.00	0.00																			0.00	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	5			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	5			Preferred Brand	4	11	1	1	3	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31				66.76	21	21	21																		21	21	21															21			21								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2461	009	0	1	18	06	H2461_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				99.80	42	42	42																		42	42	42															42			42								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2461	009	0	1	18	06	H2461_009_0	5			Specialty Tier	4	11	1	1	5	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31					25	25	25																		25	25	25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2461	010	0	1	18	06	H2461_010_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												
H2461	010	0	1	18	06	H2461_010_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												
H2461	010	0	1	18	06	H2461_010_0	4			Preferred Brand	4	11	1	1	3	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31				60.48	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	4			Non-Preferred Drug	4	11	1	1	4	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31				99.52	40	40	40																		40	40	40															40			40								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2461	010	0	1	18	06	H2461_010_0	4			Specialty Tier	4	11	1	1	5	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31					25	25	25																		25	25	25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2463	001	0	1	01	01	H2463_001_0	3		Y	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	5.00		15.00																									10.00		30.00				5.00		0.00				5.00				5.00		0.17				0.33	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2463	001	0	1	01	01	H2463_001_0	3		Y	Generic	4	11	3	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	15.00		45.00																									20.00		60.00				15.00		0.00				15.00				15.00		0.50				0.67	0.50	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2463	001	0	1	01	01	H2463_001_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	45.00		135.00																									47.00		141.00				45.00		90.00				45.00				45.00		1.50				1.57	1.50	1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2463	001	0	1	01	01	H2463_001_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		200.00				100.00				100.00		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	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					29																										29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2463	003	0	1	01	01	H2463_003_0	3		Y	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2463	003	0	1	01	01	H2463_003_0	3		Y	Preferred Generic	4	11	3	2	1	3	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H2463	003	0	1	01	01	H2463_003_0	3		Y	Generic	4	11	3	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	5.00		15.00																									20.00		60.00				5.00		0.00				5.00				5.00		0.17				0.67	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2463	003	0	1	01	01	H2463_003_0	3		Y	Generic	4	11	3	2	2	3	110		01		110	1	30		90				2	2				30		90	30		31	5.00		15.00																									20.00		60.00				5.00		0.00				5.00				5.00		0.17				0.67	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H2463	003	0	1	01	01	H2463_003_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	45.00		135.00																									47.00		141.00				45.00		90.00				45.00				45.00		1.50				1.57	1.50	1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2463	003	0	1	01	01	H2463_003_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		200.00				100.00				100.00		3.33				3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2463	003	0	1	01	01	H2463_003_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2478	001	0	1	01	01	H2478_001_0	8		N	Preferred Generic	4	11	1	2	1	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2478	001	0	1	01	01	H2478_001_0	8		N	Generic	4	11	1	2	2	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2478	001	0	1	01	01	H2478_001_0	8		N	Preferred Brand	4	11	1	2	3	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31	29.00	58.00	87.00																			29.00	58.00	87.00																29.00				29.00		0.94			0.94			0.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2478	001	0	1	01	01	H2478_001_0	8		N	Non-Preferred Drug	4	11	1	1	4	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31				98.07	35	35	35																		35	35	35															35			35								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2478	001	0	1	01	01	H2478_001_0	8		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	31								31						31		31				742.42	25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2478	002	0	1	01	01	H2478_002_0	9		Y	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												
H2478	002	0	1	01	01	H2478_002_0	9		Y	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												
H2478	002	0	1	01	01	H2478_002_0	9		Y	Preferred Brand	4	11	1	2	3	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31	47.00	94.00	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												
H2478	002	0	1	01	01	H2478_002_0	9		Y	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												
H2478	002	0	1	01	01	H2478_002_0	9		Y	Specialty Tier	4	11	1	1	5	1	010		01	010		1	31								31						31		31				818.18	31																				31																	31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2478	002	0	1	01	01	H2478_002_0	9		Y	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												
H2478	003	0	1	01	01	H2478_003_0	8		Y	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												
H2478	003	0	1	01	01	H2478_003_0	8		Y	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												
H2478	003	0	1	01	01	H2478_003_0	8		Y	Preferred Brand	4	11	1	2	3	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31	47.00	94.00	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												
H2478	003	0	1	01	01	H2478_003_0	8		Y	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												
H2478	003	0	1	01	01	H2478_003_0	8		Y	Specialty Tier	4	11	1	1	5	1	010		01	010		1	31								31						31		31				734.11	27																				27																	27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2478	003	0	1	01	01	H2478_003_0	8		Y	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												
H2486	003	0	1	01	01	H2486_003_0	4		Y	Preferred Generic	4	11	1	2	1	1	110		01		110	1	30		100				1	2				30		100	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2486	003	0	1	01	01	H2486_003_0	4		Y	Preferred Generic	4	11	1	2	1	3	110		01		110	1	30		100				1	2				30		100	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H2486	003	0	1	01	01	H2486_003_0	4		Y	Generic	4	11	1	2	2	1	110		01		110	1	30		100				2	2				30		100	30		31	0.00		0.00																									20.00		60.00				0.00		0.00				0.00				0.00		0				0.67	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2486	003	0	1	01	01	H2486_003_0	4		Y	Generic	4	11	1	2	2	3	110		01		110	1	30		100				2	2				30		100	30		31	0.00		0.00																									20.00		60.00				0.00		0.00				0.00				0.00		0				0.67	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H2486	003	0	1	01	01	H2486_003_0	4		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		100				2	2				30		100	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												
H2486	003	0	1	01	01	H2486_003_0	4		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		100				2	2				30		100	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												
H2486	003	0	1	01	01	H2486_003_0	4		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2486	005	0	1	01	01	H2486_005_0	4		Y	Preferred Generic	4	11	1	2	1	1	110		01		110	1	30		100				1	2				30		100	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2486	005	0	1	01	01	H2486_005_0	4		Y	Preferred Generic	4	11	1	2	1	3	110		01		110	1	30		100				1	2				30		100	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H2486	005	0	1	01	01	H2486_005_0	4		Y	Generic	4	11	1	2	2	1	110		01		110	1	30		100				2	2				30		100	30		31	5.00		15.00																									20.00		60.00				5.00		0.00				5.00				5.00		0.17				0.67	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2486	005	0	1	01	01	H2486_005_0	4		Y	Generic	4	11	1	2	2	3	110		01		110	1	30		100				2	2				30		100	30		31	5.00		15.00																									20.00		60.00				5.00		0.00				5.00				5.00		0.17				0.67	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H2486	005	0	1	01	01	H2486_005_0	4		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		100				2	2				30		100	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												
H2486	005	0	1	01	01	H2486_005_0	4		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		100				2	2				30		100	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												
H2486	005	0	1	01	01	H2486_005_0	4		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2486	006	0	1	01	01	H2486_006_0	4		Y	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		100				1	2				30		100	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2486	006	0	1	01	01	H2486_006_0	4		Y	Preferred Generic	4	11	3	2	1	3	110		01		110	1	30		100				1	2				30		100	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H2486	006	0	1	01	01	H2486_006_0	4		Y	Generic	4	11	3	2	2	1	110		01		110	1	30		100				2	2				30		100	30		31	0.00		0.00																									20.00		60.00				0.00		0.00				0.00				0.00		0				0.67	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2486	006	0	1	01	01	H2486_006_0	4		Y	Generic	4	11	3	2	2	3	110		01		110	1	30		100				2	2				30		100	30		31	0.00		0.00																									20.00		60.00				0.00		0.00				0.00				0.00		0				0.67	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H2486	006	0	1	01	01	H2486_006_0	4		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		100				2	2				30		100	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												
H2486	006	0	1	01	01	H2486_006_0	4		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		100				2	2				30		100	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												
H2486	006	0	1	01	01	H2486_006_0	4		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2486	007	0	1	01	01	H2486_007_0	2		Y	Preferred Generic	4	11	1	2	1	1	110		01		110	1	30		100				1	2				30		100	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2486	007	0	1	01	01	H2486_007_0	2		Y	Preferred Generic	4	11	1	2	1	3	110		01		110	1	30		100				1	2				30		100	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H2486	007	0	1	01	01	H2486_007_0	2		Y	Generic	4	11	1	2	2	1	110		01		110	1	30		100				2	2				30		100	30		31	0.00		0.00																									20.00		60.00				0.00		0.00				0.00				0.00		0				0.67	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2486	007	0	1	01	01	H2486_007_0	2		Y	Generic	4	11	1	2	2	3	110		01		110	1	30		100				2	2				30		100	30		31	0.00		0.00																									20.00		60.00				0.00		0.00				0.00				0.00		0				0.67	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H2486	007	0	1	01	01	H2486_007_0	2		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		100				2	2				30		100	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												
H2486	007	0	1	01	01	H2486_007_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		100				2	2				30		100	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												
H2486	007	0	1	01	01	H2486_007_0	2		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2486	008	0	1	01	01	H2486_008_0	3		Y	Preferred Generic	4	11	1	2	1	1	110		01		110	1	30		100				1	2				30		100	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2486	008	0	1	01	01	H2486_008_0	3		Y	Preferred Generic	4	11	1	2	1	3	110		01		110	1	30		100				1	2				30		100	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H2486	008	0	1	01	01	H2486_008_0	3		Y	Generic	4	11	1	2	2	1	110		01		110	1	30		100				2	2				30		100	30		31	5.00		15.00																									20.00		60.00				5.00		0.00				5.00				5.00		0.17				0.67	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2486	008	0	1	01	01	H2486_008_0	3		Y	Generic	4	11	1	2	2	3	110		01		110	1	30		100				2	2				30		100	30		31	5.00		15.00																									20.00		60.00				5.00		0.00				5.00				5.00		0.17				0.67	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H2486	008	0	1	01	01	H2486_008_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		100				2	2				30		100	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												
H2486	008	0	1	01	01	H2486_008_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		100				2	2				30		100	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												
H2486	008	0	1	01	01	H2486_008_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					30																										30						30					30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2486	009	0	1	01	01	H2486_009_0	2		Y	Preferred Generic	4	11	1	2	1	1	110		01		110	1	30		100				1	2				30		100	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2486	009	0	1	01	01	H2486_009_0	2		Y	Preferred Generic	4	11	1	2	1	3	110		01		110	1	30		100				1	2				30		100	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H2486	009	0	1	01	01	H2486_009_0	2		Y	Generic	4	11	1	2	2	1	110		01		110	1	30		100				2	2				30		100	30		31	5.00		15.00																									20.00		60.00				5.00		0.00				5.00				5.00		0.17				0.67	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2486	009	0	1	01	01	H2486_009_0	2		Y	Generic	4	11	1	2	2	3	110		01		110	1	30		100				2	2				30		100	30		31	5.00		15.00																									20.00		60.00				5.00		0.00				5.00				5.00		0.17				0.67	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H2486	009	0	1	01	01	H2486_009_0	2		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		100				2	2				30		100	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												
H2486	009	0	1	01	01	H2486_009_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		100				2	2				30		100	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												
H2486	009	0	1	01	01	H2486_009_0	2		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					31																										31						31					31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
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	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					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												
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					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	84.00				47.00				47.00			1.57	1.4		1.57	1.4	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, 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											74.96	50	50	50				71.97	48	48	48										50	50	50				48	48	48			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			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	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	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	2	
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								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00				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												
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								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												
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												29							29												29						29					29			29								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	3	11	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								19.00	38.00	57.00					0.00	0.00	0.00											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												
H2491	010	0	1	01	01	H2491_010_0	4			Generic	3	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					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												
H2491	010	0	1	01	01	H2491_010_0	4			Preferred Brand	3	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	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, Select Care Drugs												
H2491	010	0	1	01	01	H2491_010_0	4			Non-Preferred Drug	3	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											99.72	49	49	49				99.72	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	3	11	1	1	5	1		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												
H2491	010	0	1	01	01	H2491_010_0	4			Select Care Drugs	3	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
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								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00				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												
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								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												
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	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	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	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	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					30.00	60.00	90.00											35.00	70.00	105.00				30.00	60.00	60.00				35.00				35.00			1.17	1.00		1.17	1.00	1.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
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					95.00	190.00	285.00											100.00	200.00	300.00				95.00	190.00	190.00				100.00				100.00			3.33	3.17		3.33	3.17	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			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	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	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	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					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												
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					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	84.00				47.00				47.00			1.57	1.4		1.57	1.4	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, 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											87.04	45	45	45				83.17	43	43	43										45	45	45				43	43	43			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			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	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	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	2	
H2491	019	0	1	01	01	H2491_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								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2491	019	0	1	01	01	H2491_019_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												
H2491	019	0	1	01	01	H2491_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					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	84.00				47.00				47.00			1.57	1.4		1.57	1.4	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2491	019	0	1	01	01	H2491_019_0	4			Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											98.12	50	50	50				94.20	48	48	48										50	50	50				48	48	48			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2491	019	0	1	01	01	H2491_019_0	4			Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2491	019	0	1	01	01	H2491_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												
H2491	019	0	1	01	01	H2491_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	
H2491	020	0	1	01	01	H2491_020_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	020	0	1	01	01	H2491_020_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												
H2491	020	0	1	01	01	H2491_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											47.00	94.00	141.00				42.00	84.00	84.00				47.00				47.00			1.57	1.4		1.57	1.4	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2491	020	0	1	01	01	H2491_020_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	50	50	50				94.20	48	48	48										50	50	50				48	48	48			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2491	020	0	1	01	01	H2491_020_0	4			Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2491	020	0	1	01	01	H2491_020_0	4			Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2491	020	0	1	01	01	H2491_020_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	
H2491	021	0	1	01	01	H2491_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	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2491	021	0	1	01	01	H2491_021_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												
H2491	021	0	1	01	01	H2491_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											47.00	94.00	141.00				42.00	84.00	84.00				47.00				47.00			1.57	1.4		1.57	1.4	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2491	021	0	1	01	01	H2491_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											98.01	50	50	50				94.09	48	48	48										50	50	50				48	48	48			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2491	021	0	1	01	01	H2491_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, Select Care Drugs												
H2491	021	0	1	01	01	H2491_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	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2491	021	0	1	01	01	H2491_021_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	
H2506	001	0	1	48	05	H2506_001_0	5			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	5			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	5			Non-Medicare Rx/OTC Drugs	4	11			3	1	111		10			1	30	60	90				1	2								29	31																																																					Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	2	0.00	0.00	0.00	0.00			0.00	0.00			
H2526	001	0	1	04	01	H2526_001_0	9		Y	Preferred Generic	4	11	1	2	1	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2526	001	0	1	04	01	H2526_001_0	9		Y	Preferred Generic	4	11	1	2	1	3	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H2526	001	0	1	04	01	H2526_001_0	9		Y	Generic	4	11	3	2	2	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2526	001	0	1	04	01	H2526_001_0	9		Y	Generic	4	11	3	2	2	3	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	3
H2526	001	0	1	04	01	H2526_001_0	9		Y	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	47.00	94.00	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												
H2526	001	0	1	04	01	H2526_001_0	9		Y	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	100.00	200.00	300.00																			100.00	200.00	300.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2526	001	0	1	04	01	H2526_001_0	9		Y	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												
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	4.15	0.00	4.15	0.00	4.15	0.00	4.15			
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	10.35	0.00	10.35	0.00	10.35	0.00	10.35			
H2531	001	0	1	48	05	H2531_001_0	3			Non-Medicare Rx/OTC Drugs	4	11			3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31																																														0.00			0.00			0.00	Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	2	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H2533	001	0	1	48	05	H2533_001_0	2			Generic Drugs	4	01			1	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31																																																					Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	1	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H2533	001	0	1	48	05	H2533_001_0	2			Brand Drugs	4	11			2	1	111		01	111		1	31	60	90				2	2	31	60	90				31		31																																																					Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	1	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H2533	001	0	1	48	05	H2533_001_0	2			Non-Medicare Rx/OTC Drugs	4	11			3	1	010		01	010		1	31								31						31		31																																																					Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	2	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H2563	005	1	1	01	01	H2563_005_1	9		N	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	9		N	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	9		N	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	9		N	Non-Preferred Drug	4	11	1	2	4	1		110	01	100		1				30		90	2	2			90				30		31								95.00		285.00					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	9		N	Specialty Tier	4	11	1	1	5	1		010	01			1				30											30		31											991.44	30						991.44	30																							30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2563	005	2	1	01	01	H2563_005_2	9		N	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	9		N	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	9		N	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	9		N	Non-Preferred Drug	4	11	1	2	4	1		110	01	100		1				30		90	2	2			90				30		31								95.00		285.00					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	9		N	Specialty Tier	4	11	1	1	5	1		010	01			1				30											30		31											991.44	30						991.44	30																							30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2563	008	0	1	01	01	H2563_008_0	9		Y	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	9		Y	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	9		Y	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	9		Y	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	9		Y	Specialty Tier	4	11	1	1	5	1		010	01			1				30											30		31											1270.29	30						1270.29	30																							30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2563	009	0	1	01	01	H2563_009_0	10		Y	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	10		Y	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	10		Y	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	10		Y	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	10		Y	Specialty Tier	4	11	1	1	5	1		010	01			1				30											30		31											1041.95	30						1041.95	30																							30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2563	015	0	1	01	01	H2563_015_0	9		Y	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	9		Y	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	9		Y	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	9		Y	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	9		Y	Specialty Tier	4	11	1	1	5	1		010	01			1				30											30		31											1095.97	30						1095.97	30																							30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2563	016	0	1	01	01	H2563_016_0	9		Y	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	9		Y	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	9		Y	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	9		Y	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	9		Y	Specialty Tier	4	11	1	1	5	1		010	01			1				30											30		31											1085.93	30						1085.93	30																							30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2563	017	1	1	01	01	H2563_017_1	9		Y	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	9		Y	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	9		Y	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	9		Y	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	9		Y	Specialty Tier	4	11	1	1	5	1		010	01			1				30											30		31											937.96	30						937.96	30																							30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2563	017	2	1	01	01	H2563_017_2	9		Y	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	9		Y	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	9		Y	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	9		Y	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	9		Y	Specialty Tier	4	11	1	1	5	1		010	01			1				30											30		31											937.96	30						937.96	30																							30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2563	018	0	1	01	01	H2563_018_0	8		Y	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	018	0	1	01	01	H2563_018_0	8		Y	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	018	0	1	01	01	H2563_018_0	8		Y	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	018	0	1	01	01	H2563_018_0	8		Y	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	018	0	1	01	01	H2563_018_0	8		Y	Specialty Tier	4	11	1	1	5	1		010	01			1				30											30		31											1225.33	30						1225.33	30																							30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2563	019	0	1	01	01	H2563_019_0	9		N	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	019	0	1	01	01	H2563_019_0	9		N	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	019	0	1	01	01	H2563_019_0	9		N	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	019	0	1	01	01	H2563_019_0	9		N	Non-Preferred Drug	4	11	1	2	4	1		110	01	100		1				30		90	2	2			90				30		31								100.00		300.00					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	019	0	1	01	01	H2563_019_0	9		N	Specialty Tier	4	11	1	1	5	1		010	01			1				30											30		31											870.40	30						870.40	30																							30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2577	001	1	1	04	01	H2577_001_1	2		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2577	001	1	1	04	01	H2577_001_1	2		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H2577	001	1	1	04	01	H2577_001_1	2		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2577	001	1	1	04	01	H2577_001_1	2		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H2577	001	1	1	04	01	H2577_001_1	2		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2577	001	1	1	04	01	H2577_001_1	2		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2577	001	1	1	04	01	H2577_001_1	2		Y	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	001	2	1	04	01	H2577_001_2	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2577	001	2	1	04	01	H2577_001_2	3		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H2577	001	2	1	04	01	H2577_001_2	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2577	001	2	1	04	01	H2577_001_2	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H2577	001	2	1	04	01	H2577_001_2	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2577	001	2	1	04	01	H2577_001_2	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2577	001	2	1	04	01	H2577_001_2	3		Y	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	002	0	1	04	01	H2577_002_0	2		Y	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		100	2	2						100	30		31								10.00		30.00					0.00		0.00													30.00						0.00				10.00				10.00			0.33	0.00				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2577	002	0	1	04	01	H2577_002_0	2		Y	Preferred Generic	4	01	1	2	1	3		110	01		100	1				30		100	2	2						100	30		31								10.00		30.00					0.00		0.00													30.00						0.00				10.00				10.00			0.33	0.00				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H2577	002	0	1	04	01	H2577_002_0	2		Y	Generic	4	01	3	2	2	1		110	01		100	1				30		100	2	2						100	30		31								20.00		60.00					0.00		0.00													60.00						0.00				20.00				20.00			0.66	0.00				0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2577	002	0	1	04	01	H2577_002_0	2		Y	Generic	4	01	3	2	2	3		110	01		100	1				30		100	2	2						100	30		31								20.00		60.00					0.00		0.00													60.00						0.00				20.00				20.00			0.66	0.00				0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H2577	002	0	1	04	01	H2577_002_0	2		Y	Preferred Brand	4	11	1	2	3	1		110	01		100	1				30		100	2	2						100	30		31								47.00		141.00					47.00		131.00													141.00						131.00				47.00				47.00			1.56	1.56				1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2577	002	0	1	04	01	H2577_002_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1		110	01		100	1				30		100	2	2						100	30		31								100.00		300.00					100.00		290.00													300.00						290.00				100.00				100.00			3.33	3.33				3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2577	002	0	1	04	01	H2577_002_0	2		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											650.00	33						490.00	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2577	003	1	1	04	01	H2577_003_1	2		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2577	003	1	1	04	01	H2577_003_1	2		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H2577	003	1	1	04	01	H2577_003_1	2		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	8.00		24.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2577	003	1	1	04	01	H2577_003_1	2		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	8.00		24.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H2577	003	1	1	04	01	H2577_003_1	2		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2577	003	1	1	04	01	H2577_003_1	2		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2577	003	1	1	04	01	H2577_003_1	2		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				513.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2577	003	2	1	04	01	H2577_003_2	2		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2577	003	2	1	04	01	H2577_003_2	2		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H2577	003	2	1	04	01	H2577_003_2	2		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	8.00		24.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2577	003	2	1	04	01	H2577_003_2	2		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	8.00		24.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H2577	003	2	1	04	01	H2577_003_2	2		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2577	003	2	1	04	01	H2577_003_2	2		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2577	003	2	1	04	01	H2577_003_2	2		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				513.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2577	004	0	1	04	01	H2577_004_0	2		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2577	004	0	1	04	01	H2577_004_0	2		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H2577	004	0	1	04	01	H2577_004_0	2		Y	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												
H2577	004	0	1	04	01	H2577_004_0	2		Y	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
H2577	004	0	1	04	01	H2577_004_0	2		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2577	004	0	1	04	01	H2577_004_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2577	004	0	1	04	01	H2577_004_0	2		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				494.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2577	005	0	1	04	01	H2577_005_0	2		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2577	005	0	1	04	01	H2577_005_0	2		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H2577	005	0	1	04	01	H2577_005_0	2		Y	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												
H2577	005	0	1	04	01	H2577_005_0	2		Y	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
H2577	005	0	1	04	01	H2577_005_0	2		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2577	005	0	1	04	01	H2577_005_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2577	005	0	1	04	01	H2577_005_0	2		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				299.00	31																										31						31					31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2577	006	0	1	04	01	H2577_006_0	2		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2577	006	0	1	04	01	H2577_006_0	2		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H2577	006	0	1	04	01	H2577_006_0	2		Y	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												
H2577	006	0	1	04	01	H2577_006_0	2		Y	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
H2577	006	0	1	04	01	H2577_006_0	2		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2577	006	0	1	04	01	H2577_006_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2577	006	0	1	04	01	H2577_006_0	2		Y	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												
H2577	007	0	1	04	01	H2577_007_0	2		Y	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		100	2	2						100	30		31								10.00		30.00					0.00		0.00													30.00						0.00				10.00				10.00			0.33	0.00				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2577	007	0	1	04	01	H2577_007_0	2		Y	Preferred Generic	4	01	1	2	1	3		110	01		100	1				30		100	2	2						100	30		31								10.00		30.00					0.00		0.00													30.00						0.00				10.00				10.00			0.33	0.00				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H2577	007	0	1	04	01	H2577_007_0	2		Y	Generic	4	01	3	2	2	1		110	01		100	1				30		100	2	2						100	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	2		Y	Generic	4	01	3	2	2	3		110	01		100	1				30		100	2	2						100	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	2		Y	Preferred Brand	4	11	1	2	3	1		110	01		100	1				30		100	2	2						100	30		31								47.00		141.00					47.00		131.00													141.00						131.00				47.00				47.00			1.56	1.56				1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2577	007	0	1	04	01	H2577_007_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1		110	01		100	1				30		100	2	2						100	30		31								100.00		300.00					100.00		290.00													300.00						290.00				100.00				100.00			3.33	3.33				3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2577	007	0	1	04	01	H2577_007_0	2		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											513.00	33						402.00	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		Y	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		100	2	2						100	30		31								10.00		30.00					0.00		0.00													30.00						0.00				10.00				10.00			0.33	0.00				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2577	008	0	1	04	01	H2577_008_0	3		Y	Preferred Generic	4	01	1	2	1	3		110	01		100	1				30		100	2	2						100	30		31								10.00		30.00					0.00		0.00													30.00						0.00				10.00				10.00			0.33	0.00				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H2577	008	0	1	04	01	H2577_008_0	3		Y	Generic	4	01	3	2	2	1		110	01		100	1				30		100	2	2						100	30		31								15.00		45.00					0.00		0.00													45.00						0.00				15.00				15.00			0.50	0.00				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2577	008	0	1	04	01	H2577_008_0	3		Y	Generic	4	01	3	2	2	3		110	01		100	1				30		100	2	2						100	30		31								15.00		45.00					0.00		0.00													45.00						0.00				15.00				15.00			0.50	0.00				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H2577	008	0	1	04	01	H2577_008_0	3		Y	Preferred Brand	4	11	1	2	3	1		110	01		100	1				30		100	2	2						100	30		31								47.00		141.00					47.00		131.00													141.00						131.00				47.00				47.00			1.56	1.56				1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2577	008	0	1	04	01	H2577_008_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1		110	01		100	1				30		100	2	2						100	30		31								100.00		300.00					100.00		290.00													300.00						290.00				100.00				100.00			3.33	3.33				3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2577	008	0	1	04	01	H2577_008_0	3		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											574.00	33						397.00	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2577	009	0	1	04	01	H2577_009_0	2		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2577	009	0	1	04	01	H2577_009_0	2		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H2577	009	0	1	04	01	H2577_009_0	2		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	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												
H2577	009	0	1	04	01	H2577_009_0	2		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	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
H2577	009	0	1	04	01	H2577_009_0	2		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2577	009	0	1	04	01	H2577_009_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2577	009	0	1	04	01	H2577_009_0	2		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				278.00	30																										30						30					30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2577	011	0	1	04	01	H2577_011_0	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		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		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H2577	011	0	1	04	01	H2577_011_0	3		Y	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												
H2577	011	0	1	04	01	H2577_011_0	3		Y	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
H2577	011	0	1	04	01	H2577_011_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2577	011	0	1	04	01	H2577_011_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		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												
H2577	011	0	1	04	01	H2577_011_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				418.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2577	013	0	1	04	01	H2577_013_0	2		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2577	013	0	1	04	01	H2577_013_0	2		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H2577	013	0	1	04	01	H2577_013_0	2		Y	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												
H2577	013	0	1	04	01	H2577_013_0	2		Y	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
H2577	013	0	1	04	01	H2577_013_0	2		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2577	013	0	1	04	01	H2577_013_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2577	013	0	1	04	01	H2577_013_0	2		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				489.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2577	014	0	1	04	01	H2577_014_0	2		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2577	014	0	1	04	01	H2577_014_0	2		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H2577	014	0	1	04	01	H2577_014_0	2		Y	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												
H2577	014	0	1	04	01	H2577_014_0	2		Y	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
H2577	014	0	1	04	01	H2577_014_0	2		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2577	014	0	1	04	01	H2577_014_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2577	014	0	1	04	01	H2577_014_0	2		Y	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												
H2577	016	0	1	04	01	H2577_016_0	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2577	016	0	1	04	01	H2577_016_0	3		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H2577	016	0	1	04	01	H2577_016_0	3		Y	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												
H2577	016	0	1	04	01	H2577_016_0	3		Y	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
H2577	016	0	1	04	01	H2577_016_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2577	016	0	1	04	01	H2577_016_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		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												
H2577	016	0	1	04	01	H2577_016_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				230.00	29																										29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2577	017	0	1	04	01	H2577_017_0	2		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2577	017	0	1	04	01	H2577_017_0	2		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H2577	017	0	1	04	01	H2577_017_0	2		Y	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												
H2577	017	0	1	04	01	H2577_017_0	2		Y	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
H2577	017	0	1	04	01	H2577_017_0	2		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2577	017	0	1	04	01	H2577_017_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2577	017	0	1	04	01	H2577_017_0	2		Y	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												
H2577	018	0	1	04	01	H2577_018_0	2		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2577	018	0	1	04	01	H2577_018_0	2		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H2577	018	0	1	04	01	H2577_018_0	2		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	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	2		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	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	2		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2577	018	0	1	04	01	H2577_018_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2577	018	0	1	04	01	H2577_018_0	2		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				444.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2577	020	0	1	04	01	H2577_020_0	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2577	020	0	1	04	01	H2577_020_0	3		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H2577	020	0	1	04	01	H2577_020_0	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	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		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	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		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2577	020	0	1	04	01	H2577_020_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2577	020	0	1	04	01	H2577_020_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				405.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2577	021	0	1	04	01	H2577_021_0	2		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2577	021	0	1	04	01	H2577_021_0	2		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H2577	021	0	1	04	01	H2577_021_0	2		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	5.00		15.00																											15.00						0.00				5.00				5.00		0.16						0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2577	021	0	1	04	01	H2577_021_0	2		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	5.00		15.00																											15.00						0.00				5.00				5.00		0.16						0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H2577	021	0	1	04	01	H2577_021_0	2		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2577	021	0	1	04	01	H2577_021_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2577	021	0	1	04	01	H2577_021_0	2		Y	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												
H2577	022	0	1	04	01	H2577_022_0	2		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2577	022	0	1	04	01	H2577_022_0	2		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H2577	022	0	1	04	01	H2577_022_0	2		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2577	022	0	1	04	01	H2577_022_0	2		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H2577	022	0	1	04	01	H2577_022_0	2		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2577	022	0	1	04	01	H2577_022_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2577	022	0	1	04	01	H2577_022_0	2		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				477.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2577	023	0	1	04	01	H2577_023_0	2		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2577	023	0	1	04	01	H2577_023_0	2		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H2577	023	0	1	04	01	H2577_023_0	2		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2577	023	0	1	04	01	H2577_023_0	2		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H2577	023	0	1	04	01	H2577_023_0	2		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2577	023	0	1	04	01	H2577_023_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2577	023	0	1	04	01	H2577_023_0	2		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				435.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2577	026	0	1	04	01	H2577_026_0	2		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2577	026	0	1	04	01	H2577_026_0	2		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H2577	026	0	1	04	01	H2577_026_0	2		Y	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												
H2577	026	0	1	04	01	H2577_026_0	2		Y	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
H2577	026	0	1	04	01	H2577_026_0	2		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2577	026	0	1	04	01	H2577_026_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2577	026	0	1	04	01	H2577_026_0	2		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				310.00	28																										28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2577	027	0	1	04	01	H2577_027_0	2		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2577	027	0	1	04	01	H2577_027_0	2		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H2577	027	0	1	04	01	H2577_027_0	2		Y	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												
H2577	027	0	1	04	01	H2577_027_0	2		Y	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
H2577	027	0	1	04	01	H2577_027_0	2		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2577	027	0	1	04	01	H2577_027_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2577	027	0	1	04	01	H2577_027_0	2		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				422.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2577	028	0	1	04	01	H2577_028_0	2		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2577	028	0	1	04	01	H2577_028_0	2		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H2577	028	0	1	04	01	H2577_028_0	2		Y	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												
H2577	028	0	1	04	01	H2577_028_0	2		Y	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										1		3
H2577	028	0	1	04	01	H2577_028_0	2		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2577	028	0	1	04	01	H2577_028_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2577	028	0	1	04	01	H2577_028_0	2		Y	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	029	0	1	04	01	H2577_029_0	2		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2577	029	0	1	04	01	H2577_029_0	2		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H2577	029	0	1	04	01	H2577_029_0	2		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2577	029	0	1	04	01	H2577_029_0	2		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H2577	029	0	1	04	01	H2577_029_0	2		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2577	029	0	1	04	01	H2577_029_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2577	029	0	1	04	01	H2577_029_0	2		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				371.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2577	030	0	1	04	01	H2577_030_0	4		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2577	030	0	1	04	01	H2577_030_0	4		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H2577	030	0	1	04	01	H2577_030_0	4		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	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	030	0	1	04	01	H2577_030_0	4		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	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	030	0	1	04	01	H2577_030_0	4		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2577	030	0	1	04	01	H2577_030_0	4		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2577	030	0	1	04	01	H2577_030_0	4		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				445.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2577	031	0	1	04	01	H2577_031_0	4		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2577	031	0	1	04	01	H2577_031_0	4		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H2577	031	0	1	04	01	H2577_031_0	4		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	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												
H2577	031	0	1	04	01	H2577_031_0	4		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	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
H2577	031	0	1	04	01	H2577_031_0	4		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2577	031	0	1	04	01	H2577_031_0	4		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2577	031	0	1	04	01	H2577_031_0	4		Y	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												
H2582	004	0	1	02	01	H2582_004_0	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2582	004	0	1	02	01	H2582_004_0	3		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H2582	004	0	1	02	01	H2582_004_0	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2582	004	0	1	02	01	H2582_004_0	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H2582	004	0	1	02	01	H2582_004_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2582	004	0	1	02	01	H2582_004_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2582	004	0	1	02	01	H2582_004_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				471.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2582	005	0	1	02	01	H2582_005_0	2		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2582	005	0	1	02	01	H2582_005_0	2		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H2582	005	0	1	02	01	H2582_005_0	2		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	8.00		24.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2582	005	0	1	02	01	H2582_005_0	2		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	8.00		24.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H2582	005	0	1	02	01	H2582_005_0	2		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2582	005	0	1	02	01	H2582_005_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2582	005	0	1	02	01	H2582_005_0	2		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				444.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2593	001	0	1	01	01	H2593_001_0	5		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								5.00	10.00	15.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.15	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	001	0	1	01	01	H2593_001_0	5		N	Preferred Generic	4	01	1	2	1	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								5.00	10.00	15.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.15	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H2593	001	0	1	01	01	H2593_001_0	5		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								12.50	25.00	37.50					7.50	15.00	22.50					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	5		N	Generic	4	01	1	2	2	3		111	01	111		1				30	60	90	2	2	30	60	90				30		34								12.50	25.00	37.50					7.50	15.00	22.50					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	5		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								45.00	90.00	135.00					40.00	80.00	120.00					40.00	80.00	80.00																45.00				45.00			1.50	1.33	1.33			1.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	001	0	1	01	01	H2593_001_0	5		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								95.00	190.00	285.00					85.00	170.00	255.00					85.00	170.00	170.00																95.00				95.00			3.17	2.83	2.83			2.79	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	001	0	1	01	01	H2593_001_0	5		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	001	0	1	01	01	H2593_001_0	5		N	Select Care Drugs	4	11	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	001	0	1	01	01	H2593_001_0	5		N	Select Care Drugs	4	11	1	2	6	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	3	
H2593	003	0	1	01	01	H2593_003_0	5		N	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		34	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	003	0	1	01	01	H2593_003_0	5		N	Preferred Generic	4	01	1	2	1	3	111		01	111		1	30	60	90				1	2	30	60	90				30		34	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H2593	003	0	1	01	01	H2593_003_0	5		N	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				2	2	30	60	90				30		34	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	5		N	Generic	4	01	1	2	2	3	111		01	111		1	30	60	90				2	2	30	60	90				30		34	7.50	15.00	22.50																			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	5		N	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				2	2	30	60	90				30		34	40.00	80.00	120.00																			40.00	80.00	80.00																40.00				40.00		1.33			1.33			1.18	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	003	0	1	01	01	H2593_003_0	5		N	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	90				2	2	30	60	90				30		34	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	5		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		34					33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	003	0	1	01	01	H2593_003_0	5		N	Select Care Drugs	4	11	1	2	6	1	111		01	111		1	30	60	100				1	2	30	60	100				30		34	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	003	0	1	01	01	H2593_003_0	5		N	Select Care Drugs	4	11	1	2	6	3	111		01	111		1	30	60	100				1	2	30	60	100				30		34	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	3	
H2593	005	0	1	01	01	H2593_005_0	5		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								5.00	10.00	15.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.15	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	005	0	1	01	01	H2593_005_0	5		N	Preferred Generic	4	01	1	2	1	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								5.00	10.00	15.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.15	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H2593	005	0	1	01	01	H2593_005_0	5		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								12.50	25.00	37.50					7.50	15.00	22.50					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	5		N	Generic	4	01	1	2	2	3		111	01	111		1				30	60	90	2	2	30	60	90				30		34								12.50	25.00	37.50					7.50	15.00	22.50					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	5		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								45.00	90.00	135.00					40.00	80.00	120.00					40.00	80.00	80.00																45.00				45.00			1.50	1.33	1.33			1.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	005	0	1	01	01	H2593_005_0	5		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								95.00	190.00	285.00					85.00	170.00	255.00					85.00	170.00	170.00																95.00				95.00			3.17	2.83	2.83			2.79	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	005	0	1	01	01	H2593_005_0	5		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	005	0	1	01	01	H2593_005_0	5		N	Select Care Drugs	4	11	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	005	0	1	01	01	H2593_005_0	5		N	Select Care Drugs	4	11	1	2	6	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	3	
H2593	006	0	1	01	01	H2593_006_0	5		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								5.00	10.00	15.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.15	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	006	0	1	01	01	H2593_006_0	5		N	Preferred Generic	4	01	1	2	1	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								5.00	10.00	15.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.15	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H2593	006	0	1	01	01	H2593_006_0	5		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								12.50	25.00	37.50					7.50	15.00	22.50					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	5		N	Generic	4	01	1	2	2	3		111	01	111		1				30	60	90	2	2	30	60	90				30		34								12.50	25.00	37.50					7.50	15.00	22.50					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	5		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								45.00	90.00	135.00					40.00	80.00	120.00					40.00	80.00	80.00																45.00				45.00			1.50	1.33	1.33			1.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	006	0	1	01	01	H2593_006_0	5		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								95.00	190.00	285.00					85.00	170.00	255.00					85.00	170.00	170.00																95.00				95.00			3.17	2.83	2.83			2.79	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	006	0	1	01	01	H2593_006_0	5		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	006	0	1	01	01	H2593_006_0	5		N	Select Care Drugs	4	11	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	006	0	1	01	01	H2593_006_0	5		N	Select Care Drugs	4	11	1	2	6	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	3	
H2593	013	0	1	01	01	H2593_013_0	5		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								5.00	10.00	15.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.15	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	013	0	1	01	01	H2593_013_0	5		N	Preferred Generic	4	01	1	2	1	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								5.00	10.00	15.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.15	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H2593	013	0	1	01	01	H2593_013_0	5		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								12.50	25.00	37.50					7.50	15.00	22.50					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	5		N	Generic	4	01	1	2	2	3		111	01	111		1				30	60	90	2	2	30	60	90				30		34								12.50	25.00	37.50					7.50	15.00	22.50					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	5		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								45.00	90.00	135.00					40.00	80.00	120.00					40.00	80.00	80.00																45.00				45.00			1.50	1.33	1.33			1.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	013	0	1	01	01	H2593_013_0	5		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								95.00	190.00	285.00					85.00	170.00	255.00					85.00	170.00	170.00																95.00				95.00			3.17	2.83	2.83			2.79	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	013	0	1	01	01	H2593_013_0	5		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	013	0	1	01	01	H2593_013_0	5		N	Select Care Drugs	4	11	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	013	0	1	01	01	H2593_013_0	5		N	Select Care Drugs	4	11	1	2	6	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	3	
H2593	019	0	1	01	01	H2593_019_0	5		N	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		34	0.00	0.00	0.00																			0.00	0.00	0.00																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	5		N	Preferred Generic	4	01	1	2	1	3	111		01	111		1	30	60	90				1	2	30	60	90				30		34	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H2593	019	0	1	01	01	H2593_019_0	5		N	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				2	2	30	60	90				30		34	7.50	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	5		N	Generic	4	01	1	2	2	3	111		01	111		1	30	60	90				2	2	30	60	90				30		34	7.50	15.00	22.50																			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	5		N	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				2	2	30	60	90				30		34	40.00	80.00	120.00																			40.00	80.00	80.00																40.00				40.00		1.33			1.33			1.18	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	019	0	1	01	01	H2593_019_0	5		N	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	90				2	2	30	60	90				30		34	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	5		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		34					33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	019	0	1	01	01	H2593_019_0	5		N	Select Care Drugs	4	11	1	2	6	1	111		01	111		1	30	60	100				1	2	30	60	100				30		34	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	019	0	1	01	01	H2593_019_0	5		N	Select Care Drugs	4	11	1	2	6	3	111		01	111		1	30	60	100				1	2	30	60	100				30		34	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	3	
H2593	021	0	1	01	01	H2593_021_0	5		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								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	5		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								20.00	40.00	60.00					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	5		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								47.00	94.00	141.00					47.00	94.00	141.00					47.00	141.00	141.00																47.00				47.00			1.57	1.57	1.57			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	021	0	1	01	01	H2593_021_0	5		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	285.00	285.00																100.00				100.00			3.33	3.17	3.17			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	021	0	1	01	01	H2593_021_0	5		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												25							25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	021	0	1	01	01	H2593_021_0	5		N	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								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	8		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								7.00	14.00	21.00					2.00	4.00	6.00					0.00	0.00	0.00																7.00				7.00			0.23	0.07	0.00			0.21	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	022	0	1	01	01	H2593_022_0	8		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								13.00	26.00	39.00					8.00	16.00	24.00					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	8		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								47.00	94.00	141.00					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	8		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	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	8		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	022	0	1	01	01	H2593_022_0	8		N	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	022	0	1	01	01	H2593_022_0	8		N	Select Care Drugs	4	01	1	2	6	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H2593	029	0	1	01	01	H2593_029_0	5		N	Preferred Generic	4	01	3	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								8.00	16.00	24.00					3.00	6.00	9.00					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	5		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								15.00	30.00	45.00					10.00	20.00	30.00					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	5		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00	84.00	84.00																47.00				47.00			1.57	1.40	1.40			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	029	0	1	01	01	H2593_029_0	5		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	190.00	190.00																100.00				100.00			3.33	3.17	3.17			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	029	0	1	01	01	H2593_029_0	5		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	029	0	1	01	01	H2593_029_0	5		N	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	029	0	1	01	01	H2593_029_0	5		N	Select Care Drugs	4	01	1	2	6	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H2593	031	0	1	02	01	H2593_031_0	6		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		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	6		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								12.00	24.00	36.00					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	6		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00	126.00	126.00																47.00				47.00			1.57	1.40	1.40			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	031	0	1	02	01	H2593_031_0	6		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		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	6		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												31							31						31																	31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	031	0	1	02	01	H2593_031_0	6		N	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	031	0	1	02	01	H2593_031_0	6		N	Select Care Drugs	4	01	1	2	6	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H2593	032	0	1	01	01	H2593_032_0	5		N	Preferred Generic	4	01	3	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								15.00	30.00	45.00					15.00	30.00	45.00					15.00	45.00	45.00																15.00				15.00			0.50	0.50	0.50			0.44	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	032	0	1	01	01	H2593_032_0	5		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								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	5		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								47.00	94.00	141.00					47.00	94.00	141.00					47.00	141.00	141.00																47.00				47.00			1.57	1.57	1.57			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	032	0	1	01	01	H2593_032_0	5		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	285.00	285.00																100.00				100.00			3.33	3.17	3.17			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	032	0	1	01	01	H2593_032_0	5		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												25							25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	032	0	1	01	01	H2593_032_0	5		N	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								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	5		Y	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								5.00	10.00	15.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.15	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	037	0	1	01	01	H2593_037_0	5		Y	Preferred Generic	4	01	1	2	1	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								5.00	10.00	15.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.15	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H2593	037	0	1	01	01	H2593_037_0	5		Y	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	5		Y	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	5		Y	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												
H2593	037	0	1	01	01	H2593_037_0	5		Y	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	
H2593	037	0	1	01	01	H2593_037_0	5		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								95.00	190.00	285.00					85.00	170.00	255.00					85.00	170.00	170.00																95.00				95.00			3.17	2.83	2.83			2.79	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	037	0	1	01	01	H2593_037_0	5		Y	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	037	0	1	01	01	H2593_037_0	5		Y	Select Care Drugs	4	11	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	037	0	1	01	01	H2593_037_0	5		Y	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	6		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								5.00	10.00	15.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.15	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	038	0	1	01	01	H2593_038_0	6		N	Preferred Generic	4	01	1	2	1	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								5.00	10.00	15.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				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	6		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								12.50	25.00	37.50					7.50	15.00	22.50					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	6		N	Generic	4	01	1	2	2	3		111	01	111		1				30	60	90	2	2	30	60	90				30		34								12.50	25.00	37.50					7.50	15.00	22.50					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	6		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								45.00	90.00	135.00					40.00	80.00	120.00					40.00	80.00	80.00																45.00				45.00			1.50	1.33	1.33			1.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	038	0	1	01	01	H2593_038_0	6		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								95.00	190.00	285.00					85.00	170.00	255.00					85.00	170.00	170.00																95.00				95.00			3.17	2.83	2.83			2.79	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	038	0	1	01	01	H2593_038_0	6		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	038	0	1	01	01	H2593_038_0	6		N	Select Care Drugs	4	11	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	038	0	1	01	01	H2593_038_0	6		N	Select Care Drugs	4	11	1	2	6	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H2593	039	0	1	01	01	H2593_039_0	5		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								5.00	10.00	15.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.15	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	039	0	1	01	01	H2593_039_0	5		N	Preferred Generic	4	01	1	2	1	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								5.00	10.00	15.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.15	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H2593	039	0	1	01	01	H2593_039_0	5		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								12.50	25.00	37.50					7.50	15.00	22.50					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	5		N	Generic	4	01	1	2	2	3		111	01	111		1				30	60	90	2	2	30	60	90				30		34								12.50	25.00	37.50					7.50	15.00	22.50					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	5		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								45.00	90.00	135.00					40.00	80.00	120.00					40.00	80.00	80.00																45.00				45.00			1.50	1.33	1.33			1.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	039	0	1	01	01	H2593_039_0	5		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								95.00	190.00	285.00					85.00	170.00	255.00					85.00	170.00	170.00																95.00				95.00			3.17	2.83	2.83			2.79	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	039	0	1	01	01	H2593_039_0	5		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	039	0	1	01	01	H2593_039_0	5		N	Select Care Drugs	4	11	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	039	0	1	01	01	H2593_039_0	5		N	Select Care Drugs	4	11	1	2	6	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H2593	040	0	1	01	01	H2593_040_0	6		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								5.00	10.00	15.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.15	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	040	0	1	01	01	H2593_040_0	6		N	Preferred Generic	4	01	1	2	1	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								5.00	10.00	15.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.15	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H2593	040	0	1	01	01	H2593_040_0	6		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								12.50	25.00	37.50					7.50	15.00	22.50					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		N	Generic	4	01	1	2	2	3		111	01	111		1				30	60	90	2	2	30	60	90				30		34								12.50	25.00	37.50					7.50	15.00	22.50					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		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								45.00	90.00	135.00					40.00	80.00	120.00					40.00	80.00	80.00																45.00				45.00			1.50	1.33	1.33			1.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	040	0	1	01	01	H2593_040_0	6		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								95.00	190.00	285.00					85.00	170.00	255.00					85.00	170.00	170.00																95.00				95.00			3.17	2.83	2.83			2.79	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	040	0	1	01	01	H2593_040_0	6		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	040	0	1	01	01	H2593_040_0	6		N	Select Care Drugs	4	11	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	040	0	1	01	01	H2593_040_0	6		N	Select Care Drugs	4	11	1	2	6	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	3	
H2593	041	0	1	01	01	H2593_041_0	5		Y	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								5.00	10.00	15.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.15	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	041	0	1	01	01	H2593_041_0	5		Y	Preferred Generic	4	01	1	2	1	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								5.00	10.00	15.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.15	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H2593	041	0	1	01	01	H2593_041_0	5		Y	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	5		Y	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	5		Y	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												
H2593	041	0	1	01	01	H2593_041_0	5		Y	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	
H2593	041	0	1	01	01	H2593_041_0	5		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								95.00	190.00	285.00					85.00	170.00	255.00					85.00	170.00	170.00																95.00				95.00			3.17	2.83	2.83			2.79	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	041	0	1	01	01	H2593_041_0	5		Y	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	041	0	1	01	01	H2593_041_0	5		Y	Select Care Drugs	4	11	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	041	0	1	01	01	H2593_041_0	5		Y	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	5		N	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		34	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	042	0	1	01	01	H2593_042_0	5		N	Preferred Generic	4	01	1	2	1	3	111		01	111		1	30	60	90				1	2	30	60	90				30		34	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H2593	042	0	1	01	01	H2593_042_0	5		N	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				2	2	30	60	90				30		34	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	5		N	Generic	4	01	1	2	2	3	111		01	111		1	30	60	90				2	2	30	60	90				30		34	7.50	15.00	22.50																			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	5		N	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				2	2	30	60	90				30		34	40.00	80.00	120.00																			40.00	80.00	80.00																40.00				40.00		1.33			1.33			1.18	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	042	0	1	01	01	H2593_042_0	5		N	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	90				2	2	30	60	90				30		34	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	5		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		34					33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	042	0	1	01	01	H2593_042_0	5		N	Select Care Drugs	4	11	1	2	6	1	111		01	111		1	30	60	100				1	2	30	60	100				30		34	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	042	0	1	01	01	H2593_042_0	5		N	Select Care Drugs	4	11	1	2	6	3	111		01	111		1	30	60	100				1	2	30	60	100				30		34	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	3	
H2593	043	0	1	01	01	H2593_043_0	6		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		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	6		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								17.00	34.00	51.00					12.00	24.00	36.00					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	6		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00	126.00	126.00																47.00				47.00			1.57	1.40	1.40			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	043	0	1	01	01	H2593_043_0	6		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	285.00	285.00																100.00				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	6		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	043	0	1	01	01	H2593_043_0	6		N	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	043	0	1	01	01	H2593_043_0	6		N	Select Care Drugs	4	01	1	2	6	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H2610	005	0	1	01	01	H2610_005_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	005	0	1	01	01	H2610_005_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	005	0	1	01	01	H2610_005_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	005	0	1	01	01	H2610_005_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	005	0	1	01	01	H2610_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 Brand, Specialty Tier, Select Diabetic Drugs												
H2610	005	0	1	01	01	H2610_005_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	006	0	1	01	01	H2610_006_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	006	0	1	01	01	H2610_006_0	5			Preferred Generic	4	01	1	2	1	3		111	01	100		1				30	60	90	1	2			90				30		31								4.00	8.00	12.00					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	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	006	0	1	01	01	H2610_006_0	5			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	5			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	5			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	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 Diabetic Drugs												
H2610	006	0	1	01	01	H2610_006_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	5			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	5			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	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	011	0	1	01	01	H2610_011_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					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	5			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	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 Diabetic Drugs												
H2610	011	0	1	01	01	H2610_011_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	015	0	1	01	01	H2610_015_0	5		N	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	5		N	Generic	4	01	3	2	2	1		111	01	100		1				30	60	90	1	2			90				30		31								10.00	20.00	30.00					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	5		N	Preferred Brand	4	10	1	2	3	1		111	01	100		1				30	60	90	1	2			90				30		31								47.00	94.00	141.00					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	5		N	Non-Preferred Brand	4	10	1	2	4	1		111	01	100		1				30	60	90	1	2			90				30		31								100.00	200.00	300.00					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	5		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs												
H2610	015	0	1	01	01	H2610_015_0	5		N	Select Diabetic Drugs	4	11	1	2	6	1		111	01	100		1				30	60	90	1	2			90				30		31								0.00	0.00	0.00					0.00	0.00	0.00							0.00																0.00				0.00			0.00	0.00				0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs												
H2610	016	0	1	01	01	H2610_016_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	016	0	1	01	01	H2610_016_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	016	0	1	01	01	H2610_016_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	016	0	1	01	01	H2610_016_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	016	0	1	01	01	H2610_016_0	5			Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs												
H2610	016	0	1	01	01	H2610_016_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	019	0	1	01	01	H2610_019_0	6		Y	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												
H2610	019	0	1	01	01	H2610_019_0	6		Y	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							0.00																10.00				10.00			0.33	0.17				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2610	019	0	1	01	01	H2610_019_0	6		Y	Preferred Brand	4	10	1	2	3	1		111	01	100		1				30	60	90	1	2			90				30		31								47.00	94.00	141.00					45.00	90.00	135.00							112.50																47.00				47.00			1.57	1.50				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2610	019	0	1	01	01	H2610_019_0	6		Y	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												
H2610	019	0	1	01	01	H2610_019_0	6		Y	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2610	020	0	1	01	01	H2610_020_0	6		Y	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					2.00	4.00	6.00							0.00																7.00				7.00			0.23	0.07				0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2610	020	0	1	01	01	H2610_020_0	6		Y	Generic	4	01	3	2	2	1		111	01	100		1				30	60	90	1	2			90				30		31								14.00	28.00	42.00					9.00	18.00	27.00							0.00																14.00				14.00			0.47	0.30				0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2610	020	0	1	01	01	H2610_020_0	6		Y	Preferred Brand	4	10	1	2	3	1		111	01	100		1				30	60	90	1	2			90				30		31								47.00	94.00	141.00					45.00	90.00	135.00							112.50																47.00				47.00			1.57	1.50				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2610	020	0	1	01	01	H2610_020_0	6		Y	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												
H2610	020	0	1	01	01	H2610_020_0	6		Y	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2610	021	0	1	01	01	H2610_021_0	6		Y	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												
H2610	021	0	1	01	01	H2610_021_0	6		Y	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							0.00																10.00				10.00			0.33	0.17				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2610	021	0	1	01	01	H2610_021_0	6		Y	Preferred Brand	4	10	1	2	3	1		111	01	100		1				30	60	90	1	2			90				30		31								47.00	94.00	141.00					45.00	90.00	135.00							112.50																47.00				47.00			1.57	1.50				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2610	021	0	1	01	01	H2610_021_0	6		Y	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												
H2610	021	0	1	01	01	H2610_021_0	6		Y	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2610	022	0	1	01	01	H2610_022_0	6		Y	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					2.00	4.00	6.00							0.00																7.00				7.00			0.23	0.07				0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2610	022	0	1	01	01	H2610_022_0	6		Y	Generic	4	01	3	2	2	1		111	01	100		1				30	60	90	1	2			90				30		31								14.00	28.00	42.00					9.00	18.00	27.00							0.00																14.00				14.00			0.47	0.30				0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2610	022	0	1	01	01	H2610_022_0	6		Y	Preferred Brand	4	10	1	2	3	1		111	01	100		1				30	60	90	1	2			90				30		31								47.00	94.00	141.00					45.00	90.00	135.00							112.50																47.00				47.00			1.57	1.50				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2610	022	0	1	01	01	H2610_022_0	6		Y	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												
H2610	022	0	1	01	01	H2610_022_0	6		Y	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2610	023	0	1	01	01	H2610_023_0	6		Y	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												
H2610	023	0	1	01	01	H2610_023_0	6		Y	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							0.00																10.00				10.00			0.33	0.17				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2610	023	0	1	01	01	H2610_023_0	6		Y	Preferred Brand	4	10	1	2	3	1		111	01	100		1				30	60	90	1	2			90				30		31								47.00	94.00	141.00					40.00	80.00	120.00							100.00																47.00				47.00			1.57	1.33				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2610	023	0	1	01	01	H2610_023_0	6		Y	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												
H2610	023	0	1	01	01	H2610_023_0	6		Y	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2610	024	0	1	01	01	H2610_024_0	6		Y	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					2.00	4.00	6.00							5.00																7.00				7.00			0.23	0.07				0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2610	024	0	1	01	01	H2610_024_0	6		Y	Generic	4	01	3	2	2	1		111	01	100		1				30	60	90	1	2			90				30		31								14.00	28.00	42.00					9.00	18.00	27.00							22.50																14.00				14.00			0.47	0.30				0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2610	024	0	1	01	01	H2610_024_0	6		Y	Preferred Brand	4	10	1	2	3	1		111	01	100		1				30	60	90	1	2			90				30		31								47.00	94.00	141.00					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												
H2610	024	0	1	01	01	H2610_024_0	6		Y	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												
H2610	024	0	1	01	01	H2610_024_0	6		Y	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2624	001	0	1	01	01	H2624_001_0	8		Y	Preferred Generic	4	01	1	2	1	1	111		10	111		1	30	60	90				1	1	30	60	90					29	31	0.00	0.00	0.00																			0.00	0.00	0.00																	0.00			0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2624	001	0	1	01	01	H2624_001_0	8		Y	Preferred Generic	4	01	1	2	1	3	111		10	111		1	30	60	90				1	1	30	60	90					29	31	0.00	0.00	0.00																			0.00	0.00	0.00																	0.00			0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H2624	001	0	1	01	01	H2624_001_0	8		Y	Generic	4	11	1	2	2	1	111		10	111		1	30	60	90				1	1	30	60	90					29	31	15.00	30.00	30.00																			15.00	30.00	30.00																	15.00			15.00		0.50			0.50			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2624	001	0	1	01	01	H2624_001_0	8		Y	Preferred Brand	4	11	1	2	3	1	111		10	111		1	30	60	90				1	1	30	60	90					29	31	45.00	90.00	90.00																			45.00	90.00	90.00																	45.00			45.00		1.50			1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2624	001	0	1	01	01	H2624_001_0	8		Y	Non-Preferred Drug	4	11	1	2	4	1	111		10	111		1	30	60	90				1	1	30	60	90					29	31	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	8		Y	Specialty Tier	4	11	1	1	5	1	111		10	111		1	30	60	90				1	1	30	60	90					29	31				989.73	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	8		Y	Select Care Drugs	4	11	1	2	6	1	111		10	111		1	30	60	90				1	1	30	60	90					29	31	0.00	0.00	0.00																			0.00	0.00	0.00																	0.00			0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2624	001	0	1	01	01	H2624_001_0	8		Y	Select Care Drugs	4	11	1	2	6	3	111		10	111		1	30	60	90				1	1	30	60	90					29	31	0.00	0.00	0.00																			0.00	0.00	0.00																	0.00			0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	3	
H2663	002	0	1	01	01	H2663_002_0	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											823.68	33						514.35	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2663	005	0	1	01	01	H2663_005_0	2			Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					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	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H2663	005	0	1	01	01	H2663_005_0	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	005	0	1	01	01	H2663_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		
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					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					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	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					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					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	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											914.74	33						538.95	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2663	006	0	1	02	01	H2663_006_0	3			Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					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	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	006	0	1	02	01	H2663_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												
H2663	006	0	1	02	01	H2663_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		
H2663	006	0	1	02	01	H2663_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												
H2663	006	0	1	02	01	H2663_006_0	3			Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					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	3			Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											887.07	33						541.00	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2663	017	0	1	01	01	H2663_017_0	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												
H2663	017	0	1	01	01	H2663_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								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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	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												
H2663	017	0	1	01	01	H2663_017_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		
H2663	017	0	1	01	01	H2663_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												
H2663	017	0	1	01	01	H2663_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												
H2663	017	0	1	01	01	H2663_017_0	4			Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											816.71	33						633.73	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											792.58	33						999.37	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											877.06	33						780.81	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											841.66	33						717.61	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											1027.54	33						515.62	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											990.04	33						643.33	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											1051.78	33						641.42	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2663	034	0	1	01	01	H2663_034_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	034	0	1	01	01	H2663_034_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	034	0	1	01	01	H2663_034_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	034	0	1	01	01	H2663_034_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	034	0	1	01	01	H2663_034_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	034	0	1	01	01	H2663_034_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	034	0	1	01	01	H2663_034_0	2			Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											811.65	30						468.67	30												30						30						30		30								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											936.00	33						551.64	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											956.09	33						546.63	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											977.46	33						554.07	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2663	041	0	1	01	01	H2663_041_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	041	0	1	01	01	H2663_041_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	041	0	1	01	01	H2663_041_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	041	0	1	01	01	H2663_041_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	041	0	1	01	01	H2663_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					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					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	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	041	0	1	01	01	H2663_041_0	3			Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											985.77	33						548.07	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											959.92	33						547.48	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2663	043	0	1	01	01	H2663_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								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	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	043	0	1	01	01	H2663_043_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	043	0	1	01	01	H2663_043_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	043	0	1	01	01	H2663_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												
H2663	043	0	1	01	01	H2663_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												
H2663	043	0	1	01	01	H2663_043_0	2			Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											958.70	33						547.46	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2686	001	0	1	04	01	H2686_001_0	9		Y	Preferred Generic	4	11	1	2	1	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2686	001	0	1	04	01	H2686_001_0	9		Y	Preferred Generic	4	11	1	2	1	3	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H2686	001	0	1	04	01	H2686_001_0	9		Y	Generic	4	11	3	2	2	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2686	001	0	1	04	01	H2686_001_0	9		Y	Generic	4	11	3	2	2	3	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	3
H2686	001	0	1	04	01	H2686_001_0	9		Y	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	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												
H2686	001	0	1	04	01	H2686_001_0	9		Y	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	100.00	200.00	300.00																			100.00	200.00	300.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2686	001	0	1	04	01	H2686_001_0	9		Y	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												
H2686	002	0	1	04	01	H2686_002_0	9		Y	Preferred Generic	4	11	1	2	1	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2686	002	0	1	04	01	H2686_002_0	9		Y	Preferred Generic	4	11	1	2	1	3	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H2686	002	0	1	04	01	H2686_002_0	9		Y	Generic	4	11	3	2	2	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2686	002	0	1	04	01	H2686_002_0	9		Y	Generic	4	11	3	2	2	3	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	3
H2686	002	0	1	04	01	H2686_002_0	9		Y	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	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												
H2686	002	0	1	04	01	H2686_002_0	9		Y	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	100.00	200.00	300.00																			100.00	200.00	300.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2686	002	0	1	04	01	H2686_002_0	9		Y	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												
H2694	001	0	1	04	01	H2694_001_0	7		Y	Preferred Generic	4	01	1	2	1	1	110		01	110		1	30		100				2	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												
H2694	001	0	1	04	01	H2694_001_0	7		Y	Generic	4	01	1	2	2	1	110		01	110		1	30		100				2	2	30		100				30		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	7		Y	Preferred Brand	4	11	1	2	3	1	110		01	110		1	30		100				2	2	30		100				30		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	7		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01	110		1	30		100				2	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												
H2694	001	0	1	04	01	H2694_001_0	7		Y	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				100.00	30																				30																	30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2694	002	0	1	04	01	H2694_002_0	7			Preferred Generic	4	01	1	2	1	1	110		01	110		1	30		100				2	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												
H2694	002	0	1	04	01	H2694_002_0	7			Generic	4	01	1	2	2	1	110		01	110		1	30		100				2	2	30		100				30		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	002	0	1	04	01	H2694_002_0	7			Preferred Brand	4	11	1	2	3	1	110		01	110		1	30		100				2	2	30		100				30		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	002	0	1	04	01	H2694_002_0	7			Non-Preferred Drug	4	11	1	2	4	1	110		01	110		1	30		100				2	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												
H2694	002	0	1	04	01	H2694_002_0	7			Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				100.00	28																				28																	28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2697	001	0	1	01	01	H2697_001_0	10		Y	Preferred Generic	4	11	1	2	1	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2697	001	0	1	01	01	H2697_001_0	10		Y	Preferred Generic	4	11	1	2	1	3	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H2697	001	0	1	01	01	H2697_001_0	10		Y	Generic	4	11	3	2	2	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2697	001	0	1	01	01	H2697_001_0	10		Y	Generic	4	11	3	2	2	3	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	3
H2697	001	0	1	01	01	H2697_001_0	10		Y	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	42.00	84.00	126.00																			42.00	84.00	105.00																42.00				42.00		1.40			1.40			1.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2697	001	0	1	01	01	H2697_001_0	10		Y	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	95.00	190.00	285.00																			95.00	190.00	285.00																95.00				95.00		3.17			3.17			3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2697	001	0	1	01	01	H2697_001_0	10		Y	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												
H2697	002	0	1	01	01	H2697_002_0	10		Y	Preferred Generic	4	11	1	2	1	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2697	002	0	1	01	01	H2697_002_0	10		Y	Preferred Generic	4	11	1	2	1	3	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H2697	002	0	1	01	01	H2697_002_0	10		Y	Generic	4	11	3	2	2	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2697	002	0	1	01	01	H2697_002_0	10		Y	Generic	4	11	3	2	2	3	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	3
H2697	002	0	1	01	01	H2697_002_0	10		Y	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	42.00	84.00	126.00																			42.00	84.00	105.00																42.00				42.00		1.40			1.40			1.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2697	002	0	1	01	01	H2697_002_0	10		Y	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	95.00	190.00	285.00																			95.00	190.00	285.00																95.00				95.00		3.17			3.17			3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2697	002	0	1	01	01	H2697_002_0	10		Y	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												
H2697	003	0	1	01	01	H2697_003_0	11		N	Preferred Generic	4	11	1	2	1	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2697	003	0	1	01	01	H2697_003_0	11		N	Preferred Generic	4	11	1	2	1	3	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H2697	003	0	1	01	01	H2697_003_0	11		N	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	11		N	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	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										2	2	2
H2697	003	0	1	01	01	H2697_003_0	11		N	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	47.00	94.00	141.00																			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	11		N	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	100.00	200.00	300.00																			100.00	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	11		N	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												
H2697	004	0	1	01	01	H2697_004_0	10		Y	Preferred Generic	4	11	1	2	1	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2697	004	0	1	01	01	H2697_004_0	10		Y	Preferred Generic	4	11	1	2	1	3	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H2697	004	0	1	01	01	H2697_004_0	10		Y	Generic	4	11	3	2	2	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2697	004	0	1	01	01	H2697_004_0	10		Y	Generic	4	11	3	2	2	3	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	3
H2697	004	0	1	01	01	H2697_004_0	10		Y	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	42.00	84.00	126.00																			42.00	84.00	105.00																42.00				42.00		1.40			1.40			1.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2697	004	0	1	01	01	H2697_004_0	10		Y	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	95.00	190.00	285.00																			95.00	190.00	285.00																95.00				95.00		3.17			3.17			3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2697	004	0	1	01	01	H2697_004_0	10		Y	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												
H2697	005	0	1	01	01	H2697_005_0	10		Y	Preferred Generic	4	11	1	2	1	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2697	005	0	1	01	01	H2697_005_0	10		Y	Preferred Generic	4	11	1	2	1	3	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H2697	005	0	1	01	01	H2697_005_0	10		Y	Generic	4	11	3	2	2	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2697	005	0	1	01	01	H2697_005_0	10		Y	Generic	4	11	3	2	2	3	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	3
H2697	005	0	1	01	01	H2697_005_0	10		Y	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	42.00	84.00	126.00																			42.00	84.00	105.00																42.00				42.00		1.40			1.40			1.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2697	005	0	1	01	01	H2697_005_0	10		Y	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	95.00	190.00	285.00																			95.00	190.00	285.00																95.00				95.00		3.17			3.17			3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2697	005	0	1	01	01	H2697_005_0	10		Y	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												
H2697	006	0	1	01	01	H2697_006_0	11		N	Preferred Generic	4	11	1	2	1	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2697	006	0	1	01	01	H2697_006_0	11		N	Preferred Generic	4	11	1	2	1	3	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H2697	006	0	1	01	01	H2697_006_0	11		N	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	006	0	1	01	01	H2697_006_0	11		N	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	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										2	2	2
H2697	006	0	1	01	01	H2697_006_0	11		N	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	47.00	94.00	141.00																			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	006	0	1	01	01	H2697_006_0	11		N	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	100.00	200.00	300.00																			100.00	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	006	0	1	01	01	H2697_006_0	11		N	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												
H2697	007	0	1	01	01	H2697_007_0	10		Y	Preferred Generic	4	11	1	2	1	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2697	007	0	1	01	01	H2697_007_0	10		Y	Preferred Generic	4	11	1	2	1	3	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H2697	007	0	1	01	01	H2697_007_0	10		Y	Generic	4	11	3	2	2	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2697	007	0	1	01	01	H2697_007_0	10		Y	Generic	4	11	3	2	2	3	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	3
H2697	007	0	1	01	01	H2697_007_0	10		Y	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	42.00	84.00	126.00																			42.00	84.00	105.00																42.00				42.00		1.40			1.40			1.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2697	007	0	1	01	01	H2697_007_0	10		Y	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	95.00	190.00	285.00																			95.00	190.00	285.00																95.00				95.00		3.17			3.17			3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2697	007	0	1	01	01	H2697_007_0	10		Y	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												
H2697	008	0	1	01	01	H2697_008_0	10		Y	Preferred Generic	4	11	1	2	1	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2697	008	0	1	01	01	H2697_008_0	10		Y	Preferred Generic	4	11	1	2	1	3	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H2697	008	0	1	01	01	H2697_008_0	10		Y	Generic	4	11	3	2	2	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2697	008	0	1	01	01	H2697_008_0	10		Y	Generic	4	11	3	2	2	3	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	3
H2697	008	0	1	01	01	H2697_008_0	10		Y	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	42.00	84.00	126.00																			42.00	84.00	105.00																42.00				42.00		1.40			1.40			1.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2697	008	0	1	01	01	H2697_008_0	10		Y	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	95.00	190.00	285.00																			95.00	190.00	285.00																95.00				95.00		3.17			3.17			3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2697	008	0	1	01	01	H2697_008_0	10		Y	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												
H2697	009	0	1	01	01	H2697_009_0	11		N	Preferred Generic	4	11	1	2	1	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2697	009	0	1	01	01	H2697_009_0	11		N	Preferred Generic	4	11	1	2	1	3	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H2697	009	0	1	01	01	H2697_009_0	11		N	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	009	0	1	01	01	H2697_009_0	11		N	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	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										2	2	2
H2697	009	0	1	01	01	H2697_009_0	11		N	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	47.00	94.00	141.00																			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	009	0	1	01	01	H2697_009_0	11		N	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	100.00	200.00	300.00																			100.00	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	009	0	1	01	01	H2697_009_0	11		N	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												
H2697	010	0	1	01	01	H2697_010_0	10		N	Preferred Generic	4	11	1	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												
H2697	010	0	1	01	01	H2697_010_0	10		N	Generic	4	11	3	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												
H2697	010	0	1	01	01	H2697_010_0	10		N	Generic	4	11	3	2	2	3	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	2	2
H2697	010	0	1	01	01	H2697_010_0	10		N	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												
H2697	010	0	1	01	01	H2697_010_0	10		N	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												
H2697	010	0	1	01	01	H2697_010_0	10		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31					25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2697	011	0	1	01	01	H2697_011_0	11		N	Preferred Generic	4	11	1	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												
H2697	011	0	1	01	01	H2697_011_0	11		N	Generic	4	11	3	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												
H2697	011	0	1	01	01	H2697_011_0	11		N	Generic	4	11	3	2	2	3	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	2	2
H2697	011	0	1	01	01	H2697_011_0	11		N	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												
H2697	011	0	1	01	01	H2697_011_0	11		N	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												
H2697	011	0	1	01	01	H2697_011_0	11		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31					25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2715	001	0	1	01	01	H2715_001_0	7		Y	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												
H2715	001	0	1	01	01	H2715_001_0	7		Y	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												
H2715	001	0	1	01	01	H2715_001_0	7		Y	Preferred Brand	4	11	1	2	3	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31	47.00	94.00	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												
H2715	001	0	1	01	01	H2715_001_0	7		Y	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												
H2715	001	0	1	01	01	H2715_001_0	7		Y	Specialty Tier	4	11	1	1	5	1	010		01	010		1	31								31						31		31				818.18	31																				31																	31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2715	001	0	1	01	01	H2715_001_0	7		Y	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												
H2722	002	0	1	02	01	H2722_002_0	10		Y	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	10		Y	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	10		Y	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	10		Y	Preferred Brand	4	10	1	2	3	1		110	01		100	1				31		100	1	2						100	31		31								47.00		141.00					47.00		141.00													141.00						141.00				47.00				47.00			1.52	1.52				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2722	002	0	1	02	01	H2722_002_0	10		Y	Non-Preferred Brand	4	10	1	2	4	1		110	01		100	1				31		100	1	2						100	31		31								100.00		300.00					100.00		300.00													300.00						300.00				100.00				100.00			3.23	3.23				3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2722	002	0	1	02	01	H2722_002_0	10		Y	Specialty Tier	4	10	1	1	5	1		010	01		010	1				31								31			31		31											1387.46	25						647.34	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2722	004	0	1	02	01	H2722_004_0	10		Y	Preferred Generic	4	01	1	2	1	1		110	01		110	1				31		100	1	2				31		100	31		31								5.00		15.00					0.00		0.00											5.00		15.00				0.00		0.00				5.00				5.00			0.16	0.00		0.16	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2722	004	0	1	02	01	H2722_004_0	10		Y	Preferred Generic	4	01	1	2	1	3		110	01		110	1				31		100	1	2				31		100	31		31								5.00		15.00					0.00		0.00											5.00		15.00				0.00		0.00				5.00				5.00			0.16	0.00		0.16	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H2722	004	0	1	02	01	H2722_004_0	10		Y	Generic	4	01	1	2	2	1		110	01		100	1				31		100	1	2						100	31		31								14.00		42.00					14.00		42.00													42.00						42.00				14.00				14.00			0.45	0.45				0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2722	004	0	1	02	01	H2722_004_0	10		Y	Preferred Brand	4	10	1	2	3	1		110	01		100	1				31		100	1	2						100	31		31								47.00		141.00					47.00		141.00													141.00						141.00				47.00				47.00			1.52	1.52				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2722	004	0	1	02	01	H2722_004_0	10		Y	Non-Preferred Brand	4	10	1	2	4	1		110	01		100	1				31		100	1	2						100	31		31								100.00		300.00					100.00		300.00													300.00						300.00				100.00				100.00			3.23	3.23				3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2722	004	0	1	02	01	H2722_004_0	10		Y	Specialty Tier	4	10	1	1	5	1		010	01		010	1				31								31			31		31											1337.42	25						675.07	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2722	005	0	1	02	01	H2722_005_0	10		Y	Preferred Generic	4	01	1	2	1	1		110	01		110	1				31		100	1	2				31		100	31		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.32	0.00		0.32	0.00	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2722	005	0	1	02	01	H2722_005_0	10		Y	Preferred Generic	4	01	1	2	1	3		110	01		110	1				31		100	1	2				31		100	31		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.32	0.00		0.32	0.00	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H2722	005	0	1	02	01	H2722_005_0	10		Y	Generic	4	01	1	2	2	1		110	01		100	1				31		100	1	2						100	31		31								20.00		60.00					20.00		60.00													60.00						60.00				20.00				20.00			0.65	0.65				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2722	005	0	1	02	01	H2722_005_0	10		Y	Preferred Brand	4	10	1	2	3	1		110	01		100	1				31		100	1	2						100	31		31								47.00		141.00					47.00		141.00													141.00						141.00				47.00				47.00			1.52	1.52				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2722	005	0	1	02	01	H2722_005_0	10		Y	Non-Preferred Brand	4	10	1	2	4	1		110	01		100	1				31		100	1	2						100	31		31								100.00		300.00					100.00		300.00													300.00						300.00				100.00				100.00			3.23	3.23				3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2722	005	0	1	02	01	H2722_005_0	10		Y	Specialty Tier	4	10	1	1	5	1		010	01		010	1				31								31			31		31											1156.96	25						596.29	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2737	001	0	1	04	01	H2737_001_0	4		Y	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					0.00	0.00	0.00							8.00																4.00				4.00			0.13	0.00				0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2737	001	0	1	04	01	H2737_001_0	4		Y	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					5.00	10.00	15.00							20.00																10.00				10.00			0.33	0.17				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2737	001	0	1	04	01	H2737_001_0	4		Y	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					40.00	80.00	120.00							90.00																45.00				45.00			1.50	1.33				1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2737	001	0	1	04	01	H2737_001_0	4		Y	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					90.00	180.00	270.00							285.00																95.00				95.00			3.17	3.00				3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2737	001	0	1	04	01	H2737_001_0	4		Y	Specialty Tier	4	11	1	1	5	1		010	01			1				30											30		31											1.00	26						1.00	26																							26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2737	002	0	1	04	01	H2737_002_0	4		Y	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					0.00	0.00	0.00							8.00																4.00				4.00			0.13	0.00				0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2737	002	0	1	04	01	H2737_002_0	4		Y	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					5.00	10.00	15.00							20.00																10.00				10.00			0.33	0.17				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2737	002	0	1	04	01	H2737_002_0	4		Y	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					40.00	80.00	120.00							90.00																45.00				45.00			1.50	1.33				1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2737	002	0	1	04	01	H2737_002_0	4		Y	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					90.00	180.00	270.00							285.00																95.00				95.00			3.17	3.00				3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2737	002	0	1	04	01	H2737_002_0	4		Y	Specialty Tier	4	11	1	1	5	1		010	01			1				30											30		31											1.00	28						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		Y	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												
H2752	001	0	1	01	01	H2752_001_0	4		Y	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										1		3
H2752	001	0	1	01	01	H2752_001_0	4		Y	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								15.00	30.00	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												
H2752	001	0	1	01	01	H2752_001_0	4		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2752	001	0	1	01	01	H2752_001_0	4		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								100.00	200.00	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												
H2752	001	0	1	01	01	H2752_001_0	4		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											754.06	33						763.73	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	10.00																			4.00	8.00	10.00																4.00				4.00		0.13			0.13			0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, 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	25.00																			10.00	20.00	25.00																10.00				10.00		0.33			0.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, 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	113.00																			45.00	90.00	113.00																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	250.00																			100.00	200.00	250.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, 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	24																				24																	24			24								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				280.00	29																				29																	29			29								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	11	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	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	10.00																			4.00	8.00	10.00																4.00				4.00		0.13			0.13			0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Preferred Specialty Tier, Specialty Tier, Vaccines												
H2765	003	0	1	02	01	H2765_003_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	25.00																			10.00	20.00	25.00																10.00				10.00		0.33			0.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Preferred Specialty Tier, Specialty Tier, Vaccines												
H2765	003	0	1	02	01	H2765_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	45.00	90.00	113.00																			45.00	90.00	113.00																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	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	250.00																			100.00	200.00	250.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Preferred Specialty Tier, Specialty Tier, Vaccines												
H2765	003	0	1	02	01	H2765_003_0	8			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	003	0	1	02	01	H2765_003_0	8			Specialty Tier	4	11	1	1	6	1	010		01	010		1	30								30						30		31				280.00	30																				30																	30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Preferred Specialty Tier, Specialty Tier, Vaccines												
H2765	003	0	1	02	01	H2765_003_0	8			Vaccines	4	11	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	10.00																			4.00	8.00	10.00																4.00				4.00		0.13			0.13			0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, 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	25.00																			10.00	20.00	25.00																10.00				10.00		0.33			0.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, 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	113.00																			45.00	90.00	113.00																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	250.00																			100.00	200.00	250.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, 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				280.00	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	11	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	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												
H2775	105	0	1	04	01	H2775_105_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												
H2775	105	0	1	04	01	H2775_105_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												
H2775	105	0	1	04	01	H2775_105_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											85.76	45	45	45				81.95	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	4			Specialty Tier	4	11	1	1	5	1		010	01		010	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	4			Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			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	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												
H2775	106	0	1	04	01	H2775_106_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												
H2775	106	0	1	04	01	H2775_106_0	4			Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											47.00	94.00	141.00				37.00	74.00	74.00				47.00				47.00			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	4			Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											86.17	50	50	50				82.73	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	106	0	1	04	01	H2775_106_0	4			Specialty Tier	4	11	1	1	5	1		010	01		010	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	4			Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			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	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	
H2775	109	0	1	04	01	H2775_109_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												
H2775	109	0	1	04	01	H2775_109_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					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, Select Care Drugs												
H2775	109	0	1	04	01	H2775_109_0	4			Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											47.00	94.00	141.00				37.00	74.00	74.00				47.00				47.00			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	4			Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											74.35	47	47	47				71.19	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	4			Specialty Tier	4	11	1	1	5	1		010	01		010	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	4			Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			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	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												
H2775	111	0	1	04	01	H2775_111_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												
H2775	111	0	1	04	01	H2775_111_0	4			Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											47.00	94.00	141.00				37.00	74.00	74.00				47.00				47.00			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	4			Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											89.60	50	50	50				86.01	48	48	48										50	50	50				48	48	48			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2775	111	0	1	04	01	H2775_111_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												
H2775	111	0	1	04	01	H2775_111_0	4			Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			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	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	
H2775	113	0	1	04	01	H2775_113_0	4			Preferred Generic	4	11	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								19.00	38.00	57.00					0.00	0.00	0.00											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												
H2775	113	0	1	04	01	H2775_113_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	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												
H2775	113	0	1	04	01	H2775_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					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, Select Care Drugs												
H2775	113	0	1	04	01	H2775_113_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											98.94	46	46	46				98.94	46	46	46										46	46	46				46	46	46			46			46								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2775	113	0	1	04	01	H2775_113_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												
H2775	113	0	1	04	01	H2775_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												
H2775	114	0	1	04	01	H2775_114_0	4			Preferred Generic	4	11	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								19.00	38.00	57.00					0.00	0.00	0.00											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												
H2775	114	0	1	04	01	H2775_114_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	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												
H2775	114	0	1	04	01	H2775_114_0	4			Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	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, Select Care Drugs												
H2775	114	0	1	04	01	H2775_114_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	45	45	45				99.03	45	45	45										45	45	45				45	45	45			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2775	114	0	1	04	01	H2775_114_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												
H2775	114	0	1	04	01	H2775_114_0	4			Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			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	13		Y	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			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	13		Y	Preferred Generic	4	01	1	2	1	3		111	01	111		1				30	60	90	1	2	30	60	90				30		31								5.00	10.00	15.00					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	13		Y	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								10.00	20.00	30.00					5.00	10.00	15.00					10.00	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	13		Y	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					40.00	80.00	120.00					47.00	94.00	117.50																47.00				47.00			1.57	1.33	1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H2782	002	0	1	01	01	H2782_002_0	13		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	300.00					100.00	200.00	300.00					100.00	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	13		Y	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H2782	002	0	1	01	01	H2782_002_0	13		Y	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	13		Y	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	14		Y	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			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	14		Y	Preferred Generic	4	01	1	2	1	3		111	01	111		1				30	60	90	1	2	30	60	90				30		31								5.00	10.00	15.00					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	003	0	1	01	01	H2782_003_0	14		Y	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								10.00	20.00	30.00					5.00	10.00	15.00					10.00	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	14		Y	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								45.00	90.00	135.00					35.00	70.00	105.00					45.00	90.00	112.50																45.00				45.00			1.50	1.16	1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H2782	003	0	1	01	01	H2782_003_0	14		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	300.00					90.00	180.00	270.00					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	14		Y	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H2782	003	0	1	01	01	H2782_003_0	14		Y	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	14		Y	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	004	0	1	01	01	H2782_004_0	14		Y	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	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	004	0	1	01	01	H2782_004_0	14		Y	Preferred Generic	4	01	1	2	1	3		111	01	111		1				30	60	90	1	2	30	60	90				30		31								5.00	10.00	15.00					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	004	0	1	01	01	H2782_004_0	14		Y	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								10.00	20.00	30.00					5.00	10.00	15.00					10.00	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	004	0	1	01	01	H2782_004_0	14		Y	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					40.00	80.00	120.00					47.00	94.00	117.50																47.00				47.00			1.57	1.33	1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H2782	004	0	1	01	01	H2782_004_0	14		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	300.00					100.00	200.00	300.00					100.00	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	004	0	1	01	01	H2782_004_0	14		Y	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H2782	004	0	1	01	01	H2782_004_0	14		Y	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	004	0	1	01	01	H2782_004_0	14		Y	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		Y	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												
H2793	003	0	1	01	01	H2793_003_0	8		Y	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										1		
H2793	003	0	1	01	01	H2793_003_0	8		Y	Generic	4	11	3	2	2	1	110		01	100		1	30		100				1	2			100				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		Y	Generic	4	11	3	2	2	3	110		01	100		1	30		100				1	2			100				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										1		3
H2793	003	0	1	01	01	H2793_003_0	8		Y	Preferred Brand	4	11	1	2	3	1	110		01	100		1	30		100				1	2			100				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		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01	100		1	30		100				1	2			100				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		Y	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31				1006.93	33																																					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2793	004	0	1	01	01	H2793_004_0	8		N	Preferred Generic	4	11	1	1	1	1	110		01	100		1	30		100				1	2			100				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	8		N	Preferred Generic	4	11	1	1	1	3	110		01	100		1	30		100				1	2			100				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	8		N	Generic	4	11	3	1	2	1	110		01	100		1	30		100				1	2			100				30		31				12.21	25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2793	004	0	1	01	01	H2793_004_0	8		N	Preferred Brand	4	11	1	1	3	1	110		01	100		1	30		100				1	2			100				30		31				122.82	25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2793	004	0	1	01	01	H2793_004_0	8		N	Non-Preferred Drug	4	11	1	1	4	1	110		01	100		1	30		100				1	2			100				30		31				106.85	25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2793	004	0	1	01	01	H2793_004_0	8		N	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31				672.03	25																																					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2793	005	0	1	01	01	H2793_005_0	8		Y	Preferred Generic	4	11	1	2	1	1	110		01	100		1	30		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												
H2793	005	0	1	01	01	H2793_005_0	8		Y	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		
H2793	005	0	1	01	01	H2793_005_0	8		Y	Generic	4	11	3	2	2	1	110		01	100		1	30		100				1	2			100				30		31	5.00		12.00																					10.00																5.00				5.00		0.17						0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2793	005	0	1	01	01	H2793_005_0	8		Y	Generic	4	11	3	2	2	3	110		01	100		1	30		100				1	2			100				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										1		3
H2793	005	0	1	01	01	H2793_005_0	8		Y	Preferred Brand	4	11	1	2	3	1	110		01	100		1	30		100				1	2			100				30		31	45.00		110.00																					90.00																45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2793	005	0	1	01	01	H2793_005_0	8		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01	100		1	30		100				1	2			100				30		31	90.00		225.00																					180.00																90.00				90.00		3.00						2.90	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2793	005	0	1	01	01	H2793_005_0	8		Y	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31				1270.31	33																																					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2793	005	0	1	01	01	H2793_005_0	8		Y	Select Care Drugs	4	10	1	2	6	1	110		01	100		1	30		100				1	2			100				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	4		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2802	001	0	1	02	01	H2802_001_0	4		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H2802	001	0	1	02	01	H2802_001_0	4		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2802	001	0	1	02	01	H2802_001_0	4		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H2802	001	0	1	02	01	H2802_001_0	4		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2802	001	0	1	02	01	H2802_001_0	4		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2802	001	0	1	02	01	H2802_001_0	4		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				428.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2802	007	0	1	02	01	H2802_007_0	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2802	007	0	1	02	01	H2802_007_0	3		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H2802	007	0	1	02	01	H2802_007_0	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2802	007	0	1	02	01	H2802_007_0	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H2802	007	0	1	02	01	H2802_007_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2802	007	0	1	02	01	H2802_007_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		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	007	0	1	02	01	H2802_007_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				564.00	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		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2802	008	0	1	02	01	H2802_008_0	3		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H2802	008	0	1	02	01	H2802_008_0	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2802	008	0	1	02	01	H2802_008_0	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H2802	008	0	1	02	01	H2802_008_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2802	008	0	1	02	01	H2802_008_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		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	008	0	1	02	01	H2802_008_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				425.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2802	010	0	1	02	01	H2802_010_0	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		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		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H2802	010	0	1	02	01	H2802_010_0	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2802	010	0	1	02	01	H2802_010_0	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H2802	010	0	1	02	01	H2802_010_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2802	010	0	1	02	01	H2802_010_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		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	010	0	1	02	01	H2802_010_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				485.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2802	012	0	1	02	01	H2802_012_0	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		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		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H2802	012	0	1	02	01	H2802_012_0	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2802	012	0	1	02	01	H2802_012_0	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H2802	012	0	1	02	01	H2802_012_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2802	012	0	1	02	01	H2802_012_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		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	012	0	1	02	01	H2802_012_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				360.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2802	016	0	1	02	01	H2802_016_0	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		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	016	0	1	02	01	H2802_016_0	3		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H2802	016	0	1	02	01	H2802_016_0	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2802	016	0	1	02	01	H2802_016_0	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H2802	016	0	1	02	01	H2802_016_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2802	016	0	1	02	01	H2802_016_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		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	016	0	1	02	01	H2802_016_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				449.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2802	018	0	1	02	01	H2802_018_0	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		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		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H2802	018	0	1	02	01	H2802_018_0	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2802	018	0	1	02	01	H2802_018_0	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H2802	018	0	1	02	01	H2802_018_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2802	018	0	1	02	01	H2802_018_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		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	018	0	1	02	01	H2802_018_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				448.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2802	024	0	1	02	01	H2802_024_0	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2802	024	0	1	02	01	H2802_024_0	3		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H2802	024	0	1	02	01	H2802_024_0	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2802	024	0	1	02	01	H2802_024_0	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H2802	024	0	1	02	01	H2802_024_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2802	024	0	1	02	01	H2802_024_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2802	024	0	1	02	01	H2802_024_0	3		Y	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												
H2802	025	0	1	02	01	H2802_025_0	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2802	025	0	1	02	01	H2802_025_0	3		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H2802	025	0	1	02	01	H2802_025_0	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	8.00		24.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2802	025	0	1	02	01	H2802_025_0	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	8.00		24.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H2802	025	0	1	02	01	H2802_025_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2802	025	0	1	02	01	H2802_025_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2802	025	0	1	02	01	H2802_025_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				440.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2802	028	0	1	02	01	H2802_028_0	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		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		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H2802	028	0	1	02	01	H2802_028_0	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	6.00		12.00																											18.00						0.00				6.00				6.00		0.20						0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2802	028	0	1	02	01	H2802_028_0	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	6.00		12.00																											18.00						0.00				6.00				6.00		0.20						0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H2802	028	0	1	02	01	H2802_028_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		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		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2802	028	0	1	02	01	H2802_028_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				373.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2802	029	0	1	02	01	H2802_029_0	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		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	029	0	1	02	01	H2802_029_0	3		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H2802	029	0	1	02	01	H2802_029_0	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	14.00		42.00																											42.00						0.00				14.00				14.00		0.46						0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2802	029	0	1	02	01	H2802_029_0	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	14.00		42.00																											42.00						0.00				14.00				14.00		0.46						0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H2802	029	0	1	02	01	H2802_029_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		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		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2802	029	0	1	02	01	H2802_029_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				372.00	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		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2802	030	0	1	02	01	H2802_030_0	3		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H2802	030	0	1	02	01	H2802_030_0	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2802	030	0	1	02	01	H2802_030_0	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H2802	030	0	1	02	01	H2802_030_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2802	030	0	1	02	01	H2802_030_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		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		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				440.00	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		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2802	031	0	1	02	01	H2802_031_0	3		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H2802	031	0	1	02	01	H2802_031_0	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	8.00		16.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2802	031	0	1	02	01	H2802_031_0	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	8.00		16.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H2802	031	0	1	02	01	H2802_031_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2802	031	0	1	02	01	H2802_031_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		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		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				423.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2802	032	0	1	02	01	H2802_032_0	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2802	032	0	1	02	01	H2802_032_0	3		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H2802	032	0	1	02	01	H2802_032_0	3		Y	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	032	0	1	02	01	H2802_032_0	3		Y	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	032	0	1	02	01	H2802_032_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2802	032	0	1	02	01	H2802_032_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		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		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				550.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2802	033	0	1	02	01	H2802_033_0	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		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		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H2802	033	0	1	02	01	H2802_033_0	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	8.00		16.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2802	033	0	1	02	01	H2802_033_0	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	8.00		16.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H2802	033	0	1	02	01	H2802_033_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2802	033	0	1	02	01	H2802_033_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		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		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				365.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2802	034	0	1	02	01	H2802_034_0	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2802	034	0	1	02	01	H2802_034_0	3		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H2802	034	0	1	02	01	H2802_034_0	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2802	034	0	1	02	01	H2802_034_0	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H2802	034	0	1	02	01	H2802_034_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2802	034	0	1	02	01	H2802_034_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		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		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				380.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2802	035	0	1	02	01	H2802_035_0	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		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		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H2802	035	0	1	02	01	H2802_035_0	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	8.00		24.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2802	035	0	1	02	01	H2802_035_0	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	8.00		24.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H2802	035	0	1	02	01	H2802_035_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2802	035	0	1	02	01	H2802_035_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		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		Y	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	041	0	1	02	01	H2802_041_0	2		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2802	041	0	1	02	01	H2802_041_0	2		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H2802	041	0	1	02	01	H2802_041_0	2		Y	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	041	0	1	02	01	H2802_041_0	2		Y	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	041	0	1	02	01	H2802_041_0	2		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2802	041	0	1	02	01	H2802_041_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2802	041	0	1	02	01	H2802_041_0	2		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				470.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2802	048	0	1	02	01	H2802_048_0	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2802	048	0	1	02	01	H2802_048_0	3		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H2802	048	0	1	02	01	H2802_048_0	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	14.00		42.00																											42.00						0.00				14.00				14.00		0.46						0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2802	048	0	1	02	01	H2802_048_0	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	14.00		42.00																											42.00						0.00				14.00				14.00		0.46						0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H2802	048	0	1	02	01	H2802_048_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2802	048	0	1	02	01	H2802_048_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2802	048	0	1	02	01	H2802_048_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				433.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2802	049	0	1	02	01	H2802_049_0	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2802	049	0	1	02	01	H2802_049_0	3		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H2802	049	0	1	02	01	H2802_049_0	3		Y	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	049	0	1	02	01	H2802_049_0	3		Y	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	049	0	1	02	01	H2802_049_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2802	049	0	1	02	01	H2802_049_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		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		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				554.00	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		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2802	052	0	1	02	01	H2802_052_0	3		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H2802	052	0	1	02	01	H2802_052_0	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2802	052	0	1	02	01	H2802_052_0	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H2802	052	0	1	02	01	H2802_052_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2802	052	0	1	02	01	H2802_052_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2802	052	0	1	02	01	H2802_052_0	3		Y	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												
H2802	054	0	1	02	01	H2802_054_0	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2802	054	0	1	02	01	H2802_054_0	3		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H2802	054	0	1	02	01	H2802_054_0	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2802	054	0	1	02	01	H2802_054_0	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H2802	054	0	1	02	01	H2802_054_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2802	054	0	1	02	01	H2802_054_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2802	054	0	1	02	01	H2802_054_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				506.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2816	013	0	1	09	04	H2816_013_0	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												
H2816	013	0	1	09	04	H2816_013_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												
H2816	013	0	1	09	04	H2816_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								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	4			Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											91.49	50	50	50				87.83	48	48	48										50	50	50				48	48	48			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2816	013	0	1	09	04	H2816_013_0	4			Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2816	013	0	1	09	04	H2816_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	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	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												
H2816	019	0	1	09	04	H2816_019_0	4			Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								12.00	24.00	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	4			Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											47.00	94.00	141.00				37.00	74.00	74.00				47.00				47.00			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	4			Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											83.22	50	50	50				79.89	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	4			Specialty Tier	4	11	1	1	5	1		010	01		010	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	4			Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			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	6		Y	Preferred Generic	4	11	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								4.00	8.00	12.00					0.00	0.00	0.00					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	6		Y	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	6		Y	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	6		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								95.00	190.00	285.00					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	6		Y	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2825	002	0	1	01	01	H2825_002_0	8			Preferred Generic	4	11	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								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	8			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	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	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	8			Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	300.00					95.00	190.00	285.00					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	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												
H2825	003	0	1	01	01	H2825_003_0	7		Y	Preferred Generic	4	11	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								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	7		Y	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	7		Y	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					42.00	84.00	126.00					42.00	84.00	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	7		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	300.00					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	7		Y	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2836	005	0	1	04	01	H2836_005_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												
H2836	005	0	1	04	01	H2836_005_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												
H2836	005	0	1	04	01	H2836_005_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												
H2836	005	0	1	04	01	H2836_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		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	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												
H2836	005	0	1	04	01	H2836_005_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												
H2836	005	0	1	04	01	H2836_005_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		
H2836	006	0	1	04	01	H2836_006_0	6		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								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												
H2836	006	0	1	04	01	H2836_006_0	6		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								20.00	40.00	60.00					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	6		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								47.00	94.00	141.00					47.00	94.00	141.00					47.00	141.00	141.00																47.00				47.00			1.57	1.57	1.57			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2836	006	0	1	04	01	H2836_006_0	6		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	285.00	285.00																100.00				100.00			3.33	3.17	3.17			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2836	006	0	1	04	01	H2836_006_0	6		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												25							25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2836	006	0	1	04	01	H2836_006_0	6		N	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								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	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												
H2853	001	0	1	01	01	H2853_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					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	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												
H2853	001	0	1	01	01	H2853_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												
H2853	001	0	1	01	01	H2853_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												
H2853	001	0	1	01	01	H2853_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												
H2853	002	0	1	01	01	H2853_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								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00				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	5			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	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												
H2853	002	0	1	01	01	H2853_002_0	5			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	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												
H2853	002	0	1	01	01	H2853_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												
H2853	002	0	1	01	01	H2853_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												
H2853	002	0	1	01	01	H2853_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												
H2853	002	0	1	01	01	H2853_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	
H2879	001	0	1	01	01	H2879_001_0	7		N	Preferred Generic	4	11	1	2	1	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2879	001	0	1	01	01	H2879_001_0	7		N	Generic	4	11	1	2	2	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2879	001	0	1	01	01	H2879_001_0	7		N	Preferred Brand	4	11	1	2	3	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31	47.00	94.00	141.00																			47.00	94.00	141.00																47.00				47.00		1.52			1.52			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2879	001	0	1	01	01	H2879_001_0	7		N	Non-Preferred Drug	4	11	1	1	4	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31				92.50	36	36	36																		36	36	36															36			36								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2879	001	0	1	01	01	H2879_001_0	7		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	31								31						31		31				820.70	25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2879	002	0	1	01	01	H2879_002_0	7		Y	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	7		Y	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	7		Y	Preferred Brand	4	11	1	2	3	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31	47.00	94.00	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	7		Y	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	7		Y	Specialty Tier	4	11	1	1	5	1	010		01	010		1	31								31						31		31				842.56	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	7		Y	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	7		Y	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	7		Y	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	7		Y	Preferred Brand	4	11	1	2	3	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31	47.00	94.00	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	7		Y	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	7		Y	Specialty Tier	4	11	1	1	5	1	010		01	010		1	31								31						31		31				814.76	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	7		Y	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	004	0	1	01	01	H2879_004_0	7		Y	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												
H2879	004	0	1	01	01	H2879_004_0	7		Y	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												
H2879	004	0	1	01	01	H2879_004_0	7		Y	Preferred Brand	4	11	1	2	3	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31	47.00	94.00	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	004	0	1	01	01	H2879_004_0	7		Y	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	004	0	1	01	01	H2879_004_0	7		Y	Specialty Tier	4	11	1	1	5	1	010		01	010		1	31								31						31		31				734.09	27																				27																	27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2879	004	0	1	01	01	H2879_004_0	7		Y	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												
H2879	005	0	1	01	01	H2879_005_0	8		N	Preferred Generic	4	11	1	2	1	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2879	005	0	1	01	01	H2879_005_0	8		N	Generic	4	11	1	2	2	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2879	005	0	1	01	01	H2879_005_0	8		N	Preferred Brand	4	11	1	2	3	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31	29.00	58.00	87.00																			29.00	58.00	87.00																29.00				29.00		0.94			0.94			0.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2879	005	0	1	01	01	H2879_005_0	8		N	Non-Preferred Drug	4	11	1	1	4	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31				96.79	30	30	30																		30	30	30															30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2879	005	0	1	01	01	H2879_005_0	8		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	31								31						31		31				861.10	25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
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								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												
H2915	003	0	1	01	01	H2915_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								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
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								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												
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											77.02	47	47	47				73.74	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	003	0	1	01	01	H2915_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	
H2915	011	0	1	01	01	H2915_011_0	4			Preferred Generic	3	11	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								19.00	38.00	57.00					0.00	0.00	0.00											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												
H2915	011	0	1	01	01	H2915_011_0	4			Generic	3	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					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												
H2915	011	0	1	01	01	H2915_011_0	4			Preferred Brand	3	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	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, Select Care Drugs												
H2915	011	0	1	01	01	H2915_011_0	4			Non-Preferred Drug	3	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											98.13	45	45	45				98.13	45	45	45										45	45	45				45	45	45			45			45								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	3	11	1	1	5	1		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												
H2915	011	0	1	01	01	H2915_011_0	4			Select Care Drugs	3	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred 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								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00				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												
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								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												
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											96.70	46	46	46				92.50	44	44	44										46	46	46				44	44	44			46			46								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	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												
H2915	016	0	1	01	01	H2915_016_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					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												
H2915	016	0	1	01	01	H2915_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					37.00	74.00	111.00											47.00	94.00	141.00				37.00	74.00	74.00				47.00				47.00			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	5			Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											90.22	48	48	48				86.46	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	5			Specialty Tier	4	11	1	1	5	1		010	01		010	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	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												
H2923	001	0	1	01	01	H2923_001_0	10		Y	Preferred Generic	4	11	1	2	1	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2923	001	0	1	01	01	H2923_001_0	10		Y	Preferred Generic	4	11	1	2	1	3	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H2923	001	0	1	01	01	H2923_001_0	10		Y	Generic	4	11	3	2	2	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2923	001	0	1	01	01	H2923_001_0	10		Y	Generic	4	11	3	2	2	3	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	3
H2923	001	0	1	01	01	H2923_001_0	10		Y	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	47.00	94.00	141.00																			47.00	94.00	117.50																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2923	001	0	1	01	01	H2923_001_0	10		Y	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	100.00	200.00	300.00																			100.00	200.00	300.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2923	001	0	1	01	01	H2923_001_0	10		Y	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												
H2942	001	0	1	01	01	H2942_001_0	9			Preferred Generic	4	01	1	2	1	1		111	01	100		1				30	60	100	1	2			100				30		31								5.00	10.00	15.00					0.00	0.00	0.00							12.50																0.00				0.00			0.17	0.00				0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs												
H2942	001	0	1	01	01	H2942_001_0	9			Generic	4	01	3	2	2	1		111	01	100		1				30	60	100	1	2			100				30		31								10.00	20.00	30.00					5.00	10.00	15.00							25.00																10.00				10.00			0.33	0.17				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs												
H2942	001	0	1	01	01	H2942_001_0	9			Preferred Brand	4	10	1	2	3	1		111	01	100		1				30	60	100	1	2			100				30		31								47.00	94.00	141.00					42.00	84.00	126.00							117.50																47.00				47.00			1.57	1.40				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs												
H2942	001	0	1	01	01	H2942_001_0	9			Non-Preferred Drug	4	11	1	2	4	1		111	01	100		1				30	60	100	1	2			100				30		31								100.00	200.00	300.00					95.00	190.00	285.00							250.00																100.00				100.00			3.33	3.17				3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs												
H2942	001	0	1	01	01	H2942_001_0	9			Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											1000.00	33						1000.00	33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs												
H2942	001	0	1	01	01	H2942_001_0	9			Select Diabetic 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			0.00	0.00				0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs												
H2944	013	0	1	09	04	H2944_013_0	4			Preferred Generic	4	11	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	7.00		21.00																									10.00		30.00				7.00		0.00				7.00				7.00		0.23				0.33	0.23	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2944	013	0	1	09	04	H2944_013_0	4			Generic	4	11	1	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	14.00		42.00																									20.00		60.00				14.00		0.00				14.00				14.00		0.47				0.67	0.47	0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2944	013	0	1	09	04	H2944_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		131.00				47.00				47.00		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	4			Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	99.00		297.00																									100.00		300.00				99.00		287.00				99.00				99.00		3.30				3.33	3.30	3.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2944	013	0	1	09	04	H2944_013_0	4			Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					30																										30						30					30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2960	012	0	1	01	01	H2960_012_0	3		Y	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 Drug, Specialty Tier, Select Care Drugs												
H2960	012	0	1	01	01	H2960_012_0	3		Y	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 Drug, Specialty Tier, Select Care Drugs												
H2960	012	0	1	01	01	H2960_012_0	3		Y	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 Drug, Specialty Tier, Select Care Drugs												
H2960	012	0	1	01	01	H2960_012_0	3		Y	Non-Preferred Drug	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 Drug, Specialty Tier, Select Care Drugs												
H2960	012	0	1	01	01	H2960_012_0	3		Y	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2960	012	0	1	01	01	H2960_012_0	3		Y	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 Drug, Specialty Tier, Select Care Drugs												
H2960	012	0	1	01	01	H2960_012_0	3		Y	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				0.27	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H2960	018	0	1	01	01	H2960_018_0	4		Y	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 Drug, Specialty Tier, Select Care Drugs												
H2960	018	0	1	01	01	H2960_018_0	4		Y	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				0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H2960	018	0	1	01	01	H2960_018_0	4		Y	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 Drug, Specialty Tier, Select Care Drugs												
H2960	018	0	1	01	01	H2960_018_0	4		Y	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				0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H2960	018	0	1	01	01	H2960_018_0	4		Y	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 Drug, Specialty Tier, Select Care Drugs												
H2960	018	0	1	01	01	H2960_018_0	4		Y	Non-Preferred Drug	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 Drug, Specialty Tier, Select Care Drugs												
H2960	018	0	1	01	01	H2960_018_0	4		Y	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2960	018	0	1	01	01	H2960_018_0	4		Y	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 Drug, Specialty Tier, Select Care Drugs												
H2960	018	0	1	01	01	H2960_018_0	4		Y	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				0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H2960	019	0	1	01	01	H2960_019_0	5		Y	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				0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2960	019	0	1	01	01	H2960_019_0	5		Y	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				0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H2960	019	0	1	01	01	H2960_019_0	5		Y	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				0.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2960	019	0	1	01	01	H2960_019_0	5		Y	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				0.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H2960	019	0	1	01	01	H2960_019_0	5		Y	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 Drug, Specialty Tier, Select Care Drugs												
H2960	019	0	1	01	01	H2960_019_0	5		Y	Non-Preferred Drug	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 Drug, Specialty Tier, Select Care Drugs												
H2960	019	0	1	01	01	H2960_019_0	5		Y	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2960	019	0	1	01	01	H2960_019_0	5		Y	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 Drug, Specialty Tier, Select Care Drugs												
H2960	019	0	1	01	01	H2960_019_0	5		Y	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				0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H2960	023	0	1	01	01	H2960_023_0	4		Y	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 Drug, Specialty Tier, Select Care Drugs												
H2960	023	0	1	01	01	H2960_023_0	4		Y	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 Drug, Specialty Tier, Select Care Drugs												
H2960	023	0	1	01	01	H2960_023_0	4		Y	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 Drug, Specialty Tier, Select Care Drugs												
H2960	023	0	1	01	01	H2960_023_0	4		Y	Non-Preferred Drug	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 Drug, Specialty Tier, Select Care Drugs												
H2960	023	0	1	01	01	H2960_023_0	4		Y	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2960	023	0	1	01	01	H2960_023_0	4		Y	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 Drug, Specialty Tier, Select Care Drugs												
H2960	023	0	1	01	01	H2960_023_0	4		Y	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				0.27	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H2962	001	0	1	01	01	H2962_001_0	7		Y	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		Y	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		Y	Preferred Brand	4	11	1	2	2	1	110		01	100		1	30		90				1	2			90				30		31	15.00		45.00																					30.00																15.00				15.00		.50						.48	Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2962	001	0	1	01	01	H2962_001_0	7		Y	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		Y	Specialty Tier	4	11	1	1	4	1	010		01			1	30														30		31				778.52	33																																					33			33								Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2962	013	3	1	01	01	H2962_013_3	7		Y	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		Y	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		Y	Preferred Brand	4	11	1	2	2	1	110		01	100		1	30		90				1	2			90				30		31	15.00		45.00																					30.00																15.00				15.00		.50						.48	Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2962	013	3	1	01	01	H2962_013_3	7		Y	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		Y	Specialty Tier	4	11	1	1	4	1	010		01			1	30														30		31				798.13	33																																					33			33								Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2962	013	4	1	01	01	H2962_013_4	7		Y	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		Y	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		Y	Preferred Brand	4	11	1	2	2	1	110		01	100		1	30		90				1	2			90				30		31	15.00		45.00																					30.00																15.00				15.00		.50						.48	Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2962	013	4	1	01	01	H2962_013_4	7		Y	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		Y	Specialty Tier	4	11	1	1	4	1	010		01			1	30														30		31				798.13	33																																					33			33								Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2962	019	1	1	01	01	H2962_019_1	7		Y	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		Y	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		Y	Preferred Brand	4	11	1	2	2	1	110		01	100		1	30		90				1	2			90				30		31	10.00		30.00																					20.00																10.00				10.00		0.33						0.32	Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2962	019	1	1	01	01	H2962_019_1	7		Y	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, Select Care Drugs												
H2962	019	1	1	01	01	H2962_019_1	7		Y	Specialty Tier	4	11	1	1	4	1	010		01			1	30														30		31				906.83	33																																					33			33								Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2962	019	1	1	01	01	H2962_019_1	7		Y	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		Y	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		Y	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		Y	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		Y	Preferred Brand	4	11	1	2	2	1	110		01	100		1	30		90				1	2			90				30		31	10.00		30.00																					20.00																10.00				10.00		0.33						0.32	Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2962	019	2	1	01	01	H2962_019_2	7		Y	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, Select Care Drugs												
H2962	019	2	1	01	01	H2962_019_2	7		Y	Specialty Tier	4	11	1	1	4	1	010		01			1	30														30		31				906.83	33																																					33			33								Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2962	019	2	1	01	01	H2962_019_2	7		Y	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		Y	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	8		Y	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	8		Y	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	8		Y	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	021	0	1	01	01	H2962_021_0	8		Y	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	8		Y	Specialty Tier	4	11	1	1	4	1	010		01			1	30														30		31				921.06	33																																					33			33								Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2962	021	0	1	01	01	H2962_021_0	8		Y	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	8		Y	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		Y	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		Y	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		Y	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	022	0	1	01	01	H2962_022_0	7		Y	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		Y	Specialty Tier	4	11	1	1	4	1	010		01			1	30														30		31				907.03	33																																					33			33								Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2962	022	0	1	01	01	H2962_022_0	7		Y	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		Y	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		Y	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		Y	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		Y	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	023	0	1	01	01	H2962_023_0	7		Y	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		Y	Specialty Tier	4	11	1	1	4	1	010		01			1	30														30		31				910.08	33																																					33			33								Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2962	023	0	1	01	01	H2962_023_0	7		Y	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		Y	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		Y	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		Y	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		Y	Preferred Brand	4	11	1	2	2	1	110		01	100		1	30		90				1	2			90				30		31	10.00		30.00																					20.00																10.00				10.00		0.33						0.32	Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2962	024	0	1	01	01	H2962_024_0	7		Y	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, Select Care Drugs												
H2962	024	0	1	01	01	H2962_024_0	7		Y	Specialty Tier	4	11	1	1	4	1	010		01			1	30														30		31				902.95	33																																					33			33								Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2962	024	0	1	01	01	H2962_024_0	7		Y	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		Y	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	8		Y	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	8		Y	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	8		Y	Preferred Brand	4	11	1	2	2	1	110		01	100		1	30		90				1	2			90				30		31	10.00		30.00																					20.00																10.00				10.00		0.33						0.32	Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2962	025	0	1	01	01	H2962_025_0	8		Y	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, Select Care Drugs												
H2962	025	0	1	01	01	H2962_025_0	8		Y	Specialty Tier	4	11	1	1	4	1	010		01			1	30														30		31				910.08	33																																					33			33								Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2962	025	0	1	01	01	H2962_025_0	8		Y	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	8		Y	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	8		Y	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	8		Y	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	8		Y	Preferred Brand	4	11	1	2	2	1	110		01	100		1	30		90				1	2			90				30		31	15.00		45.00																					30.00																15.00				15.00		0.50						0.48	Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2962	026	0	1	01	01	H2962_026_0	8		Y	Non-Preferred Drug	4	11	1	2	3	1	110		01	100		1	30		90				1	2			90				30		31	55.00		165.00																					110.00																55.00				55.00		1.83						1.77	Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2962	026	0	1	01	01	H2962_026_0	8		Y	Specialty Tier	4	11	1	1	4	1	010		01			1	30														30		31				932.76	33																																					33			33								Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2962	026	0	1	01	01	H2962_026_0	8		Y	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	8		Y	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	8		Y	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	8		Y	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	8		Y	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	028	0	1	01	01	H2962_028_0	8		Y	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	8		Y	Specialty Tier	4	11	1	1	4	1	010		01			1	30														30		31				854.90	33																																					33			33								Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2962	029	0	1	01	01	H2962_029_0	8		Y	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	8		Y	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	8		Y	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	8		Y	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	8		Y	Specialty Tier	4	11	1	1	4	1	010		01			1	30														30		31				862.50	33																																					33			33								Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2962	029	0	1	01	01	H2962_029_0	8		Y	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	8		Y	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		Y	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		Y	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		Y	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	031	0	1	01	01	H2962_031_0	7		Y	Non-Preferred Drug	4	11	1	2	3	1	110		01	100		1	30		90				1	2			90				30		31	65.00		195.00																					130.00																65.00				65.00		2.17						2.10	Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2962	031	0	1	01	01	H2962_031_0	7		Y	Specialty Tier	4	11	1	1	4	1	010		01			1	30														30		31				842.68	33																																					33			33								Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2962	032	0	1	01	01	H2962_032_0	7		Y	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		Y	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		Y	Preferred Brand	4	11	1	2	2	1	110		01	100		1	30		90				1	2			90				30		31	5.00		15.00																					10.00																5.00				5.00		0.17						0.16	Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2962	032	0	1	01	01	H2962_032_0	7		Y	Non-Preferred Drug	4	11	1	2	3	1	110		01	100		1	30		90				1	2			90				30		31	45.00		135.00																					90.00																45.00				45.00		1.50						1.45	Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2962	032	0	1	01	01	H2962_032_0	7		Y	Specialty Tier	4	11	1	1	4	1	010		01			1	30														30		31				749.86	33																																					33			33								Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2962	033	0	1	01	01	H2962_033_0	7		Y	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		Y	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		Y	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		Y	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		Y	Specialty Tier	4	11	1	1	4	1	010		01			1	30														30		31				906.68	33																																					33			33								Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2962	033	0	1	01	01	H2962_033_0	7		Y	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		Y	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		Y	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		Y	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		Y	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		Y	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	034	0	1	01	01	H2962_034_0	7		Y	Specialty Tier	4	11	1	1	4	1	010		01			1	30														30		31				905.43	33																																					33			33								Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2962	034	0	1	01	01	H2962_034_0	7		Y	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		Y	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	035	0	1	01	01	H2962_035_0	7		N	Generic	4	01	1	1	1	1	110		01	100		1	30		90				1	2			90				30		31					25		25																				25															25			25								Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Supplemental Drugs												
H2962	035	0	1	01	01	H2962_035_0	7		N	Preferred Brand	4	11	1	1	2	1	110		01	100		1	30		90				1	2			90				30		31					25		25																				25															25			25								Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Supplemental Drugs												
H2962	035	0	1	01	01	H2962_035_0	7		N	Non-Preferred Drug	4	11	1	1	3	1	110		01	100		1	30		90				1	2			90				30		31					25		25																				25															25			25								Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Supplemental Drugs												
H2962	035	0	1	01	01	H2962_035_0	7		N	Specialty Tier	4	11	1	1	4	1	010		01			1	30														30		31					25																																					25			25								Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Supplemental Drugs												
H2962	035	0	1	01	01	H2962_035_0	7		N	Supplemental Drugs	4	01	2	2	5	1	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00	Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Supplemental Drugs												
H2962	035	0	1	01	01	H2962_035_0	7		N	Supplemental Drugs	4	01	2	2	5	3	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00	Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Supplemental Drugs										1		
H2962	036	0	1	01	01	H2962_036_0	7		N	Generic	4	01	1	1	1	1	110		01	100		1	30		90				1	2			90				30		31					25		25																				25															25			25								Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Supplemental Drugs												
H2962	036	0	1	01	01	H2962_036_0	7		N	Preferred Brand	4	11	1	1	2	1	110		01	100		1	30		90				1	2			90				30		31					25		25																				25															25			25								Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Supplemental Drugs												
H2962	036	0	1	01	01	H2962_036_0	7		N	Non-Preferred Drug	4	11	1	1	3	1	110		01	100		1	30		90				1	2			90				30		31					25		25																				25															25			25								Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Supplemental Drugs												
H2962	036	0	1	01	01	H2962_036_0	7		N	Specialty Tier	4	11	1	1	4	1	010		01			1	30														30		31					25																																					25			25								Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Supplemental Drugs												
H2962	036	0	1	01	01	H2962_036_0	7		N	Supplemental Drugs	4	01	2	2	5	1	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00	Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Supplemental Drugs												
H2962	036	0	1	01	01	H2962_036_0	7		N	Supplemental Drugs	4	01	2	2	5	3	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00	Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Supplemental Drugs										1		
H2962	045	0	1	01	01	H2962_045_0	7		Y	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		Y	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		Y	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	045	0	1	01	01	H2962_045_0	7		Y	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		Y	Specialty Tier	4	11	1	1	4	1	010		01			1	30														30		31				773.38	33																																					33			33								Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2962	046	0	1	01	01	H2962_046_0	9		Y	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	046	0	1	01	01	H2962_046_0	9		Y	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	046	0	1	01	01	H2962_046_0	9		Y	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	046	0	1	01	01	H2962_046_0	9		Y	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	046	0	1	01	01	H2962_046_0	9		Y	Specialty Tier	4	11	1	1	4	1	010		01			1	30														30		31				772.92	33																																					33			33								Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2962	047	0	1	01	01	H2962_047_0	9		Y	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	047	0	1	01	01	H2962_047_0	9		Y	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	047	0	1	01	01	H2962_047_0	9		Y	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	047	0	1	01	01	H2962_047_0	9		Y	Non-Preferred Drug	4	11	1	2	3	1	110		01	100		1	30		90				1	2			90				30		31	85.00		255.00																					170.00																85.00				85.00		2.83						2.74	Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2962	047	0	1	01	01	H2962_047_0	9		Y	Specialty Tier	4	11	1	1	4	1	010		01			1	30														30		31				772.84	33																																					33			33								Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2962	050	0	1	01	01	H2962_050_0	10		Y	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	050	0	1	01	01	H2962_050_0	10		Y	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	050	0	1	01	01	H2962_050_0	10		Y	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	050	0	1	01	01	H2962_050_0	10		Y	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	050	0	1	01	01	H2962_050_0	10		Y	Specialty Tier	4	11	1	1	4	1	010		01			1	30														30		31				912.25	33																																					33			33								Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2962	050	0	1	01	01	H2962_050_0	10		Y	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	050	0	1	01	01	H2962_050_0	10		Y	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	051	0	1	01	01	H2962_051_0	10		Y	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	051	0	1	01	01	H2962_051_0	10		Y	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	051	0	1	01	01	H2962_051_0	10		Y	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	051	0	1	01	01	H2962_051_0	10		Y	Non-Preferred Drug	4	11	1	2	3	1	110		01	100		1	30		90				1	2			90				30		31	65.00		195.00																					130.00																65.00				65.00		2.17						2.10	Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2962	051	0	1	01	01	H2962_051_0	10		Y	Specialty Tier	4	11	1	1	4	1	010		01			1	30														30		31				913.12	33																																					33			33								Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2962	051	0	1	01	01	H2962_051_0	10		Y	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	051	0	1	01	01	H2962_051_0	10		Y	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	052	0	1	01	01	H2962_052_0	10		Y	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	052	0	1	01	01	H2962_052_0	10		Y	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	052	0	1	01	01	H2962_052_0	10		Y	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	052	0	1	01	01	H2962_052_0	10		Y	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	052	0	1	01	01	H2962_052_0	10		Y	Specialty Tier	4	11	1	1	4	1	010		01			1	30														30		31				912.43	33																																					33			33								Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2962	052	0	1	01	01	H2962_052_0	10		Y	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	052	0	1	01	01	H2962_052_0	10		Y	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		
H2986	001	0	1	01	01	H2986_001_0	10		Y	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	10		Y	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	10		Y	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	10		Y	Preferred Brand	4	10	1	2	3	1	111		01	100		1	30	60	90				1	2			90				30		31	47.00	94.00	141.00																					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	10		Y	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	10		Y	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31					33																																					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H2986	001	0	1	01	01	H2986_001_0	10		Y	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	10		Y	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	13		Y	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	13		Y	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	13		Y	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	13		Y	Preferred Brand	4	10	1	2	3	1	111		01	100		1	30	60	90				1	2			90				30		31	47.00	94.00	141.00																					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	13		Y	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	13		Y	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31					33																																					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H2986	002	0	1	01	01	H2986_002_0	13		Y	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	13		Y	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	11		Y	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	11		Y	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	11		Y	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	11		Y	Preferred Brand	4	10	1	2	3	1	111		01	100		1	30	60	90				1	2			90				30		31	47.00	94.00	141.00																					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	11		Y	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	11		Y	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31					33																																					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H2986	004	0	1	01	01	H2986_004_0	11		Y	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	11		Y	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	12		Y	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	12		Y	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	12		Y	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	12		Y	Preferred Brand	4	10	1	2	3	1	111		01	100		1	30	60	90				1	2			90				30		31	47.00	94.00	141.00																					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	12		Y	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	12		Y	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31					33																																					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H2986	007	0	1	01	01	H2986_007_0	12		Y	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	12		Y	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	008	0	1	01	01	H2986_008_0	13		Y	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, Select Care Drugs												
H2986	008	0	1	01	01	H2986_008_0	13		Y	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, Select Care Drugs										1		
H2986	008	0	1	01	01	H2986_008_0	13		Y	Generic	4	01	3	2	2	1	111		01	100		1	30	60	90				1	2			90				30		31	10.00	20.00	30.00																					20.00																10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H2986	008	0	1	01	01	H2986_008_0	13		Y	Preferred Brand	4	10	1	2	3	1	111		01	100		1	30	60	90				1	2			90				30		31	45.00	90.00	135.00																					90.00																45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H2986	008	0	1	01	01	H2986_008_0	13		Y	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																					190.00																95.00				95.00		3.17						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H2986	008	0	1	01	01	H2986_008_0	13		Y	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31					33																																					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H2986	008	0	1	01	01	H2986_008_0	13		Y	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	008	0	1	01	01	H2986_008_0	13		Y	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		
H3041	001	0	1	01	01	H3041_001_0	10		Y	Preferred Generic	4	11	1	2	1	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3041	001	0	1	01	01	H3041_001_0	10		Y	Preferred Generic	4	11	1	2	1	3	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H3041	001	0	1	01	01	H3041_001_0	10		Y	Generic	4	11	3	2	2	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3041	001	0	1	01	01	H3041_001_0	10		Y	Generic	4	11	3	2	2	3	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	3
H3041	001	0	1	01	01	H3041_001_0	10		Y	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	47.00	94.00	141.00																			47.00	94.00	117.50																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3041	001	0	1	01	01	H3041_001_0	10		Y	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	100.00	200.00	300.00																			100.00	200.00	300.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3041	001	0	1	01	01	H3041_001_0	10		Y	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												
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	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					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												
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					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	84.00				47.00				47.00			1.57	1.4		1.57	1.4	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, 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					95.00	190.00	285.00											100.00	200.00	300.00				95.00	190.00	190.00				100.00				100.00			3.33	3.17		3.33	3.17	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			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	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	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	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					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												
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					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	84.00				47.00				47.00			1.57	1.4		1.57	1.4	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, 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					95.00	190.00	285.00											100.00	200.00	300.00				95.00	190.00	190.00				100.00				100.00			3.33	3.17		3.33	3.17	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												30							30												30						30					30			30								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	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	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	5			Preferred Generic	3	11	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								19.00	38.00	57.00					0.00	0.00	0.00											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	5			Generic	3	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00				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	5			Preferred Brand	3	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											47.00	94.00	141.00				37.00	74.00	74.00				47.00				47.00			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	5			Non-Preferred Drug	3	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											94.55	45	45	45				94.55	45	45	45										45	45	45				45	45	45			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3047	004	0	1	04	01	H3047_004_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												
H3047	004	0	1	04	01	H3047_004_0	5			Select Care Drugs	3	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			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	5		Y	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								5.00	10.00	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	5		Y	Generic	4	01	3	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	5		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	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	5		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	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	5		Y	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												
H3080	001	0	1	01	01	H3080_001_0	10		Y	Preferred Generic	4	11	1	2	1	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3080	001	0	1	01	01	H3080_001_0	10		Y	Preferred Generic	4	11	1	2	1	3	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H3080	001	0	1	01	01	H3080_001_0	10		Y	Generic	4	11	3	2	2	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3080	001	0	1	01	01	H3080_001_0	10		Y	Generic	4	11	3	2	2	3	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	3
H3080	001	0	1	01	01	H3080_001_0	10		Y	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	47.00	94.00	141.00																			47.00	94.00	117.50																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3080	001	0	1	01	01	H3080_001_0	10		Y	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	100.00	200.00	300.00																			100.00	200.00	300.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3080	001	0	1	01	01	H3080_001_0	10		Y	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												
H3080	002	0	1	01	01	H3080_002_0	11		N	Preferred Generic	4	11	1	2	1	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3080	002	0	1	01	01	H3080_002_0	11		N	Preferred Generic	4	11	1	2	1	3	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H3080	002	0	1	01	01	H3080_002_0	11		N	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												
H3080	002	0	1	01	01	H3080_002_0	11		N	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																			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										2	2	2
H3080	002	0	1	01	01	H3080_002_0	11		N	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	47.00	94.00	141.00																			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												
H3080	002	0	1	01	01	H3080_002_0	11		N	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	100.00	200.00	300.00																			100.00	200.00	300.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3080	002	0	1	01	01	H3080_002_0	11		N	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												
H3080	003	0	1	01	01	H3080_003_0	9		N	Preferred Generic	4	11	1	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												
H3080	003	0	1	01	01	H3080_003_0	9		N	Generic	4	11	3	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												
H3080	003	0	1	01	01	H3080_003_0	9		N	Generic	4	11	3	2	2	3	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	2	2
H3080	003	0	1	01	01	H3080_003_0	9		N	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												
H3080	003	0	1	01	01	H3080_003_0	9		N	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												
H3080	003	0	1	01	01	H3080_003_0	9		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31					25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3080	004	0	1	01	01	H3080_004_0	9		N	Preferred Generic	4	11	1	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												
H3080	004	0	1	01	01	H3080_004_0	9		N	Generic	4	11	3	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												
H3080	004	0	1	01	01	H3080_004_0	9		N	Generic	4	11	3	2	2	3	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	2	2
H3080	004	0	1	01	01	H3080_004_0	9		N	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												
H3080	004	0	1	01	01	H3080_004_0	9		N	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												
H3080	004	0	1	01	01	H3080_004_0	9		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31					25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3080	005	0	1	01	01	H3080_005_0	9		Y	Preferred Generic	4	11	1	2	1	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3080	005	0	1	01	01	H3080_005_0	9		Y	Preferred Generic	4	11	1	2	1	3	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H3080	005	0	1	01	01	H3080_005_0	9		Y	Generic	4	11	3	2	2	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3080	005	0	1	01	01	H3080_005_0	9		Y	Generic	4	11	3	2	2	3	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	3
H3080	005	0	1	01	01	H3080_005_0	9		Y	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	47.00	94.00	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												
H3080	005	0	1	01	01	H3080_005_0	9		Y	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	100.00	200.00	300.00																			100.00	200.00	300.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3080	005	0	1	01	01	H3080_005_0	9		Y	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												
H3080	006	0	1	01	01	H3080_006_0	9		N	Preferred Generic	4	11	1	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												
H3080	006	0	1	01	01	H3080_006_0	9		N	Generic	4	11	3	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												
H3080	006	0	1	01	01	H3080_006_0	9		N	Generic	4	11	3	2	2	3	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	2	2
H3080	006	0	1	01	01	H3080_006_0	9		N	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												
H3080	006	0	1	01	01	H3080_006_0	9		N	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												
H3080	006	0	1	01	01	H3080_006_0	9		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31					25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3080	007	0	1	01	01	H3080_007_0	9		N	Preferred Generic	4	11	1	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												
H3080	007	0	1	01	01	H3080_007_0	9		N	Generic	4	11	3	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												
H3080	007	0	1	01	01	H3080_007_0	9		N	Generic	4	11	3	2	2	3	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	2	2
H3080	007	0	1	01	01	H3080_007_0	9		N	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												
H3080	007	0	1	01	01	H3080_007_0	9		N	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												
H3080	007	0	1	01	01	H3080_007_0	9		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31					25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3113	008	0	1	02	01	H3113_008_0	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3113	008	0	1	02	01	H3113_008_0	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3113	008	0	1	02	01	H3113_008_0	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H3113	008	0	1	02	01	H3113_008_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3113	008	0	1	02	01	H3113_008_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3113	008	0	1	02	01	H3113_008_0	3		Y	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												
H3132	001	0	1	01	01	H3132_001_0	5		Y	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	5		Y	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	5		Y	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	5		Y	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	5		Y	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	5		Y	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	2		N	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	2		N	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	2		N	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	2		N	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	2		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					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	2		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					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	2		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1187.79	33						658.16	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3146	004	0	1	02	01	H3146_004_0	2		N	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	2		N	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	2		N	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	2		N	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	2		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					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	2		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					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	2		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											918.38	33						715.68	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3146	006	0	1	01	01	H3146_006_0	2		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					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	2		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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	2		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					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	2		N	Generic	4	01	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	2		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					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	2		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					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	2		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											779.10	31						438.70	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		Y	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					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		Y	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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		Y	Generic	4	01	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		Y	Generic	4	01	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		Y	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					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		Y	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					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		Y	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											936.13	33						644.73	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3146	011	0	1	01	01	H3146_011_0	2		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					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	2		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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	2		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					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	2		N	Generic	4	01	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	2		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					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	2		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					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	2		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											856.32	31						487.28	31												31						31						31		31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3146	012	0	1	01	01	H3146_012_0	2		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					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	2		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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	2		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					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	2		N	Generic	4	01	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	2		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					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	2		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					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	2		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											816.43	31						520.57	31												31						31						31		31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3146	013	0	1	01	01	H3146_013_0	2		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					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	2		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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	2		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					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	2		N	Generic	4	01	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	2		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					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	2		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					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	2		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											821.72	31						512.56	31												31						31						31		31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3146	014	0	1	02	01	H3146_014_0	2		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					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	2		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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	2		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					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	2		N	Generic	4	01	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	2		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					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	2		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					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	2		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1010.81	33						574.66	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3152	022	0	1	02	01	H3152_022_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												
H3152	022	0	1	02	01	H3152_022_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		
H3152	022	0	1	02	01	H3152_022_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												
H3152	022	0	1	02	01	H3152_022_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		
H3152	022	0	1	02	01	H3152_022_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												
H3152	022	0	1	02	01	H3152_022_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												
H3152	022	0	1	02	01	H3152_022_0	4			Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											763.71	30						421.62	30												30						30						30		30								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					5.00	10.00	10.00											20.00	40.00	60.00				5.00	10.00	10.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3152	048	0	1	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					5.00	10.00	10.00											20.00	40.00	60.00				5.00	10.00	10.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3152	048	0	1	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											863.53	29						619.86	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					5.00	10.00	10.00											20.00	40.00	60.00				5.00	10.00	10.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3152	080	0	1	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					5.00	10.00	10.00											20.00	40.00	60.00				5.00	10.00	10.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3152	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											833.53	29						554.17	29												29						29						29		29								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					10.00	20.00	20.00											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												
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					10.00	20.00	20.00											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										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											760.13	27						562.39	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					10.00	20.00	20.00											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												
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					10.00	20.00	20.00											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										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											766.05	29						499.87	29												29						29						29		29								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											871.02	28						628.92	28												28						28						28		28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3152	092	0	1	01	01	H3152_092_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	092	0	1	01	01	H3152_092_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	092	0	1	01	01	H3152_092_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	20.00											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												
H3152	092	0	1	01	01	H3152_092_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	20.00											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										1		
H3152	092	0	1	01	01	H3152_092_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	092	0	1	01	01	H3152_092_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	092	0	1	01	01	H3152_092_0	2			Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											828.50	27						614.82	27												27						27						27		27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3170	003	1	1	01	01	H3170_003_1	7			Preferred Generic	4	01	3	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	4.00	8.00	12.00																			4.00	8.00	0.00																4.00				4.00		0.13			0.13			0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3170	003	1	1	01	01	H3170_003_1	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	0.00																14.00				14.00		0.47			0.47			0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3170	003	1	1	01	01	H3170_003_1	7			Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	141.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3170	003	1	1	01	01	H3170_003_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												
H3170	003	1	1	01	01	H3170_003_1	7			Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				784.86	28																				28																	28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3170	003	2	1	01	01	H3170_003_2	7			Preferred Generic	4	01	3	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	4.00	8.00	12.00																			4.00	8.00	0.00																4.00				4.00		0.13			0.13			0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3170	003	2	1	01	01	H3170_003_2	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	0.00																14.00				14.00		0.47			0.47			0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3170	003	2	1	01	01	H3170_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																			47.00	94.00	141.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3170	003	2	1	01	01	H3170_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																			100.00	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	7			Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				784.86	28																				28																	28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3186	001	0	1	04	01	H3186_001_0	5		Y	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								2.00	4.00	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												
H3186	001	0	1	04	01	H3186_001_0	5		Y	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								10.00	20.00	30.00					4.00	8.00	12.00											10.00	20.00	30.00				4.00	8.00	12.00				10.00				10.00			0.33	0.13		0.33	0.13	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3186	001	0	1	04	01	H3186_001_0	5		Y	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												
H3186	001	0	1	04	01	H3186_001_0	5		Y	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					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00				100.00				100.00			3.33	3.33		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	5		Y	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 Drug, Specialty Tier												
H3186	002	0	1	04	01	H3186_002_0	5		Y	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								2.00	4.00	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												
H3186	002	0	1	04	01	H3186_002_0	5		Y	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								10.00	20.00	30.00					4.00	8.00	12.00											10.00	20.00	30.00				4.00	8.00	12.00				10.00				10.00			0.33	0.13		0.33	0.13	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3186	002	0	1	04	01	H3186_002_0	5		Y	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												
H3186	002	0	1	04	01	H3186_002_0	5		Y	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					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00				100.00				100.00			3.33	3.33		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	5		Y	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	28				28	28	28			28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3189	001	0	1	01	01	H3189_001_0	6		Y	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												
H3189	001	0	1	01	01	H3189_001_0	6		Y	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							0.00																10.00				10.00			0.33	0.17				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3189	001	0	1	01	01	H3189_001_0	6		Y	Preferred Brand	4	10	1	2	3	1		111	01	100		1				30	60	90	1	2			90				30		31								47.00	94.00	141.00					40.00	80.00	120.00							100.00																47.00				47.00			1.57	1.33				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3189	001	0	1	01	01	H3189_001_0	6		Y	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												
H3189	001	0	1	01	01	H3189_001_0	6		Y	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3189	002	0	1	01	01	H3189_002_0	6		Y	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					2.00	4.00	6.00							5.00																7.00				7.00			0.23	0.07				0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3189	002	0	1	01	01	H3189_002_0	6		Y	Generic	4	01	3	2	2	1		111	01	100		1				30	60	90	1	2			90				30		31								14.00	28.00	42.00					9.00	18.00	27.00							22.50																14.00				14.00			0.47	0.30				0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3189	002	0	1	01	01	H3189_002_0	6		Y	Preferred Brand	4	10	1	2	3	1		111	01	100		1				30	60	90	1	2			90				30		31								47.00	94.00	141.00					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												
H3189	002	0	1	01	01	H3189_002_0	6		Y	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												
H3189	002	0	1	01	01	H3189_002_0	6		Y	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3192	001	0	1	02	01	H3192_001_0	3		Y	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					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	3		Y	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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	3		Y	Generic	4	01	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	20.00											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												
H3192	001	0	1	02	01	H3192_001_0	3		Y	Generic	4	01	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	20.00											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										1		
H3192	001	0	1	02	01	H3192_001_0	3		Y	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					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	3		Y	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					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	3		Y	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											870.54	33						420.22	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3192	002	0	1	02	01	H3192_002_0	2		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					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	2		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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	2		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					10.00	20.00	20.00											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												
H3192	002	0	1	02	01	H3192_002_0	2		N	Generic	4	01	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	20.00											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										1		
H3192	002	0	1	02	01	H3192_002_0	2		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					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	2		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					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	2		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											828.25	33						534.05	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3192	003	0	1	02	01	H3192_003_0	2		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					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	2		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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	2		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					10.00	20.00	20.00											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												
H3192	003	0	1	02	01	H3192_003_0	2		N	Generic	4	01	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	20.00											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										1		
H3192	003	0	1	02	01	H3192_003_0	2		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					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	2		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					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	2		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											703.50	33						631.42	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3192	004	0	1	02	01	H3192_004_0	2		Y	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					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	2		Y	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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	2		Y	Generic	4	01	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	20.00											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												
H3192	004	0	1	02	01	H3192_004_0	2		Y	Generic	4	01	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	20.00											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										1		
H3192	004	0	1	02	01	H3192_004_0	2		Y	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					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	2		Y	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					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	2		Y	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											948.42	33						524.65	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3192	005	0	1	02	01	H3192_005_0	2		Y	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					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	2		Y	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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	2		Y	Generic	4	01	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	20.00											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												
H3192	005	0	1	02	01	H3192_005_0	2		Y	Generic	4	01	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	20.00											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										1		
H3192	005	0	1	02	01	H3192_005_0	2		Y	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					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	2		Y	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					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	2		Y	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1060.36	33						614.41	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3192	006	0	1	02	01	H3192_006_0	3		Y	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					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	3		Y	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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	3		Y	Generic	4	01	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	20.00											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												
H3192	006	0	1	02	01	H3192_006_0	3		Y	Generic	4	01	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	20.00											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										1		
H3192	006	0	1	02	01	H3192_006_0	3		Y	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					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	3		Y	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					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	3		Y	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											841.44	33						557.33	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3192	010	0	1	02	01	H3192_010_0	2		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					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	010	0	1	02	01	H3192_010_0	2		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3192	010	0	1	02	01	H3192_010_0	2		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					10.00	20.00	20.00											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												
H3192	010	0	1	02	01	H3192_010_0	2		N	Generic	4	01	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	20.00											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										1		
H3192	010	0	1	02	01	H3192_010_0	2		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					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	010	0	1	02	01	H3192_010_0	2		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					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	010	0	1	02	01	H3192_010_0	2		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											987.53	33						557.22	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3192	011	0	1	02	01	H3192_011_0	2		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					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	011	0	1	02	01	H3192_011_0	2		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3192	011	0	1	02	01	H3192_011_0	2		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					10.00	20.00	20.00											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												
H3192	011	0	1	02	01	H3192_011_0	2		N	Generic	4	01	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	20.00											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										1		
H3192	011	0	1	02	01	H3192_011_0	2		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					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	011	0	1	02	01	H3192_011_0	2		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					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	011	0	1	02	01	H3192_011_0	2		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											987.53	33						557.22	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3192	012	0	1	02	01	H3192_012_0	2		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					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	012	0	1	02	01	H3192_012_0	2		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3192	012	0	1	02	01	H3192_012_0	2		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					10.00	20.00	20.00											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												
H3192	012	0	1	02	01	H3192_012_0	2		N	Generic	4	01	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	20.00											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										1		
H3192	012	0	1	02	01	H3192_012_0	2		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					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	012	0	1	02	01	H3192_012_0	2		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					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	012	0	1	02	01	H3192_012_0	2		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											961.13	33						558.90	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3192	013	0	1	02	01	H3192_013_0	3		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					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	013	0	1	02	01	H3192_013_0	3		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3192	013	0	1	02	01	H3192_013_0	3		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					10.00	20.00	20.00											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												
H3192	013	0	1	02	01	H3192_013_0	3		N	Generic	4	01	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	20.00											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										1		
H3192	013	0	1	02	01	H3192_013_0	3		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					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	013	0	1	02	01	H3192_013_0	3		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					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	013	0	1	02	01	H3192_013_0	3		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											957.20	33						558.85	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3192	014	0	1	02	01	H3192_014_0	2		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					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	014	0	1	02	01	H3192_014_0	2		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3192	014	0	1	02	01	H3192_014_0	2		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					10.00	20.00	20.00											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												
H3192	014	0	1	02	01	H3192_014_0	2		N	Generic	4	01	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	20.00											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										1		
H3192	014	0	1	02	01	H3192_014_0	2		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					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	014	0	1	02	01	H3192_014_0	2		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					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	014	0	1	02	01	H3192_014_0	2		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											806.28	27						474.37	27												27						27						27		27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3192	015	0	1	02	01	H3192_015_0	2		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					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	015	0	1	02	01	H3192_015_0	2		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3192	015	0	1	02	01	H3192_015_0	2		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					10.00	20.00	20.00											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												
H3192	015	0	1	02	01	H3192_015_0	2		N	Generic	4	01	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	20.00											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										1		
H3192	015	0	1	02	01	H3192_015_0	2		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					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	015	0	1	02	01	H3192_015_0	2		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					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	015	0	1	02	01	H3192_015_0	2		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											806.28	27						474.37	27												27						27						27		27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3192	017	0	1	02	01	H3192_017_0	2		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					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	017	0	1	02	01	H3192_017_0	2		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3192	017	0	1	02	01	H3192_017_0	2		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					10.00	20.00	20.00											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												
H3192	017	0	1	02	01	H3192_017_0	2		N	Generic	4	01	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	20.00											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										1		
H3192	017	0	1	02	01	H3192_017_0	2		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					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	017	0	1	02	01	H3192_017_0	2		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					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	017	0	1	02	01	H3192_017_0	2		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											987.53	33						557.22	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3204	001	0	1	01	01	H3204_001_0	7		Y	Preferred Generic	4	01	1	2	1	1	111		01		111	1	30	60	90				2	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3204	001	0	1	01	01	H3204_001_0	7		Y	Generic	4	01	1	2	2	1	111		01		111	1	30	60	90				2	2				30	60	90	30		31	10.00	20.00	30.00																									10.00	20.00	30.00				10.00	20.00	20.00				10.00				10.00		0.33				0.33	0.33	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3204	001	0	1	01	01	H3204_001_0	7		Y	Preferred Brand	4	11	1	2	3	1	111		01		111	1	30	60	90				2	2				30	60	90	30		31	45.00	90.00	135.00																									45.00	90.00	135.00				45.00	90.00	112.50				45.00				45.00		1.50				1.50	1.50	1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3204	001	0	1	01	01	H3204_001_0	7		Y	Non-Preferred Drug	4	11	1	2	4	1	111		01		111	1	30	60	90				2	2				30	60	90	30		31	95.00	190.00	285.00																									95.00	190.00	285.00				95.00	190.00	285.00				95.00				95.00		3.17				3.17	3.17	3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3204	001	0	1	01	01	H3204_001_0	7		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3204	007	0	1	01	01	H3204_007_0	7		Y	Preferred Generic	4	01	1	2	1	1	111		01		111	1	30	60	90				2	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3204	007	0	1	01	01	H3204_007_0	7		Y	Preferred Generic	4	01	1	2	1	3	111		01		111	1	30	60	90				2	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3204	007	0	1	01	01	H3204_007_0	7		Y	Generic	4	01	1	2	2	1	111		01		111	1	30	60	90				2	2				30	60	90	30		31	10.00	20.00	30.00																									10.00	20.00	30.00				10.00	20.00	20.00				10.00				10.00		0.33				0.33	0.33	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3204	007	0	1	01	01	H3204_007_0	7		Y	Generic	4	01	1	2	2	3	111		01		111	1	30	60	90				2	2				30	60	90	30		31	10.00	20.00	30.00																									10.00	20.00	30.00				10.00	20.00	20.00				10.00				10.00		0.33				0.33	0.33	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3204	007	0	1	01	01	H3204_007_0	7		Y	Preferred Brand	4	11	1	2	3	1	111		01		111	1	30	60	90				2	2				30	60	90	30		31	45.00	90.00	135.00																									45.00	90.00	135.00				45.00	90.00	112.50				45.00				45.00		1.50				1.50	1.50	1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3204	007	0	1	01	01	H3204_007_0	7		Y	Non-Preferred Drug	4	11	1	2	4	1	111		01		111	1	30	60	90				2	2				30	60	90	30		31	95.00	190.00	285.00																									95.00	190.00	285.00				95.00	190.00	285.00				95.00				95.00		3.17				3.17	3.17	3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3204	007	0	1	01	01	H3204_007_0	7		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3204	013	4	1	01	01	H3204_013_4	8		N	Preferred Generic	3	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 Drug, Specialty Tier												
H3204	013	4	1	01	01	H3204_013_4	8		N	Generic	3	11	1	2	2	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31	11.00	22.00	33.00																			11.00	22.00	33.00																11.00				11.00		0.37			0.37			0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3204	013	4	1	01	01	H3204_013_4	8		N	Preferred Brand	3	11	1	2	3	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	141.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3204	013	4	1	01	01	H3204_013_4	8		N	Non-Preferred Drug	3	11	1	1	4	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31				90.00	43	43	43																		43	43	43															43			43								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3204	013	4	1	01	01	H3204_013_4	8		N	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	8		N	Preferred Generic	3	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 Drug, Specialty Tier												
H3204	013	5	1	01	01	H3204_013_5	8		N	Generic	3	11	1	2	2	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31	11.00	22.00	33.00																			11.00	22.00	33.00																11.00				11.00		0.37			0.37			0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3204	013	5	1	01	01	H3204_013_5	8		N	Preferred Brand	3	11	1	2	3	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	141.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3204	013	5	1	01	01	H3204_013_5	8		N	Non-Preferred Drug	3	11	1	1	4	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31				90.00	43	43	43																		43	43	43															43			43								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3204	013	5	1	01	01	H3204_013_5	8		N	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	015	0	1	02	01	H3204_015_0	9		N	Preferred Generic	4	01	1	2	1	1	111		01		111	1	30	60	90				2	2				30	60	90	30		31	4.00	8.00	12.00																									4.00	8.00	12.00				4.00	8.00	8.00				4.00				4.00		0.13				0.13	0.13	0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3204	015	0	1	02	01	H3204_015_0	9		N	Preferred Generic	4	01	1	2	1	3	111		01		111	1	30	60	90				2	2				30	60	90	30		31	4.00	8.00	12.00																									4.00	8.00	12.00				4.00	8.00	8.00				4.00				4.00		0.13				0.13	0.13	0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3204	015	0	1	02	01	H3204_015_0	9		N	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	015	0	1	02	01	H3204_015_0	9		N	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	015	0	1	02	01	H3204_015_0	9		N	Preferred Brand	4	11	1	2	3	1	111		01		111	1	30	60	90				2	2				30	60	90	30		31	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	015	0	1	02	01	H3204_015_0	9		N	Non-Preferred Drug	4	11	1	2	4	1	111		01		111	1	30	60	90				2	2				30	60	90	30		31	95.00	190.00	285.00																									95.00	190.00	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	015	0	1	02	01	H3204_015_0	9		N	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3206	001	0	1	04	01	H3206_001_0	8			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	8			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	8			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	8			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	8			Specialty Tier	3	11	1	1	5	1	010		01		010	1	30											30			30		31					25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3219	001	0	1	04	01	H3219_001_0	6		Y	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					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	6		Y	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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	6		Y	Generic	4	01	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	6		Y	Generic	4	01	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	6		Y	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					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	6		Y	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					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	6		Y	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											644.45	29						919.01	29												29						29						29		29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3219	002	0	1	04	01	H3219_002_0	3		Y	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					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	3		Y	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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	3		Y	Generic	4	01	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	3		Y	Generic	4	01	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	3		Y	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3219	002	0	1	04	01	H3219_002_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3219	002	0	1	04	01	H3219_002_0	3		Y	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1018.35	30						715.29	30												30						30						30		30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3219	003	0	1	04	01	H3219_003_0	3		Y	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					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	3		Y	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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	3		Y	Generic	4	01	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	3		Y	Generic	4	01	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	3		Y	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3219	003	0	1	04	01	H3219_003_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3219	003	0	1	04	01	H3219_003_0	3		Y	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1085.48	33						528.46	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		Y	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					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		Y	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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		Y	Generic	4	01	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		Y	Generic	4	01	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		Y	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					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		Y	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					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		Y	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											712.19	33						397.30	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3240	013	0	1	01	01	H3240_013_0	7		N	Preferred Generic	4	01	3	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3240	013	0	1	01	01	H3240_013_0	7		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3240	013	0	1	01	01	H3240_013_0	7		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								47.00	94.00	141.00					47.00	94.00	141.00					47.00	141.00	141.00																47.00				47.00			1.57	1.57	1.57			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3240	013	0	1	01	01	H3240_013_0	7		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	285.00	285.00																100.00				100.00			3.33	3.17	3.17			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3240	013	0	1	01	01	H3240_013_0	7		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												25							25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3240	013	0	1	01	01	H3240_013_0	7		N	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3240	017	0	1	02	01	H3240_017_0	6		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								8.00	16.00	24.00					3.00	6.00	9.00					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	6		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								15.00	30.00	45.00					10.00	20.00	30.00					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	6		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00	126.00	126.00																47.00				47.00			1.57	1.40	1.40			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3240	017	0	1	02	01	H3240_017_0	6		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								99.00	198.00	297.00					94.00	188.00	282.00					94.00	282.00	282.00																99.00				99.00			3.30	3.13	3.13			2.91	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3240	017	0	1	02	01	H3240_017_0	6		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												30							30						30																	30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3240	017	0	1	02	01	H3240_017_0	6		N	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3240	021	0	1	01	01	H3240_021_0	8		N	Preferred Generic	4	01	3	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								10.00	20.00	30.00					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												
H3240	021	0	1	01	01	H3240_021_0	8		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								15.00	30.00	45.00					15.00	30.00	45.00					15.00	45.00	45.00																15.00				15.00			0.50	0.50	0.50			0.44	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3240	021	0	1	01	01	H3240_021_0	8		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								47.00	94.00	141.00					47.00	94.00	141.00					47.00	141.00	141.00																47.00				47.00			1.57	1.57	1.57			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3240	021	0	1	01	01	H3240_021_0	8		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	285.00	285.00																100.00				100.00			3.33	3.17	3.17			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3240	021	0	1	01	01	H3240_021_0	8		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												25							25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3240	021	0	1	01	01	H3240_021_0	8		N	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								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												
H3240	022	0	1	01	01	H3240_022_0	6		Y	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		Y	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		Y	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												
H3240	022	0	1	01	01	H3240_022_0	6		Y	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	
H3240	022	0	1	01	01	H3240_022_0	6		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				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		Y	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		Y	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				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		Y	Select Care Drugs	4	01	1	2	6	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H3240	024	0	1	02	01	H3240_024_0	6		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3240	024	0	1	02	01	H3240_024_0	6		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								4.00	8.00	12.00					4.00	8.00	12.00					4.00	12.00	12.00																4.00				4.00			0.13	0.13	0.13			0.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3240	024	0	1	02	01	H3240_024_0	6		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								43.00	86.00	129.00					43.00	86.00	129.00					43.00	129.00	129.00																43.00				43.00			1.43	1.43	1.43			1.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3240	024	0	1	02	01	H3240_024_0	6		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	285.00	285.00																100.00				100.00			3.33	3.17	3.17			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3240	024	0	1	02	01	H3240_024_0	6		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												25							25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3240	024	0	1	02	01	H3240_024_0	6		N	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3251	002	0	1	01	01	H3251_002_0	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					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												
H3251	002	0	1	01	01	H3251_002_0	7			Preferred Generic	4	01	1	2	1	3		111	01		111	1				30	60	100	1	2				30	60	100	30		31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	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		
H3251	002	0	1	01	01	H3251_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											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												
H3251	002	0	1	01	01	H3251_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	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												
H3251	002	0	1	01	01	H3251_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	200.00	300.00				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	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												
H3251	030	0	1	01	01	H3251_030_0	7			Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	100	1	2				30	60	100	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												
H3251	030	0	1	01	01	H3251_030_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					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												
H3251	030	0	1	01	01	H3251_030_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					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												
H3251	030	0	1	01	01	H3251_030_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					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												
H3251	030	0	1	01	01	H3251_030_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												
H3274	002	0	1	01	01	H3274_002_0	5		Y	Preferred Generic	4	01	1	2	1	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	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	5		Y	Generic	4	01	1	2	2	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	15.00	30.00	45.00																			15.00	30.00	45.00																	15.00			15.00		0.50			0.50			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3274	002	0	1	01	01	H3274_002_0	5		Y	Preferred Brand	4	10	1	2	3	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	45.00	90.00	135.00																			45.00	90.00	135.00																	45.00			45.00		1.50			1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3274	002	0	1	01	01	H3274_002_0	5		Y	Non-Preferred Brand	4	10	1	2	4	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	95.00	190.00	285.00																			95.00	190.00	285.00																	95.00			95.00		3.17			3.17			3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3274	002	0	1	01	01	H3274_002_0	5		Y	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	5		Y	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	5		Y	Generic	4	01	1	2	2	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	15.00	30.00	45.00																			15.00	30.00	45.00																	15.00			15.00		0.50			0.50			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3274	003	0	1	01	01	H3274_003_0	5		Y	Preferred Brand	4	10	1	2	3	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	45.00	90.00	135.00																			45.00	90.00	135.00																	45.00			45.00		1.50			1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3274	003	0	1	01	01	H3274_003_0	5		Y	Non-Preferred Brand	4	10	1	2	4	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	95.00	190.00	285.00																			95.00	190.00	285.00																	95.00			95.00		3.17			3.17			3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3274	003	0	1	01	01	H3274_003_0	5		Y	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	004	0	1	01	01	H3274_004_0	6		Y	Preferred Generic	4	01	1	2	1	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	2.00	4.00	6.00																			2.00	4.00	6.00																	2.00			2.00		0.07			0.07			0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3274	004	0	1	01	01	H3274_004_0	6		Y	Generic	4	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																			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												
H3274	004	0	1	01	01	H3274_004_0	6		Y	Preferred Brand	4	10	1	2	3	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	45.00	90.00	135.00																			45.00	90.00	135.00																	45.00			45.00		1.50			1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3274	004	0	1	01	01	H3274_004_0	6		Y	Non-Preferred Brand	4	10	1	2	4	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	95.00	190.00	285.00																			95.00	190.00	285.00																	95.00			95.00		3.17			3.17			3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3274	004	0	1	01	01	H3274_004_0	6		Y	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, Select Care Drugs												
H3274	004	0	1	01	01	H3274_004_0	6		Y	Select Care Drugs	4	11	1	2	6	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 Brand, Specialty Tier, Select Care Drugs												
H3276	001	0	1	01	01	H3276_001_0	10		N	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	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, Select Care Drugs												
H3276	001	0	1	01	01	H3276_001_0	10		N	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	16.00	32.00	48.00																			16.00	32.00	48.00																16.00				16.00		0.53			0.53			0.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3276	001	0	1	01	01	H3276_001_0	10		N	Preferred Brand	4	10	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	47.00	94.00	141.00																			47.00	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												
H3276	001	0	1	01	01	H3276_001_0	10		N	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	100.00	200.00	300.00																			100.00	200.00	300.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3276	001	0	1	01	01	H3276_001_0	10		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31					25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3276	001	0	1	01	01	H3276_001_0	10		N	Select Care Drugs	4	01	1	2	6	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	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, Select Care Drugs												
H3276	002	0	1	01	01	H3276_002_0	10		N	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	8.00	16.00	24.00																			8.00	16.00	24.00																8.00				8.00		0.27			0.27			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3276	002	0	1	01	01	H3276_002_0	10		N	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	18.00	36.00	54.00																			18.00	36.00	54.00																18.00				18.00		0.60			0.60			0.58	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3276	002	0	1	01	01	H3276_002_0	10		N	Preferred Brand	4	10	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	47.00	94.00	141.00																			47.00	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												
H3276	002	0	1	01	01	H3276_002_0	10		N	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	100.00	200.00	300.00																			100.00	200.00	300.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3276	002	0	1	01	01	H3276_002_0	10		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31					25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3276	002	0	1	01	01	H3276_002_0	10		N	Select Care Drugs	4	01	1	2	6	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	8.00	16.00	24.00																			8.00	16.00	24.00																8.00				8.00		0.27			0.27			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3276	003	0	1	01	01	H3276_003_0	9		N	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	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												
H3276	003	0	1	01	01	H3276_003_0	9		N	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	15.00	30.00	45.00																			15.00	30.00	45.00																15.00				15.00		0.50			0.50			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3276	003	0	1	01	01	H3276_003_0	9		N	Preferred Brand	4	10	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	141.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3276	003	0	1	01	01	H3276_003_0	9		N	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	100.00	200.00	300.00																			100.00	200.00	300.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3276	003	0	1	01	01	H3276_003_0	9		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31					25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3276	003	0	1	01	01	H3276_003_0	9		N	Select Care Drugs	4	01	1	2	6	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	5.00	10.00	15.00																			5.00	10.00	15.00																5.00				5.00		0.17			0.17			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
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					10.00	20.00	20.00											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												
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					10.00	20.00	20.00											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										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											994.26	28						417.55	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					10.00	20.00	20.00											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												
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					10.00	20.00	20.00											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										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											1094.96	28						454.23	28												28						28						28		28								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					10.00	20.00	20.00											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												
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					10.00	20.00	20.00											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										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											969.12	28						519.85	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					10.00	20.00	20.00											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												
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					10.00	20.00	20.00											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										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											854.27	28						373.69	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					10.00	20.00	20.00											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												
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					10.00	20.00	20.00											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										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											1065.77	29						487.71	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					10.00	20.00	20.00											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												
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					10.00	20.00	20.00											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										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											761.32	28						559.24	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					10.00	20.00	20.00											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												
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					10.00	20.00	20.00											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										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											895.56	29						502.03	29												29						29						29		29								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					10.00	20.00	20.00											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												
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					10.00	20.00	20.00											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										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											754.33	29						400.34	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					10.00	20.00	20.00											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												
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					10.00	20.00	20.00											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										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											984.11	29						601.47	29												29						29						29		29								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					10.00	20.00	20.00											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												
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					10.00	20.00	20.00											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										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											673.72	29						703.57	29												29						29						29		29								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					10.00	20.00	20.00											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												
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					10.00	20.00	20.00											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										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											973.94	28						529.78	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					10.00	20.00	20.00											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												
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					10.00	20.00	20.00											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										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											810.38	29						397.37	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					10.00	20.00	20.00											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												
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					10.00	20.00	20.00											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										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											782.59	28						522.82	28												28						28						28		28								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								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00					5.00			5.00			0.17	0.00		0.17	0.00	0.16	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								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00					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		
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								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00					10.00			10.00			0.33	0.00		0.33	0.00	0.32	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								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00					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		
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											782.28	33						503.42	33												33						33						33		33								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								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00					5.00			5.00			0.17	0.00		0.17	0.00	0.16	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								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00					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		
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								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00					10.00			10.00			0.33	0.00		0.33	0.00	0.32	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								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00					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		
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											720.98	33						526.77	33												33						33						33		33								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					10.00	20.00	20.00											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												
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					10.00	20.00	20.00											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										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											742.45	28						556.01	28												28						28						28		28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3288	023	0	1	04	01	H3288_023_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												
H3288	023	0	1	04	01	H3288_023_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		
H3288	023	0	1	04	01	H3288_023_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												
H3288	023	0	1	04	01	H3288_023_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		
H3288	023	0	1	04	01	H3288_023_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												
H3288	023	0	1	04	01	H3288_023_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												
H3288	023	0	1	04	01	H3288_023_0	3			Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											991.65	30						587.56	30												30						30						30		30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3288	024	0	1	04	01	H3288_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												
H3288	024	0	1	04	01	H3288_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		
H3288	024	0	1	04	01	H3288_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												
H3288	024	0	1	04	01	H3288_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		
H3288	024	0	1	04	01	H3288_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												
H3288	024	0	1	04	01	H3288_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												
H3288	024	0	1	04	01	H3288_024_0	3			Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											794.98	30						573.16	30												30						30						30		30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3288	025	0	1	04	01	H3288_025_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	025	0	1	04	01	H3288_025_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	025	0	1	04	01	H3288_025_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	025	0	1	04	01	H3288_025_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	025	0	1	04	01	H3288_025_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	025	0	1	04	01	H3288_025_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	025	0	1	04	01	H3288_025_0	2			Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1232.85	30						788.28	30												30						30						30		30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3288	026	0	1	04	01	H3288_026_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												
H3288	026	0	1	04	01	H3288_026_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		
H3288	026	0	1	04	01	H3288_026_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												
H3288	026	0	1	04	01	H3288_026_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		
H3288	026	0	1	04	01	H3288_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												
H3288	026	0	1	04	01	H3288_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												
H3288	026	0	1	04	01	H3288_026_0	3			Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											967.76	30						555.42	30												30						30						30		30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3288	027	0	1	04	01	H3288_027_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												
H3288	027	0	1	04	01	H3288_027_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		
H3288	027	0	1	04	01	H3288_027_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												
H3288	027	0	1	04	01	H3288_027_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		
H3288	027	0	1	04	01	H3288_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												
H3288	027	0	1	04	01	H3288_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												
H3288	027	0	1	04	01	H3288_027_0	3			Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1013.26	30						765.29	30												30						30						30		30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3288	028	0	1	04	01	H3288_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												
H3288	028	0	1	04	01	H3288_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		
H3288	028	0	1	04	01	H3288_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												
H3288	028	0	1	04	01	H3288_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		
H3288	028	0	1	04	01	H3288_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												
H3288	028	0	1	04	01	H3288_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												
H3288	028	0	1	04	01	H3288_028_0	3			Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											978.63	30						606.05	30												30						30						30		30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3288	029	0	1	04	01	H3288_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												
H3288	029	0	1	04	01	H3288_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		
H3288	029	0	1	04	01	H3288_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					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					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	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		
H3288	029	0	1	04	01	H3288_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												
H3288	029	0	1	04	01	H3288_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												
H3288	029	0	1	04	01	H3288_029_0	3			Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1279.54	30						692.47	30												30						30						30		30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3288	030	0	1	04	01	H3288_030_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												
H3288	030	0	1	04	01	H3288_030_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		
H3288	030	0	1	04	01	H3288_030_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												
H3288	030	0	1	04	01	H3288_030_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		
H3288	030	0	1	04	01	H3288_030_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												
H3288	030	0	1	04	01	H3288_030_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												
H3288	030	0	1	04	01	H3288_030_0	3			Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1153.64	30						506.56	30												30						30						30		30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3288	031	0	1	04	01	H3288_031_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												
H3288	031	0	1	04	01	H3288_031_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		
H3288	031	0	1	04	01	H3288_031_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												
H3288	031	0	1	04	01	H3288_031_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		
H3288	031	0	1	04	01	H3288_031_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												
H3288	031	0	1	04	01	H3288_031_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												
H3288	031	0	1	04	01	H3288_031_0	3			Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											882.15	30						546.39	30												30						30						30		30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3288	032	0	1	04	01	H3288_032_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												
H3288	032	0	1	04	01	H3288_032_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		
H3288	032	0	1	04	01	H3288_032_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												
H3288	032	0	1	04	01	H3288_032_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		
H3288	032	0	1	04	01	H3288_032_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												
H3288	032	0	1	04	01	H3288_032_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												
H3288	032	0	1	04	01	H3288_032_0	3			Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1274.90	30						602.81	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					10.00	20.00	20.00											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												
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					10.00	20.00	20.00											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										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											964.65	30						539.41	30												30						30						30		30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3288	042	0	1	04	01	H3288_042_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												
H3288	042	0	1	04	01	H3288_042_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		
H3288	042	0	1	04	01	H3288_042_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												
H3288	042	0	1	04	01	H3288_042_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		
H3288	042	0	1	04	01	H3288_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					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					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	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												
H3288	042	0	1	04	01	H3288_042_0	3			Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1017.07	30						840.77	30												30						30						30		30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3288	045	0	1	04	01	H3288_045_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					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												
H3288	045	0	1	04	01	H3288_045_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					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		
H3288	045	0	1	04	01	H3288_045_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	0.00											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												
H3288	045	0	1	04	01	H3288_045_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	0.00											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		
H3288	045	0	1	04	01	H3288_045_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												
H3288	045	0	1	04	01	H3288_045_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												
H3288	045	0	1	04	01	H3288_045_0	3			Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1128.38	25						627.93	25												25						25						25		25								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					10.00	20.00	20.00											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												
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					10.00	20.00	20.00											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										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											1059.27	28						940.15	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					10.00	20.00	20.00											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												
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					10.00	20.00	20.00											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										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											808.74	28						513.58	28												28						28						28		28								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					10.00	20.00	20.00											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												
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					10.00	20.00	20.00											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										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											964.77	30						803.08	30												30						30						30		30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3305	015	0	1	02	01	H3305_015_0	8		Y	Preferred Generic	4	01	1	2	1	1	110		01	110		1	30		90				1	2	30		90				30		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3305	015	0	1	02	01	H3305_015_0	8		Y	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		Y	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		Y	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		Y	Non-Preferred Drug	4	11	1	1	4	1	110		01	110		1	30		90				2	2	30		90				30		31				97.73	26		26																		26		26															26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3305	015	0	1	02	01	H3305_015_0	8		Y	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	8		Y	Preferred Generic	4	01	1	2	1	1	110		01	110		1	30		90				1	2	30		90				30		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3305	021	0	1	02	01	H3305_021_0	8		Y	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	8		Y	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	8		Y	Preferred Brand	4	11	1	2	3	1	110		01	110		1	30		90				2	2	30		90				30		31	35.00		105.00																			35.00		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	8		Y	Non-Preferred Drug	4	11	1	1	4	1	110		01	110		1	30		90				2	2	30		90				30		31				95.31	26		26																		26		26															26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3305	021	0	1	02	01	H3305_021_0	8		Y	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	8		Y	Preferred Generic	4	01	1	2	1	1	110		01	110		1	30		90				1	2	30		90				30		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3305	022	0	1	02	01	H3305_022_0	8		Y	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	8		Y	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	8		Y	Preferred Brand	4	11	1	2	3	1	110		01	110		1	30		90				2	2	30		90				30		31	45.00		135.00																			45.00		90.00																45.00				45.00		1.50			1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3305	022	0	1	02	01	H3305_022_0	8		Y	Non-Preferred Drug	4	11	1	1	4	1	110		01	110		1	30		90				2	2	30		90				30		31				91.39	25		25																		25		25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3305	022	0	1	02	01	H3305_022_0	8		Y	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	8		Y	Preferred Generic	4	01	1	2	1	1	110		01	110		1	30		90				1	2	30		90				30		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3305	030	0	1	02	01	H3305_030_0	8		Y	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	8		Y	Preferred Brand	4	11	1	2	3	1	110		01	110		1	30		90				2	2	30		90				30		31	47.00		141.00																			47.00		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	8		Y	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	8		Y	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	8		Y	Preferred Generic	4	01	1	2	1	1	110		01	110		1	30		90				1	2	30		90				30		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3305	032	0	1	02	01	H3305_032_0	8		Y	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	8		Y	Preferred Brand	4	11	1	2	3	1	110		01	110		1	30		90				2	2	30		90				30		31	47.00		141.00																			47.00		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	8		Y	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	8		Y	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	02	01	H3307_002_0	2		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3307	002	0	1	02	01	H3307_002_0	2		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3307	002	0	1	02	01	H3307_002_0	2		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3307	002	0	1	02	01	H3307_002_0	2		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H3307	002	0	1	02	01	H3307_002_0	2		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3307	002	0	1	02	01	H3307_002_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3307	002	0	1	02	01	H3307_002_0	2		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				410.00	29																										29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3307	012	0	1	02	01	H3307_012_0	2		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3307	012	0	1	02	01	H3307_012_0	2		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3307	012	0	1	02	01	H3307_012_0	2		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3307	012	0	1	02	01	H3307_012_0	2		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H3307	012	0	1	02	01	H3307_012_0	2		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3307	012	0	1	02	01	H3307_012_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3307	012	0	1	02	01	H3307_012_0	2		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				287.00	26																										26						26					26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3307	015	0	1	02	01	H3307_015_0	2		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3307	015	0	1	02	01	H3307_015_0	2		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3307	015	0	1	02	01	H3307_015_0	2		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3307	015	0	1	02	01	H3307_015_0	2		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H3307	015	0	1	02	01	H3307_015_0	2		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3307	015	0	1	02	01	H3307_015_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3307	015	0	1	02	01	H3307_015_0	2		Y	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												
H3307	023	0	1	02	01	H3307_023_0	2		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3307	023	0	1	02	01	H3307_023_0	2		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3307	023	0	1	02	01	H3307_023_0	2		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3307	023	0	1	02	01	H3307_023_0	2		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H3307	023	0	1	02	01	H3307_023_0	2		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3307	023	0	1	02	01	H3307_023_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3307	023	0	1	02	01	H3307_023_0	2		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				377.00	28																										28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3307	025	0	1	02	01	H3307_025_0	2		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3307	025	0	1	02	01	H3307_025_0	2		Y	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		
H3307	025	0	1	02	01	H3307_025_0	2		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3307	025	0	1	02	01	H3307_025_0	2		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H3307	025	0	1	02	01	H3307_025_0	2		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3307	025	0	1	02	01	H3307_025_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3307	025	0	1	02	01	H3307_025_0	2		Y	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												
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					5.00	10.00	10.00											20.00	40.00	60.00				5.00	10.00	10.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3312	002	0	1	01	01	H3312_002_0	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		
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											736.19	29						502.50	29												29						29						29		29								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											1102.15	30						703.48	30												30						30						30		30								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											897.19	33						573.03	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					10.00	20.00	20.00											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												
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					10.00	20.00	20.00											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										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											788.11	28						511.09	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					5.00	10.00	10.00											20.00	40.00	60.00				5.00	10.00	10.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3312	064	0	1	01	01	H3312_064_0	3			Generic	4	01	1	2	2	3		111	10		111	1				30	60	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		
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											729.43	29						407.21	29												29						29						29		29								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											891.05	30						527.18	30												30						30						30		30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3312	072	0	1	01	01	H3312_072_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	072	0	1	01	01	H3312_072_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	072	0	1	01	01	H3312_072_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	20.00											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												
H3312	072	0	1	01	01	H3312_072_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	20.00											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										1		
H3312	072	0	1	01	01	H3312_072_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	072	0	1	01	01	H3312_072_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	072	0	1	01	01	H3312_072_0	3			Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											922.71	29						530.89	29												29						29						29		29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3330	021	1	1	01	01	H3330_021_1	10		Y	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								7.00	14.00	21.00					2.00	4.00	6.00											7.00	14.00	21.00				0.00	0.00	0.00				7.00				7.00			0.23	0.07		0.23	0.00	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3330	021	1	1	01	01	H3330_021_1	10		Y	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					10.00	20.00	30.00											20.00	40.00	60.00				0.00	0.00	0.00				20.00				20.00			0.67	0.33		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3330	021	1	1	01	01	H3330_021_1	10		Y	Preferred Brand	4	10	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					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												
H3330	021	1	1	01	01	H3330_021_1	10		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	300.00					95.00	190.00	285.00											100.00	200.00	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												
H3330	021	1	1	01	01	H3330_021_1	10		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												29							29												29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3330	021	1	1	01	01	H3330_021_1	10		Y	Select Care Drugs	4	01	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3330	021	1	1	01	01	H3330_021_1	10		Y	Select Care Drugs	4	01	1	2	6	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H3330	021	2	1	01	01	H3330_021_2	10		Y	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								7.00	14.00	21.00					2.00	4.00	6.00											7.00	14.00	21.00				0.00	0.00	0.00				7.00				7.00			0.23	0.07		0.23	0.00	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3330	021	2	1	01	01	H3330_021_2	10		Y	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					10.00	20.00	30.00											20.00	40.00	60.00				0.00	0.00	0.00				20.00				20.00			0.67	0.33		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3330	021	2	1	01	01	H3330_021_2	10		Y	Preferred Brand	4	10	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					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												
H3330	021	2	1	01	01	H3330_021_2	10		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	300.00					95.00	190.00	285.00											100.00	200.00	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												
H3330	021	2	1	01	01	H3330_021_2	10		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												29							29												29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3330	021	2	1	01	01	H3330_021_2	10		Y	Select Care Drugs	4	01	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3330	021	2	1	01	01	H3330_021_2	10		Y	Select Care Drugs	4	01	1	2	6	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H3330	021	3	1	01	01	H3330_021_3	11		Y	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								7.00	14.00	21.00					2.00	4.00	6.00											7.00	14.00	21.00				0.00	0.00	0.00				7.00				7.00			0.23	0.07		0.23	0.00	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3330	021	3	1	01	01	H3330_021_3	11		Y	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					10.00	20.00	30.00											20.00	40.00	60.00				0.00	0.00	0.00				20.00				20.00			0.67	0.33		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3330	021	3	1	01	01	H3330_021_3	11		Y	Preferred Brand	4	10	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					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												
H3330	021	3	1	01	01	H3330_021_3	11		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	300.00					95.00	190.00	285.00											100.00	200.00	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												
H3330	021	3	1	01	01	H3330_021_3	11		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												29							29												29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3330	021	3	1	01	01	H3330_021_3	11		Y	Select Care Drugs	4	01	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3330	021	3	1	01	01	H3330_021_3	11		Y	Select Care Drugs	4	01	1	2	6	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H3330	021	4	1	01	01	H3330_021_4	10		Y	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								7.00	14.00	21.00					2.00	4.00	6.00											7.00	14.00	21.00				0.00	0.00	0.00				7.00				7.00			0.23	0.07		0.23	0.00	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3330	021	4	1	01	01	H3330_021_4	10		Y	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					10.00	20.00	30.00											20.00	40.00	60.00				0.00	0.00	0.00				20.00				20.00			0.67	0.33		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3330	021	4	1	01	01	H3330_021_4	10		Y	Preferred Brand	4	10	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					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												
H3330	021	4	1	01	01	H3330_021_4	10		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	300.00					95.00	190.00	285.00											100.00	200.00	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												
H3330	021	4	1	01	01	H3330_021_4	10		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												29							29												29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3330	021	4	1	01	01	H3330_021_4	10		Y	Select Care Drugs	4	01	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3330	021	4	1	01	01	H3330_021_4	10		Y	Select Care Drugs	4	01	1	2	6	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H3330	032	2	1	01	01	H3330_032_2	11		N	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								7.00	14.00	21.00					2.00	4.00	6.00											7.00	14.00	21.00				0.00	0.00	0.00				7.00				7.00			0.23	0.07		0.23	0.00	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3330	032	2	1	01	01	H3330_032_2	11		N	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					15.00	30.00	45.00											20.00	40.00	60.00				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, Select Care Drugs												
H3330	032	2	1	01	01	H3330_032_2	11		N	Preferred Brand	4	10	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				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												
H3330	032	2	1	01	01	H3330_032_2	11		N	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	300.00					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												
H3330	032	2	1	01	01	H3330_032_2	11		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												27							27												27						27					27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3330	032	2	1	01	01	H3330_032_2	11		N	Select Care Drugs	4	01	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3330	032	2	1	01	01	H3330_032_2	11		N	Select Care Drugs	4	01	1	2	6	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H3330	032	3	1	01	01	H3330_032_3	10		N	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								7.00	14.00	21.00					2.00	4.00	6.00											7.00	14.00	21.00				0.00	0.00	0.00				7.00				7.00			0.23	0.07		0.23	0.00	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3330	032	3	1	01	01	H3330_032_3	10		N	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					15.00	30.00	45.00											20.00	40.00	60.00				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, Select Care Drugs												
H3330	032	3	1	01	01	H3330_032_3	10		N	Preferred Brand	4	10	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				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												
H3330	032	3	1	01	01	H3330_032_3	10		N	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	300.00					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												
H3330	032	3	1	01	01	H3330_032_3	10		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												27							27												27						27					27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3330	032	3	1	01	01	H3330_032_3	10		N	Select Care Drugs	4	01	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3330	032	3	1	01	01	H3330_032_3	10		N	Select Care Drugs	4	01	1	2	6	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H3330	032	4	1	01	01	H3330_032_4	11		N	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								7.00	14.00	21.00					2.00	4.00	6.00											7.00	14.00	21.00				0.00	0.00	0.00				7.00				7.00			0.23	0.07		0.23	0.00	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3330	032	4	1	01	01	H3330_032_4	11		N	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					15.00	30.00	45.00											20.00	40.00	60.00				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, Select Care Drugs												
H3330	032	4	1	01	01	H3330_032_4	11		N	Preferred Brand	4	10	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				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												
H3330	032	4	1	01	01	H3330_032_4	11		N	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	300.00					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												
H3330	032	4	1	01	01	H3330_032_4	11		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												27							27												27						27					27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3330	032	4	1	01	01	H3330_032_4	11		N	Select Care Drugs	4	01	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3330	032	4	1	01	01	H3330_032_4	11		N	Select Care Drugs	4	01	1	2	6	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H3330	038	0	1	01	01	H3330_038_0	11		Y	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								7.00	14.00	21.00					2.00	4.00	6.00											7.00	14.00	21.00				0.00	0.00	0.00				7.00				7.00			0.23	0.07		0.23	0.00	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3330	038	0	1	01	01	H3330_038_0	11		Y	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					10.00	20.00	30.00											20.00	40.00	60.00				0.00	0.00	0.00				20.00				20.00			0.67	0.33		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3330	038	0	1	01	01	H3330_038_0	11		Y	Preferred Brand	4	10	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					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												
H3330	038	0	1	01	01	H3330_038_0	11		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	300.00					95.00	190.00	285.00											100.00	200.00	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												
H3330	038	0	1	01	01	H3330_038_0	11		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												29							29												29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3330	038	0	1	01	01	H3330_038_0	11		Y	Select Care Drugs	4	01	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3330	038	0	1	01	01	H3330_038_0	11		Y	Select Care Drugs	4	01	1	2	6	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H3330	042	1	1	01	01	H3330_042_1	11		N	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	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												
H3330	042	1	1	01	01	H3330_042_1	11		N	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	15.00	30.00	45.00																			15.00	30.00	45.00																15.00				15.00		0.50			0.50			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3330	042	1	1	01	01	H3330_042_1	11		N	Preferred Brand	4	10	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	141.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3330	042	1	1	01	01	H3330_042_1	11		N	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	100.00	200.00	300.00																			100.00	200.00	300.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3330	042	1	1	01	01	H3330_042_1	11		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31					25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3330	042	1	1	01	01	H3330_042_1	11		N	Select Care Drugs	4	01	1	2	6	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	5.00	10.00	15.00																			5.00	10.00	15.00																5.00				5.00		0.17			0.17			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3330	042	2	1	01	01	H3330_042_2	11		N	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	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												
H3330	042	2	1	01	01	H3330_042_2	11		N	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	15.00	30.00	45.00																			15.00	30.00	45.00																15.00				15.00		0.50			0.50			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3330	042	2	1	01	01	H3330_042_2	11		N	Preferred Brand	4	10	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	141.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3330	042	2	1	01	01	H3330_042_2	11		N	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	100.00	200.00	300.00																			100.00	200.00	300.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3330	042	2	1	01	01	H3330_042_2	11		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31					25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3330	042	2	1	01	01	H3330_042_2	11		N	Select Care Drugs	4	01	1	2	6	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	5.00	10.00	15.00																			5.00	10.00	15.00																5.00				5.00		0.17			0.17			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3330	042	3	1	01	01	H3330_042_3	11		N	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	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												
H3330	042	3	1	01	01	H3330_042_3	11		N	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	15.00	30.00	45.00																			15.00	30.00	45.00																15.00				15.00		0.50			0.50			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3330	042	3	1	01	01	H3330_042_3	11		N	Preferred Brand	4	10	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	141.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3330	042	3	1	01	01	H3330_042_3	11		N	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	100.00	200.00	300.00																			100.00	200.00	300.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3330	042	3	1	01	01	H3330_042_3	11		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31					25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3330	042	3	1	01	01	H3330_042_3	11		N	Select Care Drugs	4	01	1	2	6	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	5.00	10.00	15.00																			5.00	10.00	15.00																5.00				5.00		0.17			0.17			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3330	045	0	1	01	01	H3330_045_0	11		N	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								7.00	14.00	21.00					2.00	4.00	6.00											7.00	14.00	21.00				0.00	0.00	0.00				7.00				7.00			0.23	0.07		0.23	0.00	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3330	045	0	1	01	01	H3330_045_0	11		N	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					15.00	30.00	45.00											20.00	40.00	60.00				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, Select Care Drugs												
H3330	045	0	1	01	01	H3330_045_0	11		N	Preferred Brand	4	10	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				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												
H3330	045	0	1	01	01	H3330_045_0	11		N	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	300.00					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												
H3330	045	0	1	01	01	H3330_045_0	11		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3330	045	0	1	01	01	H3330_045_0	11		N	Select Care Drugs	4	01	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3330	045	0	1	01	01	H3330_045_0	11		N	Select Care Drugs	4	01	1	2	6	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H3330	046	0	1	01	01	H3330_046_0	12		N	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								7.00	14.00	21.00					2.00	4.00	6.00											7.00	14.00	21.00				0.00	0.00	0.00				7.00				7.00			0.23	0.07		0.23	0.00	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3330	046	0	1	01	01	H3330_046_0	12		N	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					15.00	30.00	45.00											20.00	40.00	60.00				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, Select Care Drugs												
H3330	046	0	1	01	01	H3330_046_0	12		N	Preferred Brand	4	10	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				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												
H3330	046	0	1	01	01	H3330_046_0	12		N	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	300.00					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												
H3330	046	0	1	01	01	H3330_046_0	12		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												27							27												27						27					27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3330	046	0	1	01	01	H3330_046_0	12		N	Select Care Drugs	4	01	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3330	046	0	1	01	01	H3330_046_0	12		N	Select Care Drugs	4	01	1	2	6	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H3335	015	0	1	04	01	H3335_015_0	7		Y	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								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		Y	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		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	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		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	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		Y	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		N	Preferred Generic	3	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								11.00	22.00	33.00					6.00	12.00	18.00											11.00	22.00	33.00				6.00	12.00	18.00				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	018	0	1	04	01	H3335_018_0	6		N	Generic	3	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					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												
H3335	018	0	1	04	01	H3335_018_0	6		N	Preferred Brand	3	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				42.00			1.57	1.40		1.57	1.40	1.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3335	018	0	1	04	01	H3335_018_0	6		N	Non-Preferred Drug	3	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											98.00	31	31	31				93.00	31	31	31										31	31	31				31	31	31			31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3335	018	0	1	04	01	H3335_018_0	6		N	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	8		Y	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								5.00	10.00	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	8		Y	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	8		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	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	8		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	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	8		Y	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	7		Y	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								5.00	10.00	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	7		Y	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	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	7		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	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	7		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	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	7		Y	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	7		Y	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								5.00	10.00	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	055	0	1	04	01	H3335_055_0	7		Y	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								17.00	34.00	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	7		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	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	7		Y	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											92.00	30	30	30				85.00	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	7		Y	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												
H3335	056	0	1	04	01	H3335_056_0	7		Y	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								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	056	0	1	04	01	H3335_056_0	7		Y	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								17.00	34.00	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	056	0	1	04	01	H3335_056_0	7		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	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	056	0	1	04	01	H3335_056_0	7		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	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	056	0	1	04	01	H3335_056_0	7		Y	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												
H3335	057	0	1	04	01	H3335_057_0	7		Y	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								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	057	0	1	04	01	H3335_057_0	7		Y	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								17.00	34.00	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	057	0	1	04	01	H3335_057_0	7		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	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	057	0	1	04	01	H3335_057_0	7		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	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	057	0	1	04	01	H3335_057_0	7		Y	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												
H3335	058	0	1	04	01	H3335_058_0	7		Y	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								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	058	0	1	04	01	H3335_058_0	7		Y	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								17.00	34.00	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	058	0	1	04	01	H3335_058_0	7		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	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	058	0	1	04	01	H3335_058_0	7		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	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	058	0	1	04	01	H3335_058_0	7		Y	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												
H3342	023	1	1	04	01	H3342_023_1	5			Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								8.00	16.00	24.00					3.00	6.00	9.00					3.00	9.00	9.00																8.00				8.00			0.27	0.10	0.10			0.24	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3342	023	1	1	04	01	H3342_023_1	5			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	5			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	5			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	5			Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												28							28						28																	28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3342	023	1	1	04	01	H3342_023_1	5			Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3342	023	1	1	04	01	H3342_023_1	5			Select Care Drugs	4	01	1	2	6	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H3342	023	2	1	04	01	H3342_023_2	5			Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								8.00	16.00	24.00					3.00	6.00	9.00					3.00	9.00	9.00																8.00				8.00			0.27	0.10	0.10			0.24	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3342	023	2	1	04	01	H3342_023_2	5			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	5			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	5			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	5			Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												28							28						28																	28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3342	023	2	1	04	01	H3342_023_2	5			Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3342	023	2	1	04	01	H3342_023_2	5			Select Care Drugs	4	01	1	2	6	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H3344	005	0	1	04	01	H3344_005_0	5		Y	Preferred Generic	4	01	1	2	1	1	110		01	100		1	30		90				1	2			90				30		34	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3344	005	0	1	04	01	H3344_005_0	5		Y	Generic	4	01	3	2	2	1	110		01	100		1	30		90				2	2			90				30		34	15.00		37.50																					37.50																15.00				15.00		0.50						0.44	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3344	005	0	1	04	01	H3344_005_0	5		Y	Preferred Brand	4	11	1	2	3	1	110		01	100		1	30		90				2	2			90				30		34	47.00		117.50																					117.50																47.00				47.00		1.57						1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3344	005	0	1	04	01	H3344_005_0	5		Y	Non-Preferred Drug	4	11	1	1	4	1	110		01	100		1	30		90				2	2			90				30		34				68.63	40		40																				40															40			40								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3344	005	0	1	04	01	H3344_005_0	5		Y	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		34				572.14	30																																					30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3344	010	0	1	04	01	H3344_010_0	5		Y	Preferred Generic	4	01	1	2	1	1	110		01	100		1	30		90				1	2			90				30		34	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3344	010	0	1	04	01	H3344_010_0	5		Y	Preferred Generic	4	01	1	2	1	3	110		01	100		1	30		90				1	2			90				30		34	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3344	010	0	1	04	01	H3344_010_0	5		Y	Generic	4	01	3	2	2	1	110		01	100		1	30		90				2	2			90				30		34	10.00		25.00																					25.00																10.00				10.00		0.33						0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3344	010	0	1	04	01	H3344_010_0	5		Y	Preferred Brand	4	11	1	2	3	1	110		01	100		1	30		90				2	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	5		Y	Non-Preferred Drug	4	11	1	1	4	1	110		01	100		1	30		90				2	2			90				30		34				53.46	40		40																				40															40			40								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3344	010	0	1	04	01	H3344_010_0	5		Y	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		34				596.92	33																																					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3347	009	0	1	01	01	H3347_009_0	3			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	3			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	3			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	3			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	3			Specialty Tier	4	11	1	1	5	1	111		01	100		1	30	60	90				2	2			90				30		31				1077.20	25	25	25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3347	015	0	1	01	01	H3347_015_0	3			Preferred Generic	4	11	1	2	1	1	111		01	100		1	30	60	90				1	2			90				30		31	4.00	8.00	12.00																					8.00																4.00				4.00		0.13						0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3347	015	0	1	01	01	H3347_015_0	3			Generic	4	11	1	2	2	1	111		01	100		1	30	60	90				1	2			90				30		31	14.00	28.00	42.00																					28.00																14.00				14.00		0.47						0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3347	015	0	1	01	01	H3347_015_0	3			Preferred Brand	4	11	1	2	3	1	111		01	100		1	30	60	90				1	2			90				30		31	47.00	94.00	141.00																					94.00																47.00				47.00		1.57						1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3347	015	0	1	01	01	H3347_015_0	3			Non-Preferred Drug	4	11	1	1	4	1	111		01	100		1	30	60	90				1	2			90				30		31				75.87	25	25	25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3347	015	0	1	01	01	H3347_015_0	3			Specialty Tier	4	11	1	1	5	1	111		01	100		1	30	60	90				2	2			90				30		31				749.91	25	25	25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3347	016	0	1	01	01	H3347_016_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												
H3347	016	0	1	01	01	H3347_016_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												
H3347	016	0	1	01	01	H3347_016_0	4			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	016	0	1	01	01	H3347_016_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												
H3347	016	0	1	01	01	H3347_016_0	4			Specialty Tier	4	11	1	1	5	1	111		01	100		1	30	60	90				2	2			90				30		31				1278.34	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		Y	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								5.00	10.00	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		Y	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	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		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	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		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	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		Y	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		Y	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								5.00	10.00	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		Y	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								17.00	34.00	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		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	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		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	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		Y	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	012	0	1	02	01	H3351_012_0	8		Y	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								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	8		Y	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	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	8		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	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	8		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	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	8		Y	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	8		Y	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								5.00	10.00	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	8		Y	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	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	8		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	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	8		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	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	8		Y	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	7		Y	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								5.00	10.00	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	015	0	1	02	01	H3351_015_0	7		Y	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	7		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								45.00	90.00	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	7		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	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	7		Y	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	7		Y	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								5.00	10.00	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	7		Y	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	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	7		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	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	7		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	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	7		Y	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												
H3351	017	0	1	01	01	H3351_017_0	7		Y	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								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	7		Y	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	7		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	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	7		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	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	7		Y	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		Y	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								5.00	10.00	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		Y	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	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		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	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		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	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		Y	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		Y	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								5.00	10.00	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		Y	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		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	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		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	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		Y	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	7		Y	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								5.00	10.00	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	020	0	1	01	01	H3351_020_0	7		Y	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								17.00	34.00	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	7		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	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	7		Y	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											99.00	26	26	26				82.00	26	26	26										26	26	26				26	26	26			26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3351	020	0	1	01	01	H3351_020_0	7		Y	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												
H3351	021	0	1	01	01	H3351_021_0	7		Y	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								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	021	0	1	01	01	H3351_021_0	7		Y	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	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	021	0	1	01	01	H3351_021_0	7		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	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	021	0	1	01	01	H3351_021_0	7		Y	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											88.00	28	28	28				80.00	28	28	28										28	28	28				28	28	28			28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3351	021	0	1	01	01	H3351_021_0	7		Y	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												
H3359	001	0	1	01	01	H3359_001_0	10		Y	Preferred Generic	4	11	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	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	10		Y	Generic	4	11	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	10.00	20.00	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	10		Y	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	47.00	94.00	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	10		Y	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	100.00	200.00	300.00																			100.00	200.00	300.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Supplemental Drugs												
H3359	001	0	1	01	01	H3359_001_0	10		Y	Specialty Tier	4	11	1	1	5	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31					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	10		Y	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	10		Y	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	9		N	Preferred Generic	4	11	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Supplemental Drugs												
H3359	019	0	1	01	01	H3359_019_0	9		N	Generic	4	11	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	20.00	40.00	60.00																			20.00	40.00	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	9		N	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	141.00																47.00				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	9		N	Non-Preferred Drug	4	11	1	1	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31				90.25	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	9		N	Specialty Tier	4	11	1	1	5	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31					25	25	25																		25	25	25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Supplemental Drugs												
H3359	019	0	1	01	01	H3359_019_0	9		N	Supplemental Drugs	4	01	2	2	6	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	2.00	4.00	6.00																			2.00	4.00	6.00																2.00				2.00		0.07			0.07			0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Supplemental Drugs												
H3359	019	0	1	01	01	H3359_019_0	9		N	Supplemental Drugs	4	01	2	2	6	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	6.00																2.00				2.00		0.07			0.07			0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Supplemental Drugs										1		
H3359	021	0	1	01	01	H3359_021_0	9		N	Preferred Generic	4	11	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	5.00	10.00	15.00																			5.00	10.00	15.00																5.00				5.00		0.17			0.17			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Supplemental Drugs												
H3359	021	0	1	01	01	H3359_021_0	9		N	Generic	4	11	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	20.00	40.00	60.00																			20.00	40.00	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	021	0	1	01	01	H3359_021_0	9		N	Preferred Brand	4	11	1	1	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31				28.77	16	16	16																		16	16	16															16			16								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Supplemental Drugs												
H3359	021	0	1	01	01	H3359_021_0	9		N	Non-Preferred Drug	4	11	1	1	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31				92.02	50	50	50																		50	50	50															50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Supplemental Drugs												
H3359	021	0	1	01	01	H3359_021_0	9		N	Specialty Tier	4	11	1	1	5	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31					25	25	25																		25	25	25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Supplemental Drugs												
H3359	021	0	1	01	01	H3359_021_0	9		N	Supplemental Drugs	4	01	2	2	6	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	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	021	0	1	01	01	H3359_021_0	9		N	Supplemental Drugs	4	01	2	2	6	3	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	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										1		
H3359	034	0	1	01	01	H3359_034_0	10		N	Preferred Generic	4	11	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3359	034	0	1	01	01	H3359_034_0	10		N	Generic	4	11	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	20.00	40.00	60.00																			20.00	40.00	60.00																20.00				20.00		0.67			0.67			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3359	034	0	1	01	01	H3359_034_0	10		N	Preferred Brand	4	11	1	1	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31				31.41	19	19	19																		19	19	19															19			19								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3359	034	0	1	01	01	H3359_034_0	10		N	Non-Preferred Drug	4	11	1	1	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31				90.14	50	50	50																		50	50	50															50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3359	034	0	1	01	01	H3359_034_0	10		N	Specialty Tier	4	11	1	1	5	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31					25	25	25																		25	25	25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3359	038	0	1	01	01	H3359_038_0	10		N	Preferred Generic	4	11	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3359	038	0	1	01	01	H3359_038_0	10		N	Generic	4	11	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	15.00	30.00	45.00																			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	10		N	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	141.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3359	038	0	1	01	01	H3359_038_0	10		N	Non-Preferred Drug	4	11	1	1	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31				95.13	44	44	44																		44	44	44															44			44								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3359	038	0	1	01	01	H3359_038_0	10		N	Specialty Tier	4	11	1	1	5	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31					25	25	25																		25	25	25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3362	017	0	1	01	01	H3362_017_0	5		Y	Preferred Generic	4	01	1	2	1	1	110		01	100		1	30		90				1	2			90				30		34	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3362	017	0	1	01	01	H3362_017_0	5		Y	Generic	4	01	3	2	2	1	110		01	100		1	30		90				2	2			90				30		34	10.00		25.00																					25.00																10.00				10.00		0.33						0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3362	017	0	1	01	01	H3362_017_0	5		Y	Preferred Brand	4	11	1	2	3	1	110		01	100		1	30		90				2	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	5		Y	Non-Preferred Drug	4	11	1	1	4	1	110		01	100		1	30		90				2	2			90				30		34				62.03	43		43																				43															43			43								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3362	017	0	1	01	01	H3362_017_0	5		Y	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		34				620.25	33																																					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3362	020	0	1	01	01	H3362_020_0	5		N	Preferred Generic	4	01	1	2	1	1	110		01	100		1	30		90				1	2			90				30		34	4.00		10.00																					10.00																4.00				4.00		0.13						0.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3362	020	0	1	01	01	H3362_020_0	5		N	Generic	4	01	3	2	2	1	110		01	100		1	30		90				2	2			90				30		34	15.00		37.50																					37.50																15.00				15.00		0.50						0.44	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3362	020	0	1	01	01	H3362_020_0	5		N	Preferred Brand	4	11	1	1	3	1	110		01	100		1	30		90				2	2			90				30		34				65.22	25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3362	020	0	1	01	01	H3362_020_0	5		N	Non-Preferred Drug	4	11	1	1	4	1	110		01	100		1	30		90				2	2			90				30		34				30.28	25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3362	020	0	1	01	01	H3362_020_0	5		N	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		34				339.96	33																																					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3362	033	0	1	01	01	H3362_033_0	5		Y	Preferred Generic	4	01	1	2	1	1	110		01	100		1	30		90				1	2			90				30		34	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3362	033	0	1	01	01	H3362_033_0	5		Y	Generic	4	01	3	2	2	1	110		01	100		1	30		90				2	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	033	0	1	01	01	H3362_033_0	5		Y	Preferred Brand	4	11	1	2	3	1	110		01	100		1	30		90				2	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	5		Y	Non-Preferred Drug	4	11	1	1	4	1	110		01	100		1	30		90				2	2			90				30		34				62.67	44		44																				44															44			44								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3362	033	0	1	01	01	H3362_033_0	5		Y	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		34				629.65	32																																					32			32								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3362	038	0	1	01	01	H3362_038_0	5		Y	Preferred Generic	4	01	1	2	1	1	110		01	100		1	30		90				1	2			90				30		34	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3362	038	0	1	01	01	H3362_038_0	5		Y	Generic	4	01	3	2	2	1	110		01	100		1	30		90				2	2			90				30		34	15.00		37.50																					37.50																15.00				15.00		0.50						0.44	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3362	038	0	1	01	01	H3362_038_0	5		Y	Preferred Brand	4	11	1	2	3	1	110		01	100		1	30		90				2	2			90				30		34	47.00		117.50																					117.50																47.00				47.00		1.57						1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3362	038	0	1	01	01	H3362_038_0	5		Y	Non-Preferred Drug	4	11	1	1	4	1	110		01	100		1	30		90				2	2			90				30		34				61.48	45		45																				45															45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3362	038	0	1	01	01	H3362_038_0	5		Y	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		34				645.18	30																																					30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3362	039	0	1	01	01	H3362_039_0	5		Y	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	5		Y	Generic	4	01	3	2	2	1	110		01	100		1	30		90				2	2			90				30		34	20.00		50.00																					50.00																20.00				20.00		0.67						0.59	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3362	039	0	1	01	01	H3362_039_0	5		Y	Preferred Brand	4	11	1	2	3	1	110		01	100		1	30		90				2	2			90				30		34	47.00		117.50																					117.50																47.00				47.00		1.57						1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3362	039	0	1	01	01	H3362_039_0	5		Y	Non-Preferred Drug	4	11	1	1	4	1	110		01	100		1	30		90				2	2			90				30		34				87.04	46		46																				46															46			46								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3362	039	0	1	01	01	H3362_039_0	5		Y	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		34				583.16	25																																					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3362	040	0	1	01	01	H3362_040_0	6		Y	Preferred Generic	4	01	1	2	1	1	110		01	100		1	30		90				1	2			90				30		34	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3362	040	0	1	01	01	H3362_040_0	6		Y	Generic	4	01	3	2	2	1	110		01	100		1	30		90				2	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	6		Y	Preferred Brand	4	11	1	2	3	1	110		01	100		1	30		90				2	2			90				30		34	47.00		117.50																					117.50																47.00				47.00		1.57						1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3362	040	0	1	01	01	H3362_040_0	6		Y	Non-Preferred Drug	4	11	1	1	4	1	110		01	100		1	30		90				2	2			90				30		34				57.06	38		38																				38															38			38								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3362	040	0	1	01	01	H3362_040_0	6		Y	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		34				537.29	33																																					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3379	001	0	1	02	01	H3379_001_0	2		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3379	001	0	1	02	01	H3379_001_0	2		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3379	001	0	1	02	01	H3379_001_0	2		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3379	001	0	1	02	01	H3379_001_0	2		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H3379	001	0	1	02	01	H3379_001_0	2		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3379	001	0	1	02	01	H3379_001_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3379	001	0	1	02	01	H3379_001_0	2		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				310.00	28																										28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3379	039	0	1	02	01	H3379_039_0	2		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3379	039	0	1	02	01	H3379_039_0	2		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3379	039	0	1	02	01	H3379_039_0	2		Y	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												
H3379	039	0	1	02	01	H3379_039_0	2		Y	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
H3379	039	0	1	02	01	H3379_039_0	2		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3379	039	0	1	02	01	H3379_039_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3379	039	0	1	02	01	H3379_039_0	2		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				498.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3379	040	0	1	02	01	H3379_040_0	2		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3379	040	0	1	02	01	H3379_040_0	2		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3379	040	0	1	02	01	H3379_040_0	2		Y	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												
H3379	040	0	1	02	01	H3379_040_0	2		Y	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
H3379	040	0	1	02	01	H3379_040_0	2		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3379	040	0	1	02	01	H3379_040_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3379	040	0	1	02	01	H3379_040_0	2		Y	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												
H3379	041	0	1	02	01	H3379_041_0	2		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3379	041	0	1	02	01	H3379_041_0	2		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3379	041	0	1	02	01	H3379_041_0	2		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3379	041	0	1	02	01	H3379_041_0	2		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H3379	041	0	1	02	01	H3379_041_0	2		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3379	041	0	1	02	01	H3379_041_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3379	041	0	1	02	01	H3379_041_0	2		Y	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												
H3379	043	0	1	02	01	H3379_043_0	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3379	043	0	1	02	01	H3379_043_0	3		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3379	043	0	1	02	01	H3379_043_0	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	14.00		42.00																											42.00						0.00				14.00				14.00		0.46						0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3379	043	0	1	02	01	H3379_043_0	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	14.00		42.00																											42.00						0.00				14.00				14.00		0.46						0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H3379	043	0	1	02	01	H3379_043_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	42.00		126.00																											126.00						116.00				42.00				42.00		1.40						1.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3379	043	0	1	02	01	H3379_043_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	94.00		282.00																											282.00						272.00				94.00				94.00		3.13						3.03	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3379	043	0	1	02	01	H3379_043_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				305.00	27																										27						27					27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3379	045	0	1	02	01	H3379_045_0	2		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3379	045	0	1	02	01	H3379_045_0	2		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3379	045	0	1	02	01	H3379_045_0	2		Y	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												
H3379	045	0	1	02	01	H3379_045_0	2		Y	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
H3379	045	0	1	02	01	H3379_045_0	2		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3379	045	0	1	02	01	H3379_045_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3379	045	0	1	02	01	H3379_045_0	2		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				498.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3379	046	0	1	02	01	H3379_046_0	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3379	046	0	1	02	01	H3379_046_0	3		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3379	046	0	1	02	01	H3379_046_0	3		Y	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												
H3379	046	0	1	02	01	H3379_046_0	3		Y	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
H3379	046	0	1	02	01	H3379_046_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3379	046	0	1	02	01	H3379_046_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3379	046	0	1	02	01	H3379_046_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				498.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3384	013	0	1	01	01	H3384_013_0	7		Y	Preferred Generic	4	01	1	2	1	1		110	01		110	1				31		90	1	2				31		90	31		31								7.00		21.00					2.00		6.00											7.00		17.50				2.00		0.00				7.00				7.00			0.23	0.06		0.23	0.06	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3384	013	0	1	01	01	H3384_013_0	7		Y	Generic	4	01	1	2	2	1		110	01		110	1				31		90	1	2				31		90	31		31								15.00		45.00					10.00		30.00											15.00		37.50				10.00		25.00				15.00				15.00			0.48	0.32		0.48	0.32	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3384	013	0	1	01	01	H3384_013_0	7		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				31		90	1	2				31		90	31		31								47.00		141.00					42.00		126.00											47.00		117.50				42.00		105.00				47.00				47.00			1.52	1.35		1.52	1.35	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3384	013	0	1	01	01	H3384_013_0	7		Y	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				31		90	1	2				31		90	31		31								100.00		300.00					94.00		282.00											100.00		250.00				94.00		235.00				100.00				100.00			3.23	3.03		3.23	3.03	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3384	013	0	1	01	01	H3384_013_0	7		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				31								31			31		31												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	7		Y	Preferred Generic	4	01	1	2	1	1		110	01		110	1				31		90	1	2				31		90	31		31								7.00		21.00					2.00		6.00											7.00		17.50				2.00		0.00				7.00				7.00			0.23	0.06		0.23	0.06	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3384	019	0	1	01	01	H3384_019_0	7		Y	Generic	4	01	1	2	2	1		110	01		110	1				31		90	1	2				31		90	31		31								15.00		45.00					10.00		30.00											15.00		37.50				10.00		25.00				15.00				15.00			0.48	0.32		0.48	0.32	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3384	019	0	1	01	01	H3384_019_0	7		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				31		90	1	2				31		90	31		31								47.00		141.00					42.00		126.00											47.00		117.50				42.00		105.00				47.00				47.00			1.52	1.35		1.52	1.35	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3384	019	0	1	01	01	H3384_019_0	7		Y	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				31		90	1	2				31		90	31		31								100.00		300.00					94.00		282.00											100.00		250.00				94.00		235.00				100.00				100.00			3.23	3.03		3.23	3.03	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3384	019	0	1	01	01	H3384_019_0	7		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				31								31			31		31												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	7		Y	Preferred Generic	4	01	1	2	1	1		110	01		110	1				31		90	1	2				31		90	31		31								7.00		21.00					2.00		6.00											7.00		17.50				2.00		0.00				7.00				7.00			0.23	0.06		0.23	0.06	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3384	058	0	1	01	01	H3384_058_0	7		Y	Generic	4	01	1	2	2	1		110	01		110	1				31		90	1	2				31		90	31		31								15.00		45.00					10.00		30.00											15.00		37.50				10.00		25.00				15.00				15.00			0.48	0.32		0.48	0.32	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3384	058	0	1	01	01	H3384_058_0	7		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				31		90	1	2				31		90	31		31								47.00		141.00					42.00		126.00											47.00		117.50				42.00		105.00				47.00				47.00			1.52	1.35		1.52	1.35	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3384	058	0	1	01	01	H3384_058_0	7		Y	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				31		90	1	2				31		90	31		31								100.00		300.00					94.00		282.00											100.00		250.00				94.00		235.00				100.00				100.00			3.23	3.03		3.23	3.03	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3384	058	0	1	01	01	H3384_058_0	7		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				31								31			31		31												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	8		Y	Preferred Generic	4	01	1	2	1	1		110	01		110	1				31		90	1	2				31		90	31		31								7.00		21.00					2.00		6.00											7.00		17.50				2.00		0.00				7.00				7.00			0.23	0.06		0.23	0.06	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3384	059	0	1	01	01	H3384_059_0	8		Y	Generic	4	01	1	2	2	1		110	01		110	1				31		90	1	2				31		90	31		31								13.00		39.00					8.00		24.00											13.00		32.50				8.00		20.00				13.00				13.00			0.42	0.26		0.42	0.26	0.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3384	059	0	1	01	01	H3384_059_0	8		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				31		90	1	2				31		90	31		31								47.00		141.00					42.00		126.00											47.00		117.50				42.00		105.00				47.00				47.00			1.52	1.35		1.52	1.35	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3384	059	0	1	01	01	H3384_059_0	8		Y	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				31		90	1	2				31		90	31		31								100.00		300.00					94.00		282.00											100.00		250.00				94.00		235.00				100.00				100.00			3.23	3.03		3.23	3.03	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3384	059	0	1	01	01	H3384_059_0	8		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				31								31			31		31												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	7		Y	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		12.50				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												
H3384	062	0	1	01	01	H3384_062_0	7		Y	Generic	4	01	1	2	2	1		110	01		110	1				31		90	1	2				31		90	31		31								17.00		51.00					12.00		36.00											17.00		42.50				12.00		0.00				17.00				17.00			0.55	0.39		0.55	0.39	0.55	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3384	062	0	1	01	01	H3384_062_0	7		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				31		90	1	2				31		90	31		31								47.00		141.00					42.00		126.00											47.00		117.50				42.00		105.00				47.00				47.00			1.52	1.35		1.52	1.35	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3384	062	0	1	01	01	H3384_062_0	7		Y	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				31		90	1	2				31		90	31		31								100.00		300.00					94.00		282.00											100.00		250.00				94.00		235.00				100.00				100.00			3.23	3.03		3.23	3.03	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3384	062	0	1	01	01	H3384_062_0	7		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				31								31			31		31												29							29												29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3384	063	0	1	01	01	H3384_063_0	7		Y	Preferred Generic	4	01	1	2	1	1		110	01		110	1				31		90	1	2				31		90	31		31								8.00		24.00					3.00		9.00											8.00		20.00				3.00		0.00				8.00				8.00			0.26	0.10		0.26	0.10	0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3384	063	0	1	01	01	H3384_063_0	7		Y	Generic	4	01	1	2	2	1		110	01		110	1				31		90	1	2				31		90	31		31								15.00		45.00					10.00		30.00											15.00		37.50				10.00		25.00				15.00				15.00			0.48	0.32		0.48	0.32	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3384	063	0	1	01	01	H3384_063_0	7		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				31		90	1	2				31		90	31		31								47.00		141.00					42.00		126.00											47.00		117.50				42.00		105.00				47.00				47.00			1.52	1.35		1.52	1.35	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3384	063	0	1	01	01	H3384_063_0	7		Y	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				31		90	1	2				31		90	31		31								100.00		300.00					94.00		282.00											100.00		250.00				94.00		235.00				100.00				100.00			3.23	3.03		3.23	3.03	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3384	063	0	1	01	01	H3384_063_0	7		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				31								31			31		31												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	7			Preferred Generic	4	01	1	2	1	1		110	01		110	1				31		90	1	2				31		90	31		31								9.00		27.00					4.00		12.00											9.00		22.50				4.00		0.00				9.00				9.00			0.29	0.13		0.29	0.13	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3384	067	0	1	01	01	H3384_067_0	7			Generic	4	01	1	2	2	1		110	01		110	1				31		90	1	2				31		90	31		31								17.00		51.00					12.00		36.00											17.00		42.50				12.00		30.00				17.00				17.00			0.55	0.39		0.55	0.39	0.55	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3384	067	0	1	01	01	H3384_067_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					42.00		126.00											47.00		117.50				42.00		105.00				47.00				47.00			1.52	1.35		1.52	1.35	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3384	067	0	1	01	01	H3384_067_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					94.00		282.00											100.00		250.00				94.00		235.00				100.00				100.00			3.23	3.03		3.23	3.03	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3384	067	0	1	01	01	H3384_067_0	7			Specialty Tier	4	11	1	1	5	1		010	01		010	1				31								31			31		31												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	13		Y	Preferred Generic	4	01	1	2	1	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		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	13		Y	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				0.00	0.00	0.00				11.00				11.00		0.37				0.37	0.00	0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3388	002	0	1	01	01	H3388_002_0	13		Y	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	13		Y	Non-Preferred Drug	4	11	1	2	4	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	90.00	180.00	270.00																									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	13		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				1588.16	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3388	004	0	1	01	01	H3388_004_0	13		Y	Preferred Generic	4	01	1	2	1	1	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	13		Y	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				0.00	0.00	0.00				13.00				13.00		0.43				0.43	0.00	0.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3388	004	0	1	01	01	H3388_004_0	13		Y	Preferred Brand	4	11	1	2	3	1	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	13		Y	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	13		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				1662.83	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3388	013	0	1	01	01	H3388_013_0	12		Y	Preferred Generic	4	01	1	2	1	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	3.00	6.00	9.00																									3.00	6.00	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	12		Y	Generic	4	01	1	2	2	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	15.00	30.00	45.00																									15.00	30.00	45.00				0.00	0.00	0.00				15.00				15.00		0.50				0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3388	013	0	1	01	01	H3388_013_0	12		Y	Preferred Brand	4	11	1	2	3	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	45.00	90.00	135.00																									45.00	90.00	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	12		Y	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	12		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				1919.14	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3388	014	0	1	01	01	H3388_014_0	12		Y	Preferred Generic	4	01	1	2	1	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	3.00	6.00	9.00																									3.00	6.00	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	12		Y	Generic	4	01	1	2	2	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	17.00	34.00	51.00																									17.00	34.00	51.00				0.00	0.00	0.00				17.00				17.00		0.57				0.57	0.00	0.55	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3388	014	0	1	01	01	H3388_014_0	12		Y	Preferred Brand	4	11	1	2	3	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	47.00	94.00	141.00																									47.00	94.00	141.00				47.00	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	12		Y	Non-Preferred Drug	4	11	1	2	4	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	100.00	200.00	300.00																									100.00	200.00	300.00				100.00	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	12		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				1399.46	27																										27						27					27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3388	018	0	1	01	01	H3388_018_0	10		Y	Preferred Generic	4	01	1	2	1	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	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, Select Care Drugs												
H3388	018	0	1	01	01	H3388_018_0	10		Y	Generic	4	01	1	2	2	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	17.00	34.00	51.00																									17.00	34.00	51.00				0.00	0.00	0.00				17.00				17.00		0.57				0.57	0.00	0.55	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3388	018	0	1	01	01	H3388_018_0	10		Y	Preferred Brand	4	11	1	2	3	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	47.00	94.00	141.00																									47.00	94.00	141.00				47.00	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												
H3388	018	0	1	01	01	H3388_018_0	10		Y	Non-Preferred Drug	4	11	1	2	4	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	100.00	200.00	300.00																									100.00	200.00	300.00				100.00	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, Select Care Drugs												
H3388	018	0	1	01	01	H3388_018_0	10		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				1399.46	27																										27						27					27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3388	018	0	1	01	01	H3388_018_0	10		Y	Select Care Drugs	4	01	1	2	6	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3404	003	1	1	04	01	H3404_003_1	7		Y	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00				15.00				15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3404	003	1	1	04	01	H3404_003_1	7		Y	Generic	4	01	3	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					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	7		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											47.00	94.00	141.00				37.00	74.00	74.00				47.00				47.00			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	7		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	300.00					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	7		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3404	003	1	1	04	01	H3404_003_1	7		Y	Select Care Drugs	4	01	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								1.00	1.00	1.00					0.00	0.00	0.00											1.00	1.00	1.00				0.00	0.00	0.00				1.00				1.00			0.03	0.00		0.03	0.00	0.03	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3404	003	1	1	04	01	H3404_003_1	7		Y	Select Care Drugs	4	01	1	2	6	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								1.00	1.00	1.00					0.00	0.00	0.00											1.00	1.00	1.00				0.00	0.00	0.00				1.00				1.00			0.03	0.00		0.03	0.00	0.03	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H3404	003	2	1	04	01	H3404_003_2	7		Y	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00				15.00				15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3404	003	2	1	04	01	H3404_003_2	7		Y	Generic	4	01	3	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					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		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											47.00	94.00	141.00				37.00	74.00	74.00				47.00				47.00			1.57	1.23		1.57	1.23	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3404	003	2	1	04	01	H3404_003_2	7		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	300.00					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		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3404	003	2	1	04	01	H3404_003_2	7		Y	Select Care Drugs	4	01	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								1.00	1.00	1.00					0.00	0.00	0.00											1.00	1.00	1.00				0.00	0.00	0.00				1.00				1.00			0.03	0.00		0.03	0.00	0.03	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3404	003	2	1	04	01	H3404_003_2	7		Y	Select Care Drugs	4	01	1	2	6	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								1.00	1.00	1.00					0.00	0.00	0.00											1.00	1.00	1.00				0.00	0.00	0.00				1.00				1.00			0.03	0.00		0.03	0.00	0.03	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H3416	001	6	1	04	01	H3416_001_6	9		Y	Preferred Generic	4	11	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3416	001	6	1	04	01	H3416_001_6	9		Y	Generic	4	11	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3416	001	6	1	04	01	H3416_001_6	9		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		117.50				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3416	001	6	1	04	01	H3416_001_6	9		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				1	2				30		90	30		31	100.00		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	9		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3416	001	7	1	04	01	H3416_001_7	9		Y	Preferred Generic	4	11	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3416	001	7	1	04	01	H3416_001_7	9		Y	Generic	4	11	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3416	001	7	1	04	01	H3416_001_7	9		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		117.50				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3416	001	7	1	04	01	H3416_001_7	9		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				1	2				30		90	30		31	100.00		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	9		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3416	002	4	1	04	01	H3416_002_4	9		Y	Preferred Generic	4	11	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3416	002	4	1	04	01	H3416_002_4	9		Y	Preferred Generic	4	11	1	2	1	3	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				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	9		Y	Generic	4	11	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3416	002	4	1	04	01	H3416_002_4	9		Y	Generic	4	11	1	2	2	3	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3416	002	4	1	04	01	H3416_002_4	9		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		117.50				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3416	002	4	1	04	01	H3416_002_4	9		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				1	2				30		90	30		31	100.00		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	9		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3416	002	5	1	04	01	H3416_002_5	9		Y	Preferred Generic	4	11	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3416	002	5	1	04	01	H3416_002_5	9		Y	Preferred Generic	4	11	1	2	1	3	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				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	9		Y	Generic	4	11	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3416	002	5	1	04	01	H3416_002_5	9		Y	Generic	4	11	1	2	2	3	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3416	002	5	1	04	01	H3416_002_5	9		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		117.50				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3416	002	5	1	04	01	H3416_002_5	9		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				1	2				30		90	30		31	100.00		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	9		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3418	001	0	1	04	01	H3418_001_0	2		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3418	001	0	1	04	01	H3418_001_0	2		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3418	001	0	1	04	01	H3418_001_0	2		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3418	001	0	1	04	01	H3418_001_0	2		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H3418	001	0	1	04	01	H3418_001_0	2		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3418	001	0	1	04	01	H3418_001_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3418	001	0	1	04	01	H3418_001_0	2		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				402.00	29																										29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3418	002	0	1	04	01	H3418_002_0	2		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3418	002	0	1	04	01	H3418_002_0	2		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3418	002	0	1	04	01	H3418_002_0	2		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3418	002	0	1	04	01	H3418_002_0	2		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H3418	002	0	1	04	01	H3418_002_0	2		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3418	002	0	1	04	01	H3418_002_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3418	002	0	1	04	01	H3418_002_0	2		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				293.00	26																										26						26					26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3418	003	0	1	04	01	H3418_003_0	2		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3418	003	0	1	04	01	H3418_003_0	2		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3418	003	0	1	04	01	H3418_003_0	2		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	14.00		42.00																											42.00						0.00				14.00				14.00		0.46						0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3418	003	0	1	04	01	H3418_003_0	2		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	14.00		42.00																											42.00						0.00				14.00				14.00		0.46						0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H3418	003	0	1	04	01	H3418_003_0	2		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3418	003	0	1	04	01	H3418_003_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3418	003	0	1	04	01	H3418_003_0	2		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				303.00	27																										27						27					27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3418	004	0	1	04	01	H3418_004_0	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3418	004	0	1	04	01	H3418_004_0	3		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3418	004	0	1	04	01	H3418_004_0	3		Y	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												
H3418	004	0	1	04	01	H3418_004_0	3		Y	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
H3418	004	0	1	04	01	H3418_004_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3418	004	0	1	04	01	H3418_004_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3418	004	0	1	04	01	H3418_004_0	3		Y	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												
H3418	005	0	1	04	01	H3418_005_0	2		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3418	005	0	1	04	01	H3418_005_0	2		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3418	005	0	1	04	01	H3418_005_0	2		Y	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												
H3418	005	0	1	04	01	H3418_005_0	2		Y	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
H3418	005	0	1	04	01	H3418_005_0	2		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3418	005	0	1	04	01	H3418_005_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3418	005	0	1	04	01	H3418_005_0	2		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				498.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3418	006	0	1	04	01	H3418_006_0	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3418	006	0	1	04	01	H3418_006_0	3		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3418	006	0	1	04	01	H3418_006_0	3		Y	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												
H3418	006	0	1	04	01	H3418_006_0	3		Y	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
H3418	006	0	1	04	01	H3418_006_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3418	006	0	1	04	01	H3418_006_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3418	006	0	1	04	01	H3418_006_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				498.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3418	007	0	1	04	01	H3418_007_0	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3418	007	0	1	04	01	H3418_007_0	3		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3418	007	0	1	04	01	H3418_007_0	3		Y	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												
H3418	007	0	1	04	01	H3418_007_0	3		Y	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
H3418	007	0	1	04	01	H3418_007_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3418	007	0	1	04	01	H3418_007_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3418	007	0	1	04	01	H3418_007_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				498.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3418	008	0	1	04	01	H3418_008_0	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3418	008	0	1	04	01	H3418_008_0	3		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3418	008	0	1	04	01	H3418_008_0	3		Y	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												
H3418	008	0	1	04	01	H3418_008_0	3		Y	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
H3418	008	0	1	04	01	H3418_008_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3418	008	0	1	04	01	H3418_008_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3418	008	0	1	04	01	H3418_008_0	3		Y	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												
H3419	002	0	1	01	01	H3419_002_0	6		Y	Preferred Generic	4	01	1	2	1	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	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	6		Y	Generic	4	01	1	2	2	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	15.00	30.00	45.00																			15.00	30.00	45.00																	15.00			15.00		0.50			0.50			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3419	002	0	1	01	01	H3419_002_0	6		Y	Preferred Brand	4	10	1	2	3	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	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	6		Y	Non-Preferred Brand	4	10	1	2	4	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	95.00	190.00	285.00																			95.00	190.00	285.00																	95.00			95.00		3.17			3.17			3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3419	002	0	1	01	01	H3419_002_0	6		Y	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												
H3419	003	0	1	01	01	H3419_003_0	4		N	Preferred Generic	4	01	1	2	1	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	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	003	0	1	01	01	H3419_003_0	4		N	Generic	4	01	1	2	2	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	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	003	0	1	01	01	H3419_003_0	4		N	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	003	0	1	01	01	H3419_003_0	4		N	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	003	0	1	01	01	H3419_003_0	4		N	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	2		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3442	001	0	1	04	01	H3442_001_0	2		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3442	001	0	1	04	01	H3442_001_0	2		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3442	001	0	1	04	01	H3442_001_0	2		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H3442	001	0	1	04	01	H3442_001_0	2		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3442	001	0	1	04	01	H3442_001_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3442	001	0	1	04	01	H3442_001_0	2		Y	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												
H3442	003	0	1	04	01	H3442_003_0	2		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3442	003	0	1	04	01	H3442_003_0	2		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3442	003	0	1	04	01	H3442_003_0	2		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	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	003	0	1	04	01	H3442_003_0	2		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	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	003	0	1	04	01	H3442_003_0	2		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3442	003	0	1	04	01	H3442_003_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3442	003	0	1	04	01	H3442_003_0	2		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				269.00	30																										30						30					30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3442	004	0	1	04	01	H3442_004_0	2		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3442	004	0	1	04	01	H3442_004_0	2		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3442	004	0	1	04	01	H3442_004_0	2		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	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	004	0	1	04	01	H3442_004_0	2		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	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	004	0	1	04	01	H3442_004_0	2		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3442	004	0	1	04	01	H3442_004_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3442	004	0	1	04	01	H3442_004_0	2		Y	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												
H3442	006	0	1	04	01	H3442_006_0	2		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3442	006	0	1	04	01	H3442_006_0	2		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3442	006	0	1	04	01	H3442_006_0	2		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	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	2		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	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	2		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3442	006	0	1	04	01	H3442_006_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3442	006	0	1	04	01	H3442_006_0	2		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				505.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3442	007	0	1	04	01	H3442_007_0	2		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3442	007	0	1	04	01	H3442_007_0	2		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3442	007	0	1	04	01	H3442_007_0	2		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	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	007	0	1	04	01	H3442_007_0	2		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	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	007	0	1	04	01	H3442_007_0	2		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3442	007	0	1	04	01	H3442_007_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3442	007	0	1	04	01	H3442_007_0	2		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				225.00	30																										30						30					30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3442	010	0	1	04	01	H3442_010_0	2		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3442	010	0	1	04	01	H3442_010_0	2		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3442	010	0	1	04	01	H3442_010_0	2		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3442	010	0	1	04	01	H3442_010_0	2		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H3442	010	0	1	04	01	H3442_010_0	2		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3442	010	0	1	04	01	H3442_010_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3442	010	0	1	04	01	H3442_010_0	2		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				399.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3442	011	0	1	04	01	H3442_011_0	2		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3442	011	0	1	04	01	H3442_011_0	2		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3442	011	0	1	04	01	H3442_011_0	2		Y	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												
H3442	011	0	1	04	01	H3442_011_0	2		Y	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
H3442	011	0	1	04	01	H3442_011_0	2		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3442	011	0	1	04	01	H3442_011_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3442	011	0	1	04	01	H3442_011_0	2		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				353.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3443	001	0	1	01	01	H3443_001_0	5		N	Preferred Generic	4	11	1	2	1	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3443	001	0	1	01	01	H3443_001_0	5		N	Preferred Generic	4	11	1	2	1	3	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H3443	001	0	1	01	01	H3443_001_0	5		N	Generic	4	01	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3443	001	0	1	01	01	H3443_001_0	5		N	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	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	5		N	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	300.00																			100.00	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	5		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				841.00	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	5		N	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	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	5		N	Select Care Drugs	4	01	1	2	6	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, Select Care Drugs										1		
H3443	002	0	1	01	01	H3443_002_0	5		N	Preferred Generic	4	11	1	2	1	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3443	002	0	1	01	01	H3443_002_0	5		N	Preferred Generic	4	11	1	2	1	3	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H3443	002	0	1	01	01	H3443_002_0	5		N	Generic	4	01	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3443	002	0	1	01	01	H3443_002_0	5		N	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	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	5		N	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	300.00																			100.00	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	5		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				840.50	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	5		N	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	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	5		N	Select Care Drugs	4	01	1	2	6	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, Select Care Drugs										1		
H3443	003	0	1	01	01	H3443_003_0	6		Y	Preferred Generic	4	11	1	2	1	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																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		Y	Preferred Generic	4	11	1	2	1	3	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H3443	003	0	1	01	01	H3443_003_0	6		Y	Generic	4	01	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3443	003	0	1	01	01	H3443_003_0	6		Y	Preferred Brand	4	11	3	2	3	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	40.00	80.00	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		Y	Non-Preferred Drug	4	11	3	2	4	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	100.00	200.00	300.00																			100.00	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		Y	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				865.12	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		Y	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	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		Y	Select Care Drugs	4	01	1	2	6	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, Select Care Drugs										1		
H3447	001	0	1	01	01	H3447_001_0	5		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								5.00	10.00	15.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.15	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3447	001	0	1	01	01	H3447_001_0	5		N	Preferred Generic	4	01	1	2	1	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								5.00	10.00	15.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.15	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H3447	001	0	1	01	01	H3447_001_0	5		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								14.50	29.00	43.50					9.50	19.00	28.50					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	5		N	Generic	4	01	1	2	2	3		111	01	111		1				30	60	90	2	2	30	60	90				30		34								14.50	29.00	43.50					9.50	19.00	28.50					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	5		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								45.00	90.00	135.00					40.00	80.00	120.00					40.00	80.00	80.00																45.00				45.00			1.50	1.33	1.33			1.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3447	001	0	1	01	01	H3447_001_0	5		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								95.00	190.00	285.00					85.00	170.00	255.00					85.00	170.00	170.00																95.00				95.00			3.17	2.83	2.83			2.79	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3447	001	0	1	01	01	H3447_001_0	5		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3447	001	0	1	01	01	H3447_001_0	5		N	Select Care Drugs	4	11	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3447	001	0	1	01	01	H3447_001_0	5		N	Select Care Drugs	4	11	1	2	6	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	3	
H3447	003	0	1	01	01	H3447_003_0	6		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								5.00	10.00	15.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.15	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3447	003	0	1	01	01	H3447_003_0	6		N	Preferred Generic	4	01	1	2	1	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								5.00	10.00	15.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				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		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								14.50	29.00	43.50					9.50	19.00	28.50					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		N	Generic	4	01	1	2	2	3		111	01	111		1				30	60	90	2	2	30	60	90				30		34								14.50	29.00	43.50					9.50	19.00	28.50					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		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								45.00	90.00	135.00					40.00	80.00	120.00					40.00	80.00	80.00																45.00				45.00			1.50	1.33	1.33			1.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3447	003	0	1	01	01	H3447_003_0	6		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								95.00	190.00	285.00					85.00	170.00	255.00					85.00	170.00	170.00																95.00				95.00			3.17	2.83	2.83			2.79	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3447	003	0	1	01	01	H3447_003_0	6		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3447	003	0	1	01	01	H3447_003_0	6		N	Select Care Drugs	4	11	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			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		N	Select Care Drugs	4	11	1	2	6	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	3	
H3447	004	0	1	01	01	H3447_004_0	6		Y	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		Y	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		Y	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		Y	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		Y	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		Y	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		Y	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		Y	Specialty Tier	4	11	1	1	5	1		010	01	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		Y	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		Y	Select Care Drugs	4	11	1	2	6	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	3	
H3447	005	0	1	01	01	H3447_005_0	5		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								10.00	20.00	30.00					5.00	10.00	15.00					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	5		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								17.50	35.00	52.50					12.50	25.00	37.50					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	5		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								45.00	90.00	135.00					40.00	80.00	120.00					40.00	80.00	80.00																45.00				45.00			1.50	1.33	1.33			1.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3447	005	0	1	01	01	H3447_005_0	5		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								95.00	190.00	285.00					90.00	180.00	270.00					90.00	180.00	180.00																95.00				95.00			3.17	3.00	3.00			2.79	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3447	005	0	1	01	01	H3447_005_0	5		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3447	005	0	1	01	01	H3447_005_0	5		N	Select Care Drugs	4	11	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								10.00	20.00	30.00					10.00	20.00	30.00					10.00	20.00	20.00																10.00				10.00			0.33	0.33	0.33			0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3447	010	0	1	01	01	H3447_010_0	5		N	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		34	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3447	010	0	1	01	01	H3447_010_0	5		N	Preferred Generic	4	01	1	2	1	3	111		01	111		1	30	60	90				1	2	30	60	90				30		34	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H3447	010	0	1	01	01	H3447_010_0	5		N	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				2	2	30	60	90				30		34	7.50	15.00	22.50																			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	5		N	Generic	4	01	1	2	2	3	111		01	111		1	30	60	90				2	2	30	60	90				30		34	7.50	15.00	22.50																			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	5		N	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				2	2	30	60	90				30		34	40.00	80.00	120.00																			40.00	80.00	80.00																40.00				40.00		1.33			1.33			1.18	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3447	010	0	1	01	01	H3447_010_0	5		N	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	90				2	2	30	60	90				30		34	85.00	170.00	255.00																			85.00	170.00	170.00																85.00				85.00		2.83			2.83			2.50	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3447	010	0	1	01	01	H3447_010_0	5		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		34					33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3447	010	0	1	01	01	H3447_010_0	5		N	Select Care Drugs	4	11	1	2	6	1	111		01	111		1	30	60	100				1	2	30	60	100				30		34	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3447	010	0	1	01	01	H3447_010_0	5		N	Select Care Drugs	4	11	1	2	6	3	111		01	111		1	30	60	100				1	2	30	60	100				30		34	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	3	
H3447	011	0	1	01	01	H3447_011_0	7		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								10.00	20.00	30.00					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	011	0	1	01	01	H3447_011_0	7		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								20.00	40.00	60.00					20.00	40.00	60.00					20.00	60.00	60.00																20.00				20.00			0.67	0.67	0.67			0.59	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3447	011	0	1	01	01	H3447_011_0	7		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								40.00	80.00	120.00					40.00	80.00	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	7		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	285.00	285.00																100.00				100.00			3.33	3.17	3.17			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3447	011	0	1	01	01	H3447_011_0	7		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												25							25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3447	011	0	1	01	01	H3447_011_0	7		N	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								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	6		Y	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												
H3447	013	0	1	01	01	H3447_013_0	6		Y	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	6		Y	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	6		Y	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	6		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	285.00	285.00																100.00				100.00			3.33	3.17	3.17			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3447	013	0	1	01	01	H3447_013_0	6		Y	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												30							30						30																	30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3447	013	0	1	01	01	H3447_013_0	6		Y	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3447	013	0	1	01	01	H3447_013_0	6		Y	Select Care Drugs	4	01	1	2	6	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				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	5		Y	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												
H3447	014	0	1	01	01	H3447_014_0	5		Y	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	5		Y	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	5		Y	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	5		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				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	5		Y	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												
H3447	014	0	1	01	01	H3447_014_0	5		Y	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				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	5		Y	Select Care Drugs	4	01	1	2	6	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				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	6		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								10.00	20.00	30.00					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	018	0	1	01	01	H3447_018_0	6		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								15.00	30.00	45.00					15.00	30.00	45.00					15.00	45.00	45.00																15.00				15.00			0.50	0.50	0.50			0.44	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3447	018	0	1	01	01	H3447_018_0	6		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		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	6		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	285.00	285.00																100.00				100.00			3.33	3.17	3.17			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3447	018	0	1	01	01	H3447_018_0	6		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												25							25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3447	018	0	1	01	01	H3447_018_0	6		N	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								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	5		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								15.00	30.00	45.00					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	020	0	1	01	01	H3447_020_0	5		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								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	5		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								47.00	94.00	141.00					47.00	94.00	141.00					47.00	141.00	141.00																47.00				47.00			1.57	1.57	1.57			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3447	020	0	1	01	01	H3447_020_0	5		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	285.00	285.00																100.00				100.00			3.33	3.17	3.17			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3447	020	0	1	01	01	H3447_020_0	5		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												25							25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3447	020	0	1	01	01	H3447_020_0	5		N	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								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	024	0	1	01	01	H3447_024_0	5		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								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	024	0	1	01	01	H3447_024_0	5		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								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	024	0	1	01	01	H3447_024_0	5		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								47.00	94.00	141.00					37.00	74.00	111.00					37.00	111.00	111.00																47.00				47.00			1.57	1.23	1.23			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3447	024	0	1	01	01	H3447_024_0	5		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								100.00	200.00	300.00					90.00	180.00	270.00					90.00	270.00	270.00																100.00				100.00			3.33	3.00	3.00			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3447	024	0	1	01	01	H3447_024_0	5		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												25							25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3447	024	0	1	01	01	H3447_024_0	5		N	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								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	025	0	1	01	01	H3447_025_0	6		Y	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												
H3447	025	0	1	01	01	H3447_025_0	6		Y	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	6		Y	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	6		Y	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	6		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				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	6		Y	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	025	0	1	01	01	H3447_025_0	6		Y	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				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	6		Y	Select Care Drugs	4	01	1	2	6	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H3447	026	0	1	01	01	H3447_026_0	5		N	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		34	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3447	026	0	1	01	01	H3447_026_0	5		N	Preferred Generic	4	01	1	2	1	3	111		01	111		1	30	60	90				1	2	30	60	90				30		34	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H3447	026	0	1	01	01	H3447_026_0	5		N	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				2	2	30	60	90				30		34	7.50	15.00	22.50																			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	5		N	Generic	4	01	1	2	2	3	111		01	111		1	30	60	90				2	2	30	60	90				30		34	7.50	15.00	22.50																			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	5		N	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				2	2	30	60	90				30		34	40.00	80.00	120.00																			40.00	80.00	80.00																40.00				40.00		1.33			1.33			1.18	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3447	026	0	1	01	01	H3447_026_0	5		N	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	90				2	2	30	60	90				30		34	85.00	170.00	255.00																			85.00	170.00	170.00																85.00				85.00		2.83			2.83			2.50	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3447	026	0	1	01	01	H3447_026_0	5		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		34					33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3447	026	0	1	01	01	H3447_026_0	5		N	Select Care Drugs	4	11	1	2	6	1	111		01	111		1	30	60	100				1	2	30	60	100				30		34	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3447	026	0	1	01	01	H3447_026_0	5		N	Select Care Drugs	4	11	1	2	6	3	111		01	111		1	30	60	100				1	2	30	60	100				30		34	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	3	
H3447	027	0	1	01	01	H3447_027_0	6		N	Preferred Generic	4	01	3	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3447	027	0	1	01	01	H3447_027_0	6		N	Preferred Generic	4	01	3	2	1	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		3
H3447	027	0	1	01	01	H3447_027_0	6		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								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	6		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								47.00	94.00	141.00					47.00	94.00	141.00					47.00	141.00	141.00																47.00				47.00			1.57	1.57	1.57			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3447	027	0	1	01	01	H3447_027_0	6		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	285.00	285.00																100.00				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	6		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												25							25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3447	027	0	1	01	01	H3447_027_0	6		N	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3447	027	0	1	01	01	H3447_027_0	6		N	Select Care Drugs	4	01	1	2	6	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H3447	028	0	1	01	01	H3447_028_0	6		N	Preferred Generic	4	01	3	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3447	028	0	1	01	01	H3447_028_0	6		N	Preferred Generic	4	01	3	2	1	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		1
H3447	028	0	1	01	01	H3447_028_0	6		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								10.00	20.00	30.00					10.00	20.00	30.00					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		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								47.00	94.00	141.00					47.00	94.00	141.00					47.00	141.00	141.00																47.00				47.00			1.57	1.57	1.57			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3447	028	0	1	01	01	H3447_028_0	6		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	285.00	285.00																100.00				100.00			3.33	3.17	3.17			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3447	028	0	1	01	01	H3447_028_0	6		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												25							25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3447	028	0	1	01	01	H3447_028_0	6		N	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3447	028	0	1	01	01	H3447_028_0	6		N	Select Care Drugs	4	01	1	2	6	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H3447	030	0	1	01	01	H3447_030_0	6		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								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	030	0	1	01	01	H3447_030_0	6		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								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	030	0	1	01	01	H3447_030_0	6		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								47.00	94.00	141.00					47.00	94.00	141.00					47.00	141.00	141.00																47.00				47.00			1.57	1.57	1.57			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3447	030	0	1	01	01	H3447_030_0	6		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	285.00	285.00																100.00				100.00			3.33	3.17	3.17			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3447	030	0	1	01	01	H3447_030_0	6		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												25							25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3447	030	0	1	01	01	H3447_030_0	6		N	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								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	033	0	1	01	01	H3447_033_0	6		N	Preferred Generic	4	01	3	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								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	6		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								15.00	30.00	45.00					10.00	20.00	30.00					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	6		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00	126.00	126.00																47.00				47.00			1.57	1.40	1.40			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3447	033	0	1	01	01	H3447_033_0	6		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	285.00	285.00																100.00				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	6		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												27							27						27																	27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3447	033	0	1	01	01	H3447_033_0	6		N	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3447	033	0	1	01	01	H3447_033_0	6		N	Select Care Drugs	4	01	1	2	6	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H3447	037	0	1	01	01	H3447_037_0	5		Y	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	5		Y	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	5		Y	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	5		Y	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	5		Y	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	5		Y	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	5		Y	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	5		Y	Specialty Tier	4	11	1	1	5	1		010	01	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	5		Y	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	5		Y	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	5		Y	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	5		Y	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	038	1	1	01	01	H3447_038_1	5		Y	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	038	1	1	01	01	H3447_038_1	5		Y	Preferred Brand	4	11	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	5		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				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	5		Y	Specialty Tier	4	11	1	1	5	1		010	01	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	5		Y	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				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	5		Y	Select Care Drugs	4	01	1	2	6	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				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	5		Y	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	5		Y	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	038	2	1	01	01	H3447_038_2	5		Y	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	038	2	1	01	01	H3447_038_2	5		Y	Preferred Brand	4	11	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	5		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				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	5		Y	Specialty Tier	4	11	1	1	5	1		010	01	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	5		Y	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				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	5		Y	Select Care Drugs	4	01	1	2	6	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				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	6		Y	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												
H3447	039	0	1	01	01	H3447_039_0	6		Y	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	6		Y	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	039	0	1	01	01	H3447_039_0	6		Y	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	039	0	1	01	01	H3447_039_0	6		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				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	6		Y	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	6		Y	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				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	6		Y	Select Care Drugs	4	01	1	2	6	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				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	042	1	1	01	01	H3447_042_1	6		Y	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	042	1	1	01	01	H3447_042_1	6		Y	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	042	1	1	01	01	H3447_042_1	6		Y	Preferred Brand	4	11	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	042	1	1	01	01	H3447_042_1	6		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				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	042	1	1	01	01	H3447_042_1	6		Y	Specialty Tier	4	11	1	1	5	1		010	01	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	042	1	1	01	01	H3447_042_1	6		Y	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3447	042	1	1	01	01	H3447_042_1	6		Y	Select Care Drugs	4	01	1	2	6	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				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	042	2	1	01	01	H3447_042_2	6		Y	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	042	2	1	01	01	H3447_042_2	6		Y	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	042	2	1	01	01	H3447_042_2	6		Y	Preferred Brand	4	11	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	042	2	1	01	01	H3447_042_2	6		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				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	042	2	1	01	01	H3447_042_2	6		Y	Specialty Tier	4	11	1	1	5	1		010	01	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	042	2	1	01	01	H3447_042_2	6		Y	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3447	042	2	1	01	01	H3447_042_2	6		Y	Select Care Drugs	4	01	1	2	6	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				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	042	3	1	01	01	H3447_042_3	6		Y	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	042	3	1	01	01	H3447_042_3	6		Y	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	042	3	1	01	01	H3447_042_3	6		Y	Preferred Brand	4	11	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	042	3	1	01	01	H3447_042_3	6		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				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	042	3	1	01	01	H3447_042_3	6		Y	Specialty Tier	4	11	1	1	5	1		010	01	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	042	3	1	01	01	H3447_042_3	6		Y	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3447	042	3	1	01	01	H3447_042_3	6		Y	Select Care Drugs	4	01	1	2	6	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				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	042	4	1	01	01	H3447_042_4	6		Y	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	042	4	1	01	01	H3447_042_4	6		Y	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	042	4	1	01	01	H3447_042_4	6		Y	Preferred Brand	4	11	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	042	4	1	01	01	H3447_042_4	6		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				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	042	4	1	01	01	H3447_042_4	6		Y	Specialty Tier	4	11	1	1	5	1		010	01	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	042	4	1	01	01	H3447_042_4	6		Y	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3447	042	4	1	01	01	H3447_042_4	6		Y	Select Care Drugs	4	01	1	2	6	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				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	02	01	H3449_023_1	7		Y	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00				15.00				15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3449	023	1	1	02	01	H3449_023_1	7		Y	Generic	4	01	3	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					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	02	01	H3449_023_1	7		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											47.00	94.00	141.00				37.00	74.00	74.00				47.00				47.00			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	02	01	H3449_023_1	7		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	300.00					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	02	01	H3449_023_1	7		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												30							30												30						30					30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3449	023	1	1	02	01	H3449_023_1	7		Y	Select Care Drugs	4	01	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								3.00	3.00	3.00					0.00	0.00	0.00											3.00	3.00	3.00				0.00	0.00	0.00				3.00				3.00			0.10	0.00		0.10	0.00	0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3449	023	1	1	02	01	H3449_023_1	7		Y	Select Care Drugs	4	01	1	2	6	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								3.00	3.00	3.00					0.00	0.00	0.00											3.00	3.00	3.00				0.00	0.00	0.00				3.00				3.00			0.10	0.00		0.10	0.00	0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H3449	023	2	1	02	01	H3449_023_2	7		Y	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00				15.00				15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3449	023	2	1	02	01	H3449_023_2	7		Y	Generic	4	01	3	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					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	02	01	H3449_023_2	7		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											47.00	94.00	141.00				37.00	74.00	74.00				47.00				47.00			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	02	01	H3449_023_2	7		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	300.00					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	02	01	H3449_023_2	7		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												30							30												30						30					30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3449	023	2	1	02	01	H3449_023_2	7		Y	Select Care Drugs	4	01	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								3.00	3.00	3.00					0.00	0.00	0.00											3.00	3.00	3.00				0.00	0.00	0.00				3.00				3.00			0.10	0.00		0.10	0.00	0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3449	023	2	1	02	01	H3449_023_2	7		Y	Select Care Drugs	4	01	1	2	6	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								3.00	3.00	3.00					0.00	0.00	0.00											3.00	3.00	3.00				0.00	0.00	0.00				3.00				3.00			0.10	0.00		0.10	0.00	0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H3449	023	4	1	02	01	H3449_023_4	7		Y	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00				15.00				15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3449	023	4	1	02	01	H3449_023_4	7		Y	Generic	4	01	3	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					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	02	01	H3449_023_4	7		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											47.00	94.00	141.00				37.00	74.00	74.00				47.00				47.00			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	02	01	H3449_023_4	7		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	300.00					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	02	01	H3449_023_4	7		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												30							30												30						30					30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3449	023	4	1	02	01	H3449_023_4	7		Y	Select Care Drugs	4	01	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								3.00	3.00	3.00					0.00	0.00	0.00											3.00	3.00	3.00				0.00	0.00	0.00				3.00				3.00			0.10	0.00		0.10	0.00	0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3449	023	4	1	02	01	H3449_023_4	7		Y	Select Care Drugs	4	01	1	2	6	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								3.00	3.00	3.00					0.00	0.00	0.00											3.00	3.00	3.00				0.00	0.00	0.00				3.00				3.00			0.10	0.00		0.10	0.00	0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H3449	023	5	1	02	01	H3449_023_5	7		Y	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00				15.00				15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3449	023	5	1	02	01	H3449_023_5	7		Y	Generic	4	01	3	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					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	02	01	H3449_023_5	7		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											47.00	94.00	141.00				37.00	74.00	74.00				47.00				47.00			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	02	01	H3449_023_5	7		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	300.00					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	02	01	H3449_023_5	7		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												30							30												30						30					30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3449	023	5	1	02	01	H3449_023_5	7		Y	Select Care Drugs	4	01	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								3.00	3.00	3.00					0.00	0.00	0.00											3.00	3.00	3.00				0.00	0.00	0.00				3.00				3.00			0.10	0.00		0.10	0.00	0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3449	023	5	1	02	01	H3449_023_5	7		Y	Select Care Drugs	4	01	1	2	6	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								3.00	3.00	3.00					0.00	0.00	0.00											3.00	3.00	3.00				0.00	0.00	0.00				3.00				3.00			0.10	0.00		0.10	0.00	0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H3449	024	1	1	02	01	H3449_024_1	8		Y	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00				15.00				15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3449	024	1	1	02	01	H3449_024_1	8		Y	Generic	4	01	3	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					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	02	01	H3449_024_1	8		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											47.00	94.00	141.00				37.00	74.00	74.00				47.00				47.00			1.57	1.23		1.57	1.23	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3449	024	1	1	02	01	H3449_024_1	8		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	300.00					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	02	01	H3449_024_1	8		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3449	024	1	1	02	01	H3449_024_1	8		Y	Select Care Drugs	4	01	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								1.00	1.00	1.00					0.00	0.00	0.00											1.00	1.00	1.00				0.00	0.00	0.00				1.00				1.00			0.03	0.00		0.03	0.00	0.03	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3449	024	1	1	02	01	H3449_024_1	8		Y	Select Care Drugs	4	01	1	2	6	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								1.00	1.00	1.00					0.00	0.00	0.00											1.00	1.00	1.00				0.00	0.00	0.00				1.00				1.00			0.03	0.00		0.03	0.00	0.03	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H3449	024	2	1	02	01	H3449_024_2	7		Y	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00				15.00				15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3449	024	2	1	02	01	H3449_024_2	7		Y	Generic	4	01	3	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					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	02	01	H3449_024_2	7		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											47.00	94.00	141.00				37.00	74.00	74.00				47.00				47.00			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	02	01	H3449_024_2	7		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	300.00					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	02	01	H3449_024_2	7		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3449	024	2	1	02	01	H3449_024_2	7		Y	Select Care Drugs	4	01	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								1.00	1.00	1.00					0.00	0.00	0.00											1.00	1.00	1.00				0.00	0.00	0.00				1.00				1.00			0.03	0.00		0.03	0.00	0.03	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3449	024	2	1	02	01	H3449_024_2	7		Y	Select Care Drugs	4	01	1	2	6	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								1.00	1.00	1.00					0.00	0.00	0.00											1.00	1.00	1.00				0.00	0.00	0.00				1.00				1.00			0.03	0.00		0.03	0.00	0.03	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H3449	024	3	1	02	01	H3449_024_3	7		Y	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00				15.00				15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3449	024	3	1	02	01	H3449_024_3	7		Y	Generic	4	01	3	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					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	02	01	H3449_024_3	7		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											47.00	94.00	141.00				37.00	74.00	74.00				47.00				47.00			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	02	01	H3449_024_3	7		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	300.00					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	02	01	H3449_024_3	7		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3449	024	3	1	02	01	H3449_024_3	7		Y	Select Care Drugs	4	01	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								1.00	1.00	1.00					0.00	0.00	0.00											1.00	1.00	1.00				0.00	0.00	0.00				1.00				1.00			0.03	0.00		0.03	0.00	0.03	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3449	024	3	1	02	01	H3449_024_3	7		Y	Select Care Drugs	4	01	1	2	6	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								1.00	1.00	1.00					0.00	0.00	0.00											1.00	1.00	1.00				0.00	0.00	0.00				1.00				1.00			0.03	0.00		0.03	0.00	0.03	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H3449	026	0	1	01	01	H3449_026_0	7		Y	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00				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	7		Y	Generic	4	01	3	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					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	7		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											47.00	94.00	141.00				37.00	74.00	74.00				47.00				47.00			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	7		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	300.00					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	7		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3449	026	0	1	01	01	H3449_026_0	7		Y	Select Care Drugs	4	01	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								3.00	3.00	3.00					0.00	0.00	0.00											3.00	3.00	3.00				0.00	0.00	0.00				3.00				3.00			0.10	0.00		0.10	0.00	0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3449	026	0	1	01	01	H3449_026_0	7		Y	Select Care Drugs	4	01	1	2	6	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								3.00	3.00	3.00					0.00	0.00	0.00											3.00	3.00	3.00				0.00	0.00	0.00				3.00				3.00			0.10	0.00		0.10	0.00	0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H3449	027	1	1	01	01	H3449_027_1	7		Y	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00				15.00				15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3449	027	1	1	01	01	H3449_027_1	7		Y	Generic	4	01	3	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					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	7		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											47.00	94.00	141.00				37.00	74.00	74.00				47.00				47.00			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	7		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	300.00					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	7		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												27							27												27						27					27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3449	027	1	1	01	01	H3449_027_1	7		Y	Select Care Drugs	4	01	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								3.00	3.00	3.00					0.00	0.00	0.00											3.00	3.00	3.00				0.00	0.00	0.00				3.00				3.00			0.10	0.00		0.10	0.00	0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3449	027	1	1	01	01	H3449_027_1	7		Y	Select Care Drugs	4	01	1	2	6	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								3.00	3.00	3.00					0.00	0.00	0.00											3.00	3.00	3.00				0.00	0.00	0.00				3.00				3.00			0.10	0.00		0.10	0.00	0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H3449	027	2	1	01	01	H3449_027_2	7		Y	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00				15.00				15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3449	027	2	1	01	01	H3449_027_2	7		Y	Generic	4	01	3	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					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	7		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											47.00	94.00	141.00				37.00	74.00	74.00				47.00				47.00			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	7		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	300.00					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	7		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												27							27												27						27					27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3449	027	2	1	01	01	H3449_027_2	7		Y	Select Care Drugs	4	01	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								3.00	3.00	3.00					0.00	0.00	0.00											3.00	3.00	3.00				0.00	0.00	0.00				3.00				3.00			0.10	0.00		0.10	0.00	0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3449	027	2	1	01	01	H3449_027_2	7		Y	Select Care Drugs	4	01	1	2	6	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								3.00	3.00	3.00					0.00	0.00	0.00											3.00	3.00	3.00				0.00	0.00	0.00				3.00				3.00			0.10	0.00		0.10	0.00	0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H3464	001	0	1	02	01	H3464_001_0	2		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3464	001	0	1	02	01	H3464_001_0	2		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3464	001	0	1	02	01	H3464_001_0	2		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	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	02	01	H3464_001_0	2		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	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	02	01	H3464_001_0	2		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3464	001	0	1	02	01	H3464_001_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3464	001	0	1	02	01	H3464_001_0	2		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				378.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3464	002	0	1	02	01	H3464_002_0	2		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3464	002	0	1	02	01	H3464_002_0	2		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3464	002	0	1	02	01	H3464_002_0	2		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	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	02	01	H3464_002_0	2		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	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	02	01	H3464_002_0	2		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3464	002	0	1	02	01	H3464_002_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3464	002	0	1	02	01	H3464_002_0	2		Y	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												
H3464	008	0	1	02	01	H3464_008_0	2		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3464	008	0	1	02	01	H3464_008_0	2		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3464	008	0	1	02	01	H3464_008_0	2		Y	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												
H3464	008	0	1	02	01	H3464_008_0	2		Y	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
H3464	008	0	1	02	01	H3464_008_0	2		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3464	008	0	1	02	01	H3464_008_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3464	008	0	1	02	01	H3464_008_0	2		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				211.00	26																										26						26					26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3471	001	0	1	01	01	H3471_001_0	6		Y	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	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	6		Y	Preferred Generic	4	01	1	2	1	3	111		01	111		1	30	60	90				1	2	30	60	90				30		31	2.00	4.00	6.00																			2.00	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	6		Y	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	15.00	30.00	45.00																			15.00	30.00	30.00																15.00				15.00		0.50			0.50			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3471	001	0	1	01	01	H3471_001_0	6		Y	Preferred Brand	4	10	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	94.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3471	001	0	1	01	01	H3471_001_0	6		Y	Non-Preferred Drug	4	11	1	1	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31				59.45	50	50	50																		50	50	50															50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3471	001	0	1	01	01	H3471_001_0	6		Y	Specialty Tier	4	11	1	1	5	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31					33	33	33																		33	33	33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3471	002	0	1	01	01	H3471_002_0	6		Y	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	2.00	4.00	6.00																			2.00	4.00	4.00																2.00				2.00		0.07			0.07			0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3471	002	0	1	01	01	H3471_002_0	6		Y	Preferred Generic	4	01	1	2	1	3	111		01	111		1	30	60	90				1	2	30	60	90				30		31	2.00	4.00	6.00																			2.00	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	6		Y	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	15.00	30.00	45.00																			15.00	30.00	30.00																15.00				15.00		0.50			0.50			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3471	002	0	1	01	01	H3471_002_0	6		Y	Preferred Brand	4	10	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	94.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3471	002	0	1	01	01	H3471_002_0	6		Y	Non-Preferred Drug	4	11	1	1	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31				48.27	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	6		Y	Specialty Tier	4	11	1	1	5	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31					33	33	33																		33	33	33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3471	004	0	1	01	01	H3471_004_0	5		Y	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	2.00	4.00	6.00																			2.00	4.00	4.00																2.00				2.00		0.07			0.07			0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3471	004	0	1	01	01	H3471_004_0	5		Y	Preferred Generic	4	01	1	2	1	3	111		01	111		1	30	60	90				1	2	30	60	90				30		31	2.00	4.00	6.00																			2.00	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	5		Y	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	15.00	30.00	45.00																			15.00	30.00	30.00																15.00				15.00		0.50			0.50			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3471	004	0	1	01	01	H3471_004_0	5		Y	Preferred Brand	4	10	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	94.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3471	004	0	1	01	01	H3471_004_0	5		Y	Non-Preferred Drug	4	11	1	1	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31				65.40	50	50	50																		50	50	50															50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3471	004	0	1	01	01	H3471_004_0	5		Y	Specialty Tier	4	11	1	1	5	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31					33	33	33																		33	33	33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3471	005	0	1	01	01	H3471_005_0	5		Y	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	2.00	4.00	6.00																			2.00	4.00	4.00																2.00				2.00		0.07			0.07			0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3471	005	0	1	01	01	H3471_005_0	5		Y	Preferred Generic	4	01	1	2	1	3	111		01	111		1	30	60	90				1	2	30	60	90				30		31	2.00	4.00	6.00																			2.00	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	5		Y	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	15.00	30.00	45.00																			15.00	30.00	30.00																15.00				15.00		0.50			0.50			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3471	005	0	1	01	01	H3471_005_0	5		Y	Preferred Brand	4	10	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	94.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3471	005	0	1	01	01	H3471_005_0	5		Y	Non-Preferred Drug	4	11	1	1	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31				82.49	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	5		Y	Specialty Tier	4	11	1	1	5	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31					33	33	33																		33	33	33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3471	010	0	1	01	01	H3471_010_0	6		Y	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	2.00	4.00	6.00																			2.00	4.00	4.00																2.00				2.00		0.07			0.07			0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3471	010	0	1	01	01	H3471_010_0	6		Y	Preferred Generic	4	01	1	2	1	3	111		01	111		1	30	60	90				1	2	30	60	90				30		31	2.00	4.00	6.00																			2.00	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	6		Y	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	15.00	30.00	45.00																			15.00	30.00	30.00																15.00				15.00		0.50			0.50			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3471	010	0	1	01	01	H3471_010_0	6		Y	Preferred Brand	4	10	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	94.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3471	010	0	1	01	01	H3471_010_0	6		Y	Non-Preferred Drug	4	11	1	1	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31				51.46	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	6		Y	Specialty Tier	4	11	1	1	5	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31					33	33	33																		33	33	33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3471	013	0	1	02	01	H3471_013_0	8		Y	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	2.00	4.00	6.00																			2.00	4.00	4.00																2.00				2.00		0.07			0.07			0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3471	013	0	1	02	01	H3471_013_0	8		Y	Preferred Generic	4	01	1	2	1	3	111		01	111		1	30	60	90				1	2	30	60	90				30		31	2.00	4.00	6.00																			2.00	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	8		Y	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	15.00	30.00	45.00																			15.00	30.00	30.00																15.00				15.00		0.50			0.50			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3471	013	0	1	02	01	H3471_013_0	8		Y	Preferred Brand	4	10	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	47.00	94.00	141.00																			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	8		Y	Non-Preferred Drug	4	11	1	1	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31				56.60	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	8		Y	Specialty Tier	4	11	1	1	5	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31					33	33	33																		33	33	33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3471	014	0	1	02	01	H3471_014_0	7		Y	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	2.00	4.00	6.00																			2.00	4.00	4.00																2.00				2.00		0.07			0.07			0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3471	014	0	1	02	01	H3471_014_0	7		Y	Preferred Generic	4	01	1	2	1	3	111		01	111		1	30	60	90				1	2	30	60	90				30		31	2.00	4.00	6.00																			2.00	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	7		Y	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	15.00	30.00	45.00																			15.00	30.00	30.00																15.00				15.00		0.50			0.50			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3471	014	0	1	02	01	H3471_014_0	7		Y	Preferred Brand	4	10	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	94.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3471	014	0	1	02	01	H3471_014_0	7		Y	Non-Preferred Drug	4	11	1	1	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31				56.60	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	7		Y	Specialty Tier	4	11	1	1	5	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31					33	33	33																		33	33	33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3471	017	0	1	01	01	H3471_017_0	6		Y	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	2.00	4.00	6.00																			2.00	4.00	4.00																2.00				2.00		0.07			0.07			0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3471	017	0	1	01	01	H3471_017_0	6		Y	Preferred Generic	4	01	1	2	1	3	111		01	111		1	30	60	90				1	2	30	60	90				30		31	2.00	4.00	6.00																			2.00	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	6		Y	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	15.00	30.00	45.00																			15.00	30.00	30.00																15.00				15.00		0.50			0.50			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3471	017	0	1	01	01	H3471_017_0	6		Y	Preferred Brand	4	10	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	94.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3471	017	0	1	01	01	H3471_017_0	6		Y	Non-Preferred Drug	4	11	1	1	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31				56.60	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	6		Y	Specialty Tier	4	11	1	1	5	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31					33	33	33																		33	33	33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3471	018	0	1	02	01	H3471_018_0	9		Y	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	2.00	4.00	6.00																			2.00	4.00	4.00																2.00				2.00		0.07			0.07			0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3471	018	0	1	02	01	H3471_018_0	9		Y	Preferred Generic	4	01	1	2	1	3	111		01	111		1	30	60	90				1	2	30	60	90				30		31	2.00	4.00	6.00																			2.00	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		Y	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	15.00	30.00	45.00																			15.00	30.00	30.00																15.00				15.00		0.50			0.50			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3471	018	0	1	02	01	H3471_018_0	9		Y	Preferred Brand	4	10	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	94.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3471	018	0	1	02	01	H3471_018_0	9		Y	Non-Preferred Drug	4	11	1	1	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31				46.76	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		Y	Specialty Tier	4	11	1	1	5	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31					30	30	30																		30	30	30															30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3471	019	0	1	02	01	H3471_019_0	7		Y	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	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	02	01	H3471_019_0	7		Y	Preferred Generic	4	01	1	2	1	3	111		01	111		1	30	60	90				1	2	30	60	90				30		31	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	02	01	H3471_019_0	7		Y	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	15.00	30.00	45.00																			15.00	30.00	30.00																15.00				15.00		0.50			0.50			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3471	019	0	1	02	01	H3471_019_0	7		Y	Preferred Brand	4	10	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	94.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3471	019	0	1	02	01	H3471_019_0	7		Y	Non-Preferred Drug	4	11	1	1	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31				56.60	50	50	50																		50	50	50															50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3471	019	0	1	02	01	H3471_019_0	7		Y	Specialty Tier	4	11	1	1	5	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31					33	33	33																		33	33	33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3499	002	0	1	01	01	H3499_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												
H3499	002	0	1	01	01	H3499_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
H3499	002	0	1	01	01	H3499_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												
H3499	002	0	1	01	01	H3499_002_0	4			Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											47.00	94.00	141.00				37.00	74.00	74.00				47.00				47.00			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	4			Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											82.80	45	45	45				79.12	43	43	43										45	45	45				43	43	43			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3499	002	0	1	01	01	H3499_002_0	4			Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3499	002	0	1	01	01	H3499_002_0	4			Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3499	002	0	1	01	01	H3499_002_0	4			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	
H3499	007	0	1	01	01	H3499_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												
H3499	007	0	1	01	01	H3499_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												
H3499	007	0	1	01	01	H3499_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												
H3499	007	0	1	01	01	H3499_007_0	4			Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											91.53	50	50	50				87.87	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	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												
H3499	007	0	1	01	01	H3499_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												
H3499	008	0	1	01	01	H3499_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								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												
H3499	008	0	1	01	01	H3499_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	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												
H3499	008	0	1	01	01	H3499_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	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, Select Care Drugs												
H3499	008	0	1	01	01	H3499_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											98.83	47	47	47				98.83	47	47	47										47	47	47				47	47	47			47			47								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3499	008	0	1	01	01	H3499_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												
H3499	008	0	1	01	01	H3499_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												
H3528	006	0	1	02	01	H3528_006_0	10		N	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								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, Select Care Drugs												
H3528	006	0	1	02	01	H3528_006_0	10		N	Preferred Generic	4	01	1	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								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, Select Care Drugs										1		
H3528	006	0	1	02	01	H3528_006_0	10		N	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					10.00	20.00	30.00											20.00	40.00	60.00				0.00	0.00	0.00				20.00				20.00			0.67	0.33		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3528	006	0	1	02	01	H3528_006_0	10		N	Generic	4	01	1	2	2	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					10.00	20.00	30.00											20.00	40.00	60.00				0.00	0.00	0.00				20.00				20.00			0.67	0.33		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H3528	006	0	1	02	01	H3528_006_0	10		N	Preferred Brand	4	10	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				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												
H3528	006	0	1	02	01	H3528_006_0	10		N	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	300.00					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												
H3528	006	0	1	02	01	H3528_006_0	10		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												27							27												27						27					27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3528	006	0	1	02	01	H3528_006_0	10		N	Select Care Drugs	4	01	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3528	006	0	1	02	01	H3528_006_0	10		N	Select Care Drugs	4	01	1	2	6	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H3528	010	0	1	01	01	H3528_010_0	8		N	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								9.00	18.00	27.00					2.00	4.00	6.00											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, Select Care Drugs												
H3528	010	0	1	01	01	H3528_010_0	8		N	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					10.00	20.00	30.00											20.00	40.00	60.00				0.00	0.00	0.00				20.00				20.00			0.67	0.33		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3528	010	0	1	01	01	H3528_010_0	8		N	Preferred Brand	4	10	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				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												
H3528	010	0	1	01	01	H3528_010_0	8		N	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	300.00					95.00	190.00	285.00											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												
H3528	010	0	1	01	01	H3528_010_0	8		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												30							30												30						30					30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3528	010	0	1	01	01	H3528_010_0	8		N	Select Care Drugs	4	01	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3528	010	0	1	01	01	H3528_010_0	8		N	Select Care Drugs	4	01	1	2	6	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H3528	011	1	1	02	01	H3528_011_1	10			Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								9.00	18.00	27.00					2.00	4.00	6.00											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, Select Care Drugs												
H3528	011	1	1	02	01	H3528_011_1	10			Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					10.00	20.00	30.00											20.00	40.00	60.00				0.00	0.00	0.00				20.00				20.00			0.67	0.33		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3528	011	1	1	02	01	H3528_011_1	10			Preferred Brand	4	10	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				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												
H3528	011	1	1	02	01	H3528_011_1	10			Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	300.00					95.00	190.00	285.00											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												
H3528	011	1	1	02	01	H3528_011_1	10			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												
H3528	011	1	1	02	01	H3528_011_1	10			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												
H3528	011	1	1	02	01	H3528_011_1	10			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		
H3528	011	2	1	02	01	H3528_011_2	9			Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								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, Select Care Drugs												
H3528	011	2	1	02	01	H3528_011_2	9			Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					10.00	20.00	30.00											20.00	40.00	60.00				0.00	0.00	0.00				20.00				20.00			0.67	0.33		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3528	011	2	1	02	01	H3528_011_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	126.00				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												
H3528	011	2	1	02	01	H3528_011_2	9			Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	300.00					95.00	190.00	285.00											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												
H3528	011	2	1	02	01	H3528_011_2	9			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												
H3528	011	2	1	02	01	H3528_011_2	9			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												
H3528	011	2	1	02	01	H3528_011_2	9			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		
H3528	014	0	1	01	01	H3528_014_0	9			Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								9.00	18.00	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, Select Care Drugs												
H3528	014	0	1	01	01	H3528_014_0	9			Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					10.00	20.00	30.00											20.00	40.00	60.00				0.00	0.00	0.00				20.00				20.00			0.67	0.33		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3528	014	0	1	01	01	H3528_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					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				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												
H3528	014	0	1	01	01	H3528_014_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											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												
H3528	014	0	1	01	01	H3528_014_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, Select Care Drugs												
H3528	014	0	1	01	01	H3528_014_0	9			Select Care Drugs	4	01	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3528	014	0	1	01	01	H3528_014_0	9			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		
H3528	015	0	1	02	01	H3528_015_0	9		Y	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								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, Select Care Drugs												
H3528	015	0	1	02	01	H3528_015_0	9		Y	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					10.00	20.00	30.00											20.00	40.00	60.00				0.00	0.00	0.00				20.00				20.00			0.67	0.33		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3528	015	0	1	02	01	H3528_015_0	9		Y	Preferred Brand	4	10	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				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												
H3528	015	0	1	02	01	H3528_015_0	9		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	300.00					95.00	190.00	285.00											100.00	200.00	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												
H3528	015	0	1	02	01	H3528_015_0	9		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												27							27												27						27					27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3528	015	0	1	02	01	H3528_015_0	9		Y	Select Care Drugs	4	01	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3528	015	0	1	02	01	H3528_015_0	9		Y	Select Care Drugs	4	01	1	2	6	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H3528	016	0	1	01	01	H3528_016_0	10		Y	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								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, Select Care Drugs												
H3528	016	0	1	01	01	H3528_016_0	10		Y	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, Select Care Drugs										1		
H3528	016	0	1	01	01	H3528_016_0	10		Y	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					10.00	20.00	30.00											20.00	40.00	60.00				0.00	0.00	0.00				20.00				20.00			0.67	0.33		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3528	016	0	1	01	01	H3528_016_0	10		Y	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, Select Care Drugs										1		
H3528	016	0	1	01	01	H3528_016_0	10		Y	Preferred Brand	4	10	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				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												
H3528	016	0	1	01	01	H3528_016_0	10		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	300.00					95.00	190.00	285.00											100.00	200.00	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												
H3528	016	0	1	01	01	H3528_016_0	10		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												27							27												27						27					27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3528	016	0	1	01	01	H3528_016_0	10		Y	Select Care Drugs	4	01	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3528	016	0	1	01	01	H3528_016_0	10		Y	Select Care Drugs	4	01	1	2	6	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H3533	006	0	1	01	01	H3533_006_0	2		Y	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3533	006	0	1	01	01	H3533_006_0	2		Y	Preferred Generic	4	11	3	2	1	3	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H3533	006	0	1	01	01	H3533_006_0	2		Y	Generic	4	11	3	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	0.00		0.00																									20.00		60.00				0.00		0.00				0.00				0.00		0				0.67	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3533	006	0	1	01	01	H3533_006_0	2		Y	Generic	4	11	3	2	2	3	110		01		110	1	30		90				2	2				30		90	30		31	0.00		0.00																									20.00		60.00				0.00		0.00				0.00				0.00		0				0.67	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H3533	006	0	1	01	01	H3533_006_0	2		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		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	2		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		290.00				100.00				100.00		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	2		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					28																										28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3533	010	0	1	01	01	H3533_010_0	2		Y	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	2.00		6.00																									10.00		30.00				2.00		0.00				2.00				2.00		0.07				0.33	0.07	0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3533	010	0	1	01	01	H3533_010_0	2		Y	Generic	4	11	3	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	9.00		27.00																									20.00		60.00				9.00		0.00				9.00				9.00		0.30				0.67	0.30	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3533	010	0	1	01	01	H3533_010_0	2		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	47.00		141.00																									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												
H3533	010	0	1	01	01	H3533_010_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	100.00		300.00																									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												
H3533	010	0	1	01	01	H3533_010_0	2		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					29																										29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3533	013	0	1	01	01	H3533_013_0	2		Y	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	4.00		12.00																									10.00		30.00				4.00		0.00				4.00				4.00		0.13				0.33	0.13	0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3533	013	0	1	01	01	H3533_013_0	2		Y	Preferred Generic	4	11	3	2	1	3	110		01		110	1	30		90				1	2				30		90	30		31	4.00		12.00																									10.00		30.00				4.00		0.00				4.00				4.00		0.13				0.33	0.13	0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H3533	013	0	1	01	01	H3533_013_0	2		Y	Generic	4	11	3	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	12.00		36.00																									20.00		60.00				12.00		0.00				12.00				12.00		0.40				0.67	0.40	0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3533	013	0	1	01	01	H3533_013_0	2		Y	Generic	4	11	3	2	2	3	110		01		110	1	30		90				2	2				30		90	30		31	12.00		36.00																									20.00		60.00				12.00		0.00				12.00				12.00		0.40				0.67	0.40	0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H3533	013	0	1	01	01	H3533_013_0	2		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		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	2		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		290.00				100.00				100.00		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	2		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					28																										28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3533	027	0	1	01	01	H3533_027_0	2		N	Preferred Generic	4	11	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	6.00		18.00																									10.00		30.00				6.00		0.00				6.00				6.00		0.20				0.33	0.20	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3533	027	0	1	01	01	H3533_027_0	2		N	Generic	4	11	1	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	16.00		48.00																									20.00		60.00				16.00		0.00				16.00				16.00		0.53				0.67	0.53	0.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3533	027	0	1	01	01	H3533_027_0	2		N	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		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	2		N	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		290.00				100.00				100.00		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	2		N	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					26																										26						26					26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3533	032	1	1	01	01	H3533_032_1	2		Y	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	2.00		6.00																									10.00		30.00				2.00		0.00				2.00				2.00		0.07				0.33	0.07	0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3533	032	1	1	01	01	H3533_032_1	2		Y	Generic	4	11	3	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	9.00		27.00																									20.00		60.00				9.00		0.00				9.00				9.00		0.30				0.67	0.30	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3533	032	1	1	01	01	H3533_032_1	2		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		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	2		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		290.00				100.00				100.00		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	2		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					29																										29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3533	032	2	1	01	01	H3533_032_2	2		Y	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	2.00		6.00																									10.00		30.00				2.00		0.00				2.00				2.00		0.07				0.33	0.07	0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3533	032	2	1	01	01	H3533_032_2	2		Y	Generic	4	11	3	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	9.00		27.00																									20.00		60.00				9.00		0.00				9.00				9.00		0.30				0.67	0.30	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3533	032	2	1	01	01	H3533_032_2	2		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		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	2		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		290.00				100.00				100.00		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	2		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					29																										29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3533	033	0	1	01	01	H3533_033_0	2		Y	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	2.00		6.00																									10.00		30.00				2.00		0.00				2.00				2.00		0.07				0.33	0.07	0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3533	033	0	1	01	01	H3533_033_0	2		Y	Generic	4	11	3	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	9.00		27.00																									20.00		60.00				9.00		0.00				9.00				9.00		0.30				0.67	0.30	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3533	033	0	1	01	01	H3533_033_0	2		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		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	2		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		290.00				100.00				100.00		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	2		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					27																										27						27					27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3536	002	0	1	01	01	H3536_002_0	5		N	Preferred Generic	4	01	3	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								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	5		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								20.00	40.00	60.00					15.00	30.00	45.00					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	5		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00	84.00	84.00																47.00				47.00			1.57	1.40	1.40			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3536	002	0	1	01	01	H3536_002_0	5		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	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	5		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												30							30						30																	30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3536	002	0	1	01	01	H3536_002_0	5		N	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3536	002	0	1	01	01	H3536_002_0	5		N	Select Care Drugs	4	01	1	2	6	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H3536	004	0	1	01	01	H3536_004_0	5		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								10.00	20.00	30.00					5.00	10.00	15.00					5.00	15.00	15.00																10.00				10.00			0.33	0.17	0.17			0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3536	004	0	1	01	01	H3536_004_0	5		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								20.00	40.00	60.00					15.00	30.00	45.00					15.00	45.00	45.00																20.00				20.00			0.67	0.50	0.50			0.59	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3536	004	0	1	01	01	H3536_004_0	5		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								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	5		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	285.00	285.00																100.00				100.00			3.33	3.17	3.17			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3536	004	0	1	01	01	H3536_004_0	5		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												25							25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3536	004	0	1	01	01	H3536_004_0	5		N	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								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												
H3536	006	0	1	01	01	H3536_006_0	5		Y	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												
H3536	006	0	1	01	01	H3536_006_0	5		Y	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	5		Y	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												
H3536	006	0	1	01	01	H3536_006_0	5		Y	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	
H3536	006	0	1	01	01	H3536_006_0	5		Y	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	5		Y	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	5		Y	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				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	5		Y	Select Care Drugs	4	01	1	2	6	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				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	5		Y	Preferred Generic	4	01	1	2	1	1	110		01	110		1	30		100				1	2	30		100				30		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3554	002	0	1	04	01	H3554_002_0	5		Y	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	5		Y	Preferred Brand	4	11	1	2	3	1	110		01	110		1	30		100				1	2	30		100				30		31	47.00		141.00																			47.00		141.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3554	002	0	1	04	01	H3554_002_0	5		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01	110		1	30		100				1	2	30		100				30		31	100.00		300.00																			100.00		300.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3554	002	0	1	04	01	H3554_002_0	5		Y	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				1134.90	29																				29																	29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3554	002	0	1	04	01	H3554_002_0	5		Y	Select Care Drugs	4	01	3	2	6	1	110		01	110		1	30		100				1	2	30		100				30		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3554	002	0	1	04	01	H3554_002_0	5		Y	Select Care Drugs	4	01	3	2	6	3	110		01	110		1	30		100				1	2	30		100				30		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		3
H3554	004	0	1	04	01	H3554_004_0	5		Y	Preferred Generic	4	01	1	2	1	1	110		01	110		1	30		100				1	2	30		100				30		31	1.00		2.00																			1.00		0.00																1.00				1.00		0.03			0.03			0.03	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3554	004	0	1	04	01	H3554_004_0	5		Y	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	5		Y	Preferred Brand	4	11	1	2	3	1	110		01	110		1	30		100				1	2	30		100				30		31	47.00		141.00																			47.00		141.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3554	004	0	1	04	01	H3554_004_0	5		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01	110		1	30		100				1	2	30		100				30		31	100.00		300.00																			100.00		300.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3554	004	0	1	04	01	H3554_004_0	5		Y	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				1236.92	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	5		Y	Select Care Drugs	4	01	3	2	6	1	110		01	110		1	30		100				1	2	30		100				30		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3554	004	0	1	04	01	H3554_004_0	5		Y	Select Care Drugs	4	01	3	2	6	3	110		01	110		1	30		100				1	2	30		100				30		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		3
H3554	007	0	1	04	01	H3554_007_0	5		Y	Preferred Generic	4	01	1	2	1	1	110		01	110		1	30		100				1	2	30		100				30		31	1.00		2.00																			1.00		0.00																1.00				1.00		0.03			0.03			0.03	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3554	007	0	1	04	01	H3554_007_0	5		Y	Preferred Generic	4	01	1	2	1	3	110		01	110		1	30		100				1	2	30		100				30		31	1.00		2.00																			1.00		0.00																1.00				1.00		0.03			0.03			0.03	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H3554	007	0	1	04	01	H3554_007_0	5		Y	Generic	4	01	1	2	2	1	110		01	110		1	30		100				1	2	30		100				30		31	10.00		20.00																			10.00		0.00																10.00				10.00		0.33			0.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3554	007	0	1	04	01	H3554_007_0	5		Y	Preferred Brand	4	11	1	2	3	1	110		01	110		1	30		100				1	2	30		100				30		31	47.00		141.00																			47.00		141.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3554	007	0	1	04	01	H3554_007_0	5		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01	110		1	30		100				1	2	30		100				30		31	100.00		300.00																			100.00		300.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3554	007	0	1	04	01	H3554_007_0	5		Y	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				896.95	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	5		Y	Select Care Drugs	4	01	3	2	6	1	110		01	110		1	30		100				1	2	30		100				30		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3554	007	0	1	04	01	H3554_007_0	5		Y	Select Care Drugs	4	01	3	2	6	3	110		01	110		1	30		100				1	2	30		100				30		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		3
H3557	001	0	1	04	01	H3557_001_0	11		Y	Preferred Generic	4	01	1	2	1	1		111	01	101		1				30	60	90	1	2		60	90				30		31								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												
H3557	001	0	1	04	01	H3557_001_0	11		Y	Preferred Generic	4	01	1	2	1	3		111	01	101		1				30	60	90	1	2		60	90				30		31								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										1		
H3557	001	0	1	04	01	H3557_001_0	11		Y	Generic	4	01	1	2	2	1		111	01	101		1				30	60	90	1	2		60	90				30		31								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												
H3557	001	0	1	04	01	H3557_001_0	11		Y	Generic	4	01	1	2	2	3		111	01	101		1				30	60	90	1	2		60	90				30		31								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										1		
H3557	001	0	1	04	01	H3557_001_0	11		Y	Preferred Brand	4	11	1	2	3	1		111	01	101		1				30	60	90	1	2		60	90				30		31								47.00	94.00	141.00					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												
H3557	001	0	1	04	01	H3557_001_0	11		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01	101		1				30	60	90	1	2		60	90				30		31								100.00	200.00	300.00					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												
H3557	001	0	1	04	01	H3557_001_0	11		Y	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3597	001	0	1	01	01	H3597_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												
H3597	001	0	1	01	01	H3597_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		
H3597	001	0	1	01	01	H3597_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												
H3597	001	0	1	01	01	H3597_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		
H3597	001	0	1	01	01	H3597_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												
H3597	001	0	1	01	01	H3597_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												
H3597	001	0	1	01	01	H3597_001_0	2			Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1005.10	33						601.26	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3597	007	0	1	01	01	H3597_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					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	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		
H3597	007	0	1	01	01	H3597_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												
H3597	007	0	1	01	01	H3597_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		
H3597	007	0	1	01	01	H3597_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												
H3597	007	0	1	01	01	H3597_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												
H3597	007	0	1	01	01	H3597_007_0	2			Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											924.50	33						811.91	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3597	009	0	1	01	01	H3597_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												
H3597	009	0	1	01	01	H3597_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		
H3597	009	0	1	01	01	H3597_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	20.00											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												
H3597	009	0	1	01	01	H3597_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	20.00											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										1		
H3597	009	0	1	01	01	H3597_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												
H3597	009	0	1	01	01	H3597_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												
H3597	009	0	1	01	01	H3597_009_0	2			Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											777.58	30						641.95	30												30						30						30		30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3632	001	0	1	04	01	H3632_001_0	7		Y	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	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	7		Y	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					10.00	20.00	30.00											20.00	40.00	60.00				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	7		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	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	7		Y	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											79.67	50	50	50				60.33	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	7		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3653	004	0	1	01	01	H3653_004_0	7		Y	Preferred Generic	4	11	1	2	1	1	110		01	110		1	30		90				1	2	30		90				30		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3653	004	0	1	01	01	H3653_004_0	7		Y	Preferred Generic	4	11	1	2	1	3	110		01	110		1	30		90				1	2	30		90				30		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3653	004	0	1	01	01	H3653_004_0	7		Y	Generic	4	11	1	2	2	1	110		01	110		1	30		90				2	2	30		90				30		31	10.00		30.00																			10.00		20.00																10.00				10.00		0.33			0.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3653	004	0	1	01	01	H3653_004_0	7		Y	Generic	4	11	1	2	2	3	110		01	110		1	30		90				2	2	30		90				30		31	10.00		30.00																			10.00		20.00																10.00				10.00		0.33			0.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3653	004	0	1	01	01	H3653_004_0	7		Y	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												
H3653	004	0	1	01	01	H3653_004_0	7		Y	Non-Preferred Drug	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												
H3653	004	0	1	01	01	H3653_004_0	7		Y	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31				1310.87	33																																					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3653	015	0	1	01	01	H3653_015_0	7		N	Preferred Generic	4	11	1	2	1	1	110		01	110		1	30		90				1	2	30		90				30		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3653	015	0	1	01	01	H3653_015_0	7		N	Preferred Generic	4	11	1	2	1	3	110		01	110		1	30		90				1	2	30		90				30		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3653	015	0	1	01	01	H3653_015_0	7		N	Generic	4	11	1	2	2	1	110		01	110		1	30		90				2	2	30		90				30		31	8.00		24.00																			8.00		16.00																8.00				8.00		0.27			0.27			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3653	015	0	1	01	01	H3653_015_0	7		N	Generic	4	11	1	2	2	3	110		01	110		1	30		90				2	2	30		90				30		31	8.00		24.00																			8.00		16.00																8.00				8.00		0.27			0.27			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3653	015	0	1	01	01	H3653_015_0	7		N	Preferred Brand	4	11	1	2	3	1	110		01	110		1	30		90				2	2	30		90				30		31	45.00		135.00																			45.00		90.00																45.00				45.00		1.50			1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3653	015	0	1	01	01	H3653_015_0	7		N	Non-Preferred Drug	4	11	1	2	4	1	110		01	110		1	30		90				2	2	30		90				30		31	100.00		300.00																			100.00		200.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3653	015	0	1	01	01	H3653_015_0	7		N	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31				967.71	33																																					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3653	022	0	1	01	01	H3653_022_0	7		Y	Preferred Generic	4	11	1	2	1	1	110		01	110		1	30		90				1	2	30		90				30		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3653	022	0	1	01	01	H3653_022_0	7		Y	Preferred Generic	4	11	1	2	1	3	110		01	110		1	30		90				1	2	30		90				30		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3653	022	0	1	01	01	H3653_022_0	7		Y	Generic	4	11	1	2	2	1	110		01	110		1	30		90				2	2	30		90				30		31	10.00		30.00																			10.00		20.00																10.00				10.00		0.33			0.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3653	022	0	1	01	01	H3653_022_0	7		Y	Generic	4	11	1	2	2	3	110		01	110		1	30		90				2	2	30		90				30		31	10.00		30.00																			10.00		20.00																10.00				10.00		0.33			0.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3653	022	0	1	01	01	H3653_022_0	7		Y	Preferred Brand	4	11	1	2	3	1	110		01	110		1	30		90				2	2	30		90				30		31	45.00		135.00																			45.00		90.00																45.00				45.00		1.50			1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3653	022	0	1	01	01	H3653_022_0	7		Y	Non-Preferred Drug	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												
H3653	022	0	1	01	01	H3653_022_0	7		Y	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31				1136.34	33																																					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3653	024	0	1	01	01	H3653_024_0	6		Y	Preferred Generic	4	11	1	2	1	1	110		01	110		1	30		90				1	2	30		90				30		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3653	024	0	1	01	01	H3653_024_0	6		Y	Preferred Generic	4	11	1	2	1	3	110		01	110		1	30		90				1	2	30		90				30		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3653	024	0	1	01	01	H3653_024_0	6		Y	Generic	4	11	1	2	2	1	110		01	110		1	30		90				2	2	30		90				30		31	8.00		24.00																			8.00		16.00																8.00				8.00		0.27			0.27			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3653	024	0	1	01	01	H3653_024_0	6		Y	Generic	4	11	1	2	2	3	110		01	110		1	30		90				2	2	30		90				30		31	8.00		24.00																			8.00		16.00																8.00				8.00		0.27			0.27			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3653	024	0	1	01	01	H3653_024_0	6		Y	Preferred Brand	4	11	1	2	3	1	110		01	110		1	30		90				2	2	30		90				30		31	45.00		135.00																			45.00		90.00																45.00				45.00		1.50			1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3653	024	0	1	01	01	H3653_024_0	6		Y	Non-Preferred Drug	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												
H3653	024	0	1	01	01	H3653_024_0	6		Y	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31				1038.08	33																																					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3653	025	0	1	01	01	H3653_025_0	7		N	Preferred Generic	4	11	1	2	1	1	110		01	110		1	30		90				1	2	30		90				30		31	2.00		6.00																			2.00		4.00																2.00				2.00		0.07			0.07			0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3653	025	0	1	01	01	H3653_025_0	7		N	Preferred Generic	4	11	1	2	1	3	110		01	110		1	30		90				1	2	30		90				30		31	2.00		6.00																			2.00		4.00																2.00				2.00		0.07			0.07			0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3653	025	0	1	01	01	H3653_025_0	7		N	Generic	4	11	1	2	2	1	110		01	110		1	30		90				2	2	30		90				30		31	8.00		24.00																			8.00		16.00																8.00				8.00		0.27			0.27			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3653	025	0	1	01	01	H3653_025_0	7		N	Generic	4	11	1	2	2	3	110		01	110		1	30		90				2	2	30		90				30		31	8.00		24.00																			8.00		16.00																8.00				8.00		0.27			0.27			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3653	025	0	1	01	01	H3653_025_0	7		N	Preferred Brand	4	11	1	2	3	1	110		01	110		1	30		90				2	2	30		90				30		31	45.00		135.00																			45.00		90.00																45.00				45.00		1.50			1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3653	025	0	1	01	01	H3653_025_0	7		N	Non-Preferred Drug	4	11	1	2	4	1	110		01	110		1	30		90				2	2	30		90				30		31	100.00		300.00																			100.00		200.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3653	025	0	1	01	01	H3653_025_0	7		N	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31				1322.64	30																																					30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3653	026	0	1	01	01	H3653_026_0	7		N	Preferred Generic	4	11	1	2	1	1	110		01	110		1	30		90				1	2	30		90				30		31	2.00		6.00																			2.00		4.00																2.00				2.00		0.07			0.07			0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3653	026	0	1	01	01	H3653_026_0	7		N	Preferred Generic	4	11	1	2	1	3	110		01	110		1	30		90				1	2	30		90				30		31	2.00		6.00																			2.00		4.00																2.00				2.00		0.07			0.07			0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3653	026	0	1	01	01	H3653_026_0	7		N	Generic	4	11	1	2	2	1	110		01	110		1	30		90				2	2	30		90				30		31	8.00		24.00																			8.00		16.00																8.00				8.00		0.27			0.27			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3653	026	0	1	01	01	H3653_026_0	7		N	Generic	4	11	1	2	2	3	110		01	110		1	30		90				2	2	30		90				30		31	8.00		24.00																			8.00		16.00																8.00				8.00		0.27			0.27			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3653	026	0	1	01	01	H3653_026_0	7		N	Preferred Brand	4	11	1	2	3	1	110		01	110		1	30		90				2	2	30		90				30		31	45.00		135.00																			45.00		90.00																45.00				45.00		1.50			1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3653	026	0	1	01	01	H3653_026_0	7		N	Non-Preferred Drug	4	11	1	2	4	1	110		01	110		1	30		90				2	2	30		90				30		31	100.00		300.00																			100.00		200.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3653	026	0	1	01	01	H3653_026_0	7		N	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31				943.86	30																																					30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3653	027	0	1	01	01	H3653_027_0	7		N	Preferred Generic	4	11	1	2	1	1	110		01	110		1	30		90				1	2	30		90				30		31	2.00		6.00																			2.00		4.00																2.00				2.00		0.07			0.07			0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3653	027	0	1	01	01	H3653_027_0	7		N	Preferred Generic	4	11	1	2	1	3	110		01	110		1	30		90				1	2	30		90				30		31	2.00		6.00																			2.00		4.00																2.00				2.00		0.07			0.07			0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3653	027	0	1	01	01	H3653_027_0	7		N	Generic	4	11	1	2	2	1	110		01	110		1	30		90				2	2	30		90				30		31	8.00		24.00																			8.00		16.00																8.00				8.00		0.27			0.27			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3653	027	0	1	01	01	H3653_027_0	7		N	Generic	4	11	1	2	2	3	110		01	110		1	30		90				2	2	30		90				30		31	8.00		24.00																			8.00		16.00																8.00				8.00		0.27			0.27			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3653	027	0	1	01	01	H3653_027_0	7		N	Preferred Brand	4	11	1	2	3	1	110		01	110		1	30		90				2	2	30		90				30		31	45.00		135.00																			45.00		90.00																45.00				45.00		1.50			1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3653	027	0	1	01	01	H3653_027_0	7		N	Non-Preferred Drug	4	11	1	2	4	1	110		01	110		1	30		90				2	2	30		90				30		31	100.00		300.00																			100.00		200.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3653	027	0	1	01	01	H3653_027_0	7		N	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31				944.34	30																																					30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3653	028	0	1	02	01	H3653_028_0	6		N	Preferred Generic	4	11	1	2	1	1	110		01	110		1	30		90				1	2	30		90				30		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3653	028	0	1	02	01	H3653_028_0	6		N	Preferred Generic	4	11	1	2	1	3	110		01	110		1	30		90				1	2	30		90				30		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3653	028	0	1	02	01	H3653_028_0	6		N	Generic	4	11	1	2	2	1	110		01	110		1	30		90				2	2	30		90				30		31	8.00		24.00																			8.00		16.00																8.00				8.00		0.27			0.27			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3653	028	0	1	02	01	H3653_028_0	6		N	Preferred Brand	4	11	1	2	3	1	110		01	110		1	30		90				2	2	30		90				30		31	45.00		135.00																			45.00		90.00																45.00				45.00		1.50			1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3653	028	0	1	02	01	H3653_028_0	6		N	Non-Preferred Drug	4	11	1	2	4	1	110		01	110		1	30		90				2	2	30		90				30		31	100.00		300.00																			100.00		200.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3653	028	0	1	02	01	H3653_028_0	6		N	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31				1039.48	33																																					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3655	033	0	1	01	01	H3655_033_0	5		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								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	5		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								20.00	40.00	60.00					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	5		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								47.00	94.00	141.00					47.00	94.00	141.00					47.00	141.00	141.00																47.00				47.00			1.57	1.57	1.57			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3655	033	0	1	01	01	H3655_033_0	5		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	285.00	285.00																100.00				100.00			3.33	3.17	3.17			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3655	033	0	1	01	01	H3655_033_0	5		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												25							25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3655	033	0	1	01	01	H3655_033_0	5		N	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								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	5		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								7.00	14.00	21.00					2.00	4.00	6.00					0.00	0.00	0.00																7.00				7.00			0.23	0.07	0.00			0.21	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3655	034	0	1	01	01	H3655_034_0	5		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								15.00	30.00	45.00					10.00	20.00	30.00					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	5		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								47.00	94.00	141.00					37.00	74.00	111.00					37.00	74.00	74.00																47.00				47.00			1.57	1.23	1.23			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3655	034	0	1	01	01	H3655_034_0	5		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								100.00	200.00	300.00					90.00	180.00	270.00					90.00	180.00	180.00																100.00				100.00			3.33	3.00	3.00			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3655	034	0	1	01	01	H3655_034_0	5		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3655	034	0	1	01	01	H3655_034_0	5		N	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3655	034	0	1	01	01	H3655_034_0	5		N	Select Care Drugs	4	01	1	2	6	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H3655	038	0	1	01	01	H3655_038_0	6		Y	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	6		Y	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	6		Y	Preferred Brand	4	11	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	6		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				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	6		Y	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3655	038	0	1	01	01	H3655_038_0	6		Y	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3655	038	0	1	01	01	H3655_038_0	6		Y	Select Care Drugs	4	01	1	2	6	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H3655	041	0	1	01	01	H3655_041_0	5		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								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	041	0	1	01	01	H3655_041_0	5		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								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	041	0	1	01	01	H3655_041_0	5		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								47.00	94.00	141.00					47.00	94.00	141.00					47.00	141.00	141.00																47.00				47.00			1.57	1.57	1.57			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3655	041	0	1	01	01	H3655_041_0	5		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	285.00	285.00																100.00				100.00			3.33	3.17	3.17			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3655	041	0	1	01	01	H3655_041_0	5		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												25							25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3655	041	0	1	01	01	H3655_041_0	5		N	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								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	042	0	1	01	01	H3655_042_0	5		Y	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								9.00	18.00	27.00					4.00	8.00	12.00					0.00	0.00	0.00																9.00				9.00			0.30	0.13	0.00			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3655	042	0	1	01	01	H3655_042_0	5		Y	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	5		Y	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00	84.00	84.00																47.00				47.00			1.57	1.40	1.40			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3655	042	0	1	01	01	H3655_042_0	5		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	190.00	190.00																100.00				100.00			3.33	3.17	3.17			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3655	042	0	1	01	01	H3655_042_0	5		Y	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3655	042	0	1	01	01	H3655_042_0	5		Y	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3655	042	0	1	01	01	H3655_042_0	5		Y	Select Care Drugs	4	01	1	2	6	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				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	5		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								10.00	20.00	30.00					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	5		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								20.00	40.00	60.00					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	5		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								47.00	94.00	141.00					47.00	94.00	141.00					47.00	141.00	141.00																47.00				47.00			1.57	1.57	1.57			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3655	044	0	1	01	01	H3655_044_0	5		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	285.00	285.00																100.00				100.00			3.33	3.17	3.17			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3655	044	0	1	01	01	H3655_044_0	5		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												26							26						26																	26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3655	044	0	1	01	01	H3655_044_0	5		N	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								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		Y	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		Y	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		Y	Preferred Brand	4	11	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		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				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		Y	Specialty Tier	4	11	1	1	5	1		010	01	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		Y	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				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		Y	Select Care Drugs	4	01	1	2	6	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				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	6		Y	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	6		Y	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	6		Y	Preferred Brand	4	11	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	6		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				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	6		Y	Specialty Tier	4	11	1	1	5	1		010	01	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	6		Y	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				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	6		Y	Select Care Drugs	4	01	1	2	6	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				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	6		Y	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	6		Y	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	6		Y	Preferred Brand	4	11	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	6		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				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	6		Y	Specialty Tier	4	11	1	1	5	1		010	01	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	6		Y	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				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	6		Y	Select Care Drugs	4	01	1	2	6	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				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	6		Y	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	6		Y	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	6		Y	Preferred Brand	4	11	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	6		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				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	6		Y	Specialty Tier	4	11	1	1	5	1		010	01	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	6		Y	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				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	6		Y	Select Care Drugs	4	01	1	2	6	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				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	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, Select Care Drugs												
H3660	028	0	1	02	01	H3660_028_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, Select Care Drugs										1		
H3660	028	0	1	02	01	H3660_028_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, Select Care Drugs												
H3660	028	0	1	02	01	H3660_028_0	7			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, Select Care Drugs												
H3660	028	0	1	02	01	H3660_028_0	7			Non-Preferred Drug	4	11	1	2	4	1	110		01	100		1	30		90				1	2			90				30		31	95.00		285.00																					285.00																95.00				95.00		3.17						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3660	028	0	1	02	01	H3660_028_0	7			Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31					33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3660	028	0	1	02	01	H3660_028_0	7			Select Care Drugs	4	11	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 Care Drugs												
H3660	028	0	1	02	01	H3660_028_0	7			Select Care Drugs	4	11	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 Care Drugs										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, Select Care Drugs												
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, Select Care Drugs										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, Select Care Drugs												
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, Select Care Drugs												
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, Select Care Drugs												
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, Select Care Drugs												
H3660	029	0	1	02	01	H3660_029_0	7			Select Care Drugs	4	11	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 Care Drugs												
H3660	029	0	1	02	01	H3660_029_0	7			Select Care Drugs	4	11	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 Care Drugs										1		
H3660	044	0	1	01	01	H3660_044_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, Select Care Drugs												
H3660	044	0	1	01	01	H3660_044_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, Select Care Drugs										1		
H3660	044	0	1	01	01	H3660_044_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, Select Care Drugs												
H3660	044	0	1	01	01	H3660_044_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, Select Care Drugs												
H3660	044	0	1	01	01	H3660_044_0	7			Non-Preferred Drug	4	11	1	2	4	1	110		01	100		1	30		90				1	2			90				30		31	100.00		300.00																					300.00																100.00				100.00		3.33						3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3660	044	0	1	01	01	H3660_044_0	7			Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31					33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3660	044	0	1	01	01	H3660_044_0	7			Select Care Drugs	4	11	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 Care Drugs												
H3660	044	0	1	01	01	H3660_044_0	7			Select Care Drugs	4	11	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 Care Drugs										1		
H3660	050	0	1	01	01	H3660_050_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, Select Care Drugs												
H3660	050	0	1	01	01	H3660_050_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, Select Care Drugs										1		
H3660	050	0	1	01	01	H3660_050_0	7			Generic	4	11	1	2	2	1	110		01	100		1	30		90				1	2			90				30		31	9.00		22.50																					22.50																9.00				9.00		0.30						0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3660	050	0	1	01	01	H3660_050_0	7			Preferred Brand	4	11	3	2	3	1	110		01	100		1	30		90				1	2			90				30		31	46.00		115.00																					115.00																46.00				46.00		1.53						1.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3660	050	0	1	01	01	H3660_050_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, Select Care Drugs												
H3660	050	0	1	01	01	H3660_050_0	7			Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31					33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3660	050	0	1	01	01	H3660_050_0	7			Select Care Drugs	4	11	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 Care Drugs												
H3660	050	0	1	01	01	H3660_050_0	7			Select Care Drugs	4	11	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 Care Drugs										1		
H3660	053	1	1	01	01	H3660_053_1	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, Select Care Drugs												
H3660	053	1	1	01	01	H3660_053_1	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, Select Care Drugs										1		
H3660	053	1	1	01	01	H3660_053_1	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, Select Care Drugs												
H3660	053	1	1	01	01	H3660_053_1	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, Select Care Drugs												
H3660	053	1	1	01	01	H3660_053_1	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, Select Care Drugs												
H3660	053	1	1	01	01	H3660_053_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, Select Care Drugs												
H3660	053	1	1	01	01	H3660_053_1	7			Select Care Drugs	4	11	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 Care Drugs												
H3660	053	1	1	01	01	H3660_053_1	7			Select Care Drugs	4	11	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 Care Drugs										1		
H3660	053	2	1	01	01	H3660_053_2	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, Select Care Drugs												
H3660	053	2	1	01	01	H3660_053_2	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, Select Care Drugs										1		
H3660	053	2	1	01	01	H3660_053_2	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, Select Care Drugs												
H3660	053	2	1	01	01	H3660_053_2	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, Select Care Drugs												
H3660	053	2	1	01	01	H3660_053_2	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, Select Care Drugs												
H3660	053	2	1	01	01	H3660_053_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, Select Care Drugs												
H3660	053	2	1	01	01	H3660_053_2	7			Select Care Drugs	4	11	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 Care Drugs												
H3660	053	2	1	01	01	H3660_053_2	7			Select Care Drugs	4	11	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 Care Drugs										1		
H3660	056	1	1	01	01	H3660_056_1	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, Select Care Drugs												
H3660	056	1	1	01	01	H3660_056_1	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, Select Care Drugs										1		
H3660	056	1	1	01	01	H3660_056_1	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, Select Care Drugs												
H3660	056	1	1	01	01	H3660_056_1	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, Select Care Drugs												
H3660	056	1	1	01	01	H3660_056_1	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, Select Care Drugs												
H3660	056	1	1	01	01	H3660_056_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, Select Care Drugs												
H3660	056	1	1	01	01	H3660_056_1	8			Select Care Drugs	4	11	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 Care Drugs												
H3660	056	1	1	01	01	H3660_056_1	8			Select Care Drugs	4	11	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 Care Drugs										1		
H3660	056	2	1	01	01	H3660_056_2	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, Select Care Drugs												
H3660	056	2	1	01	01	H3660_056_2	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, Select Care Drugs										1		
H3660	056	2	1	01	01	H3660_056_2	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, Select Care Drugs												
H3660	056	2	1	01	01	H3660_056_2	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, Select Care Drugs												
H3660	056	2	1	01	01	H3660_056_2	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, Select Care Drugs												
H3660	056	2	1	01	01	H3660_056_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, Select Care Drugs												
H3660	056	2	1	01	01	H3660_056_2	8			Select Care Drugs	4	11	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 Care Drugs												
H3660	056	2	1	01	01	H3660_056_2	8			Select Care Drugs	4	11	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 Care Drugs										1		
H3664	017	0	1	02	01	H3664_017_0	3		Y	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								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	3		Y	Preferred Generic	4	01	1	2	1	3		111	01	111		1				30	60	90	1	2	30	60	90				30		31								10.00	20.00	30.00					0.00	0.00	0.00					0.00	0.00	0.00																10.00				0.00			0.33	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3664	017	0	1	02	01	H3664_017_0	3		Y	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	3		Y	Generic	4	01	1	2	2	3		111	01	111		1				30	60	90	1	2	30	60	90				30		31								16.00	32.00	48.00					8.00	16.00	24.00					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										1		
H3664	017	0	1	02	01	H3664_017_0	3		Y	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					42.00	84.00	126.00					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	3		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	300.00					95.00	190.00	285.00					95.00	190.00	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	3		Y	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											687.32	31						687.32	31						31																	31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3664	020	0	1	02	01	H3664_020_0	3		Y	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								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	3		Y	Preferred Generic	4	01	1	2	1	3		111	01	111		1				30	60	90	1	2	30	60	90				30		31								10.00	20.00	30.00					0.00	0.00	0.00					0.00	0.00	0.00																10.00				0.00			0.33	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3664	020	0	1	02	01	H3664_020_0	3		Y	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	3		Y	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					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										1		
H3664	020	0	1	02	01	H3664_020_0	3		Y	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					42.00	84.00	126.00					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	3		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	300.00					95.00	190.00	285.00					95.00	190.00	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	3		Y	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											1248.51	30						1248.51	30						30																	30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3664	021	0	1	02	01	H3664_021_0	3		Y	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								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	3		Y	Preferred Generic	4	01	1	2	1	3		111	01	111		1				30	60	90	1	2	30	60	90				30		31								10.00	20.00	30.00					0.00	0.00	0.00					0.00	0.00	0.00																10.00				0.00			0.33	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3664	021	0	1	02	01	H3664_021_0	3		Y	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								20.00	40.00	60.00					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	3		Y	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					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										1		
H3664	021	0	1	02	01	H3664_021_0	3		Y	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					42.00	84.00	126.00					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	3		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	300.00					95.00	190.00	285.00					95.00	190.00	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	3		Y	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											895.07	29						895.07	29						29																	29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3668	018	1	1	01	01	H3668_018_1	4		Y	Preferred Generic	4	11	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3668	018	1	1	01	01	H3668_018_1	4		Y	Preferred Generic	4	11	1	2	1	3	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3668	018	1	1	01	01	H3668_018_1	4		Y	Generic	4	11	3	2	2	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31	5.00	10.00	15.00																			0.00	0.00	0.00																5.00				5.00		0.17			0.00			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3668	018	1	1	01	01	H3668_018_1	4		Y	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	45.00	90.00	135.00																			45.00	90.00	90.00																45.00				45.00		1.50			1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3668	018	1	1	01	01	H3668_018_1	4		Y	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	75.00	150.00	225.00																			75.00	150.00	150.00																75.00				75.00		2.50			2.50			2.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3668	018	1	1	01	01	H3668_018_1	4		Y	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	4		Y	Preferred Generic	4	11	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3668	018	2	1	01	01	H3668_018_2	4		Y	Preferred Generic	4	11	1	2	1	3	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3668	018	2	1	01	01	H3668_018_2	4		Y	Generic	4	11	3	2	2	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31	5.00	10.00	15.00																			0.00	0.00	0.00																5.00				5.00		0.17			0.00			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3668	018	2	1	01	01	H3668_018_2	4		Y	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	45.00	90.00	135.00																			45.00	90.00	90.00																45.00				45.00		1.50			1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3668	018	2	1	01	01	H3668_018_2	4		Y	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	75.00	150.00	225.00																			75.00	150.00	150.00																75.00				75.00		2.50			2.50			2.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3668	018	2	1	01	01	H3668_018_2	4		Y	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	4		Y	Preferred Generic	4	11	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3668	019	1	1	01	01	H3668_019_1	4		Y	Preferred Generic	4	11	1	2	1	3	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3668	019	1	1	01	01	H3668_019_1	4		Y	Generic	4	11	3	2	2	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31	5.00	10.00	15.00																			0.00	0.00	0.00																5.00				5.00		0.17			0.00			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3668	019	1	1	01	01	H3668_019_1	4		Y	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	45.00	90.00	135.00																			45.00	90.00	90.00																45.00				45.00		1.50			1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3668	019	1	1	01	01	H3668_019_1	4		Y	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	95.00	190.00	285.00																			95.00	190.00	190.00																95.00				95.00		3.17			3.17			3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3668	019	1	1	01	01	H3668_019_1	4		Y	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	4		Y	Preferred Generic	4	11	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3668	019	2	1	01	01	H3668_019_2	4		Y	Preferred Generic	4	11	1	2	1	3	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3668	019	2	1	01	01	H3668_019_2	4		Y	Generic	4	11	3	2	2	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31	5.00	10.00	15.00																			0.00	0.00	0.00																5.00				5.00		0.17			0.00			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3668	019	2	1	01	01	H3668_019_2	4		Y	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	45.00	90.00	135.00																			45.00	90.00	90.00																45.00				45.00		1.50			1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3668	019	2	1	01	01	H3668_019_2	4		Y	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	95.00	190.00	285.00																			95.00	190.00	190.00																95.00				95.00		3.17			3.17			3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3668	019	2	1	01	01	H3668_019_2	4		Y	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	4		Y	Preferred Generic	4	11	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3668	020	0	1	01	01	H3668_020_0	4		Y	Preferred Generic	4	11	1	2	1	3	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3668	020	0	1	01	01	H3668_020_0	4		Y	Generic	4	11	3	2	2	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31	10.00	20.00	30.00																			0.00	0.00	0.00																10.00				10.00		0.33			0.00			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3668	020	0	1	01	01	H3668_020_0	4		Y	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	45.00	90.00	135.00																			45.00	90.00	90.00																45.00				45.00		1.5			1.5			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3668	020	0	1	01	01	H3668_020_0	4		Y	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	75.00	150.00	225.00																			75.00	150.00	150.00																75.00				75.00		2.5			2.5			2.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3668	020	0	1	01	01	H3668_020_0	4		Y	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	4		Y	Preferred Generic	4	11	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3668	022	0	1	01	01	H3668_022_0	4		Y	Preferred Generic	4	11	1	2	1	3	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3668	022	0	1	01	01	H3668_022_0	4		Y	Generic	4	11	3	2	2	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31	10.00	20.00	30.00																			0.00	0.00	0.00																10.00				10.00		0.33			0.00			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3668	022	0	1	01	01	H3668_022_0	4		Y	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	45.00	90.00	135.00																			45.00	90.00	90.00																45.00				45.00		1.50			1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3668	022	0	1	01	01	H3668_022_0	4		Y	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	75.00	150.00	225.00																			75.00	150.00	150.00																75.00				75.00		2.50			2.50			2.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3668	022	0	1	01	01	H3668_022_0	4		Y	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	4		Y	Preferred Generic	4	11	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3668	023	0	1	01	01	H3668_023_0	4		Y	Preferred Generic	4	11	1	2	1	3	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3668	023	0	1	01	01	H3668_023_0	4		Y	Generic	4	11	3	2	2	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31	10.00	20.00	30.00																			0.00	0.00	0.00																10.00				10.00		0.33			0.00			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3668	023	0	1	01	01	H3668_023_0	4		Y	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	45.00	90.00	135.00																			45.00	90.00	90.00																45.00				45.00		1.50			1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3668	023	0	1	01	01	H3668_023_0	4		Y	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	75.00	150.00	225.00																			75.00	150.00	150.00																75.00				75.00		2.50			2.50			2.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3668	023	0	1	01	01	H3668_023_0	4		Y	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	4		Y	Preferred Generic	4	11	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3668	025	0	1	01	01	H3668_025_0	4		Y	Preferred Generic	4	11	1	2	1	3	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3668	025	0	1	01	01	H3668_025_0	4		Y	Generic	4	11	3	2	2	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3668	025	0	1	01	01	H3668_025_0	4		Y	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	45.00	90.00	135.00																			45.00	90.00	90.00																45.00				45.00		1.5			1.5			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3668	025	0	1	01	01	H3668_025_0	4		Y	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	95.00	190.00	285.00																			95.00	190.00	190.00																95.00				95.00		3.17			3.17			3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3668	025	0	1	01	01	H3668_025_0	4		Y	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	4		Y	Preferred Generic	4	11	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3668	026	0	1	01	01	H3668_026_0	4		Y	Preferred Generic	4	11	1	2	1	3	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3668	026	0	1	01	01	H3668_026_0	4		Y	Generic	4	11	3	2	2	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3668	026	0	1	01	01	H3668_026_0	4		Y	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	45.00	90.00	135.00																			45.00	90.00	90.00																45.00				45.00		1.5			1.5			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3668	026	0	1	01	01	H3668_026_0	4		Y	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	95.00	190.00	285.00																			95.00	190.00	190.00																95.00				95.00		3.17			3.17			3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3668	026	0	1	01	01	H3668_026_0	4		Y	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	030	0	1	01	01	H3668_030_0	4		N	Preferred Generic	4	11	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	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	030	0	1	01	01	H3668_030_0	4		N	Preferred Generic	4	11	1	2	1	3	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3668	030	0	1	01	01	H3668_030_0	4		N	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	030	0	1	01	01	H3668_030_0	4		N	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	94.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3668	030	0	1	01	01	H3668_030_0	4		N	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	100.00	200.00	300.00																			100.00	200.00	200.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3668	030	0	1	01	01	H3668_030_0	4		N	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												
H3668	031	0	1	01	01	H3668_031_0	4		N	Preferred Generic	4	11	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	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	031	0	1	01	01	H3668_031_0	4		N	Preferred Generic	4	11	1	2	1	3	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3668	031	0	1	01	01	H3668_031_0	4		N	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	031	0	1	01	01	H3668_031_0	4		N	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	94.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3668	031	0	1	01	01	H3668_031_0	4		N	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	100.00	200.00	300.00																			100.00	200.00	200.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3668	031	0	1	01	01	H3668_031_0	4		N	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												
H3672	013	0	1	01	01	H3672_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					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												
H3672	013	0	1	01	01	H3672_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					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00				20.00				20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3672	013	0	1	01	01	H3672_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												
H3672	013	0	1	01	01	H3672_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												
H3672	013	0	1	01	01	H3672_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												
H3672	020	0	1	01	01	H3672_020_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					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												
H3672	020	0	1	01	01	H3672_020_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					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00				20.00				20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3672	020	0	1	01	01	H3672_020_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												
H3672	020	0	1	01	01	H3672_020_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												
H3672	020	0	1	01	01	H3672_020_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												
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					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												
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					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00				20.00				20.00			0.67	0.00		0.67	0.00	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	8		N	Preferred Generic	4	11	3	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	001	0	1	01	01	H3706_001_0	8		N	Preferred Generic	4	11	3	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		3
H3706	001	0	1	01	01	H3706_001_0	8		N	Generic	4	11	3	2	2	1		110	01		110	1				30		100	1	1				30		100	30		31								15.00		45.00					10.00		0.00											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												
H3706	001	0	1	01	01	H3706_001_0	8		N	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	8		N	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	8		N	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	8		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3706	023	0	1	01	01	H3706_023_0	8		N	Preferred Generic	4	11	3	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	023	0	1	01	01	H3706_023_0	8		N	Preferred Generic	4	11	3	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		3
H3706	023	0	1	01	01	H3706_023_0	8		N	Generic	4	11	3	2	2	1		110	01		110	1				30		100	1	1				30		100	30		31								15.00		45.00					10.00		0.00											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												
H3706	023	0	1	01	01	H3706_023_0	8		N	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	8		N	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	8		N	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	8		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3706	024	0	1	01	01	H3706_024_0	8		Y	Preferred Generic	4	11	3	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		Y	Preferred Generic	4	11	3	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		3
H3706	024	0	1	01	01	H3706_024_0	8		Y	Generic	4	11	3	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		Y	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		Y	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		Y	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		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3706	025	0	1	01	01	H3706_025_0	8		Y	Preferred Generic	4	11	3	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	8		Y	Preferred Generic	4	11	3	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		3
H3706	025	0	1	01	01	H3706_025_0	8		Y	Generic	4	11	3	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	8		Y	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	8		Y	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	8		Y	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	8		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3727	001	1	1	01	01	H3727_001_1	9		Y	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	6.00	12.00	18.00																			5.00	10.00	15.00																6.00				6.00		0.20			0.17			0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3727	001	1	1	01	01	H3727_001_1	9		Y	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	17.00	34.00	51.00																			15.00	30.00	45.00																17.00				17.00		0.57			0.50			0.55	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3727	001	1	1	01	01	H3727_001_1	9		Y	Preferred Brand	4	10	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	45.00	90.00	135.00																			40.00	80.00	120.00																45.00				45.00		1.50			1.33			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3727	001	1	1	01	01	H3727_001_1	9		Y	Non-Preferred Drug	4	10	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	92.00	184.00	276.00																			90.00	180.00	270.00																92.00				92.00		3.07			3.00			2.97	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3727	001	1	1	01	01	H3727_001_1	9		Y	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	9		Y	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	6.00	12.00	18.00																			5.00	10.00	15.00																6.00				6.00		0.20			0.17			0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3727	001	2	1	01	01	H3727_001_2	9		Y	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	17.00	34.00	51.00																			15.00	30.00	45.00																17.00				17.00		0.57			0.50			0.55	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3727	001	2	1	01	01	H3727_001_2	9		Y	Preferred Brand	4	10	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	45.00	90.00	135.00																			40.00	80.00	120.00																45.00				45.00		1.50			1.33			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3727	001	2	1	01	01	H3727_001_2	9		Y	Non-Preferred Drug	4	10	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	92.00	184.00	276.00																			90.00	180.00	270.00																92.00				92.00		3.07			3.00			2.97	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3727	001	2	1	01	01	H3727_001_2	9		Y	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	9		Y	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	6.00	12.00	18.00																			5.00	10.00	15.00																6.00				6.00		0.20			0.17			0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3727	001	3	1	01	01	H3727_001_3	9		Y	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	17.00	34.00	51.00																			15.00	30.00	45.00																17.00				17.00		0.57			0.50			0.55	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3727	001	3	1	01	01	H3727_001_3	9		Y	Preferred Brand	4	10	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	45.00	90.00	135.00																			40.00	80.00	120.00																45.00				45.00		1.50			1.33			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3727	001	3	1	01	01	H3727_001_3	9		Y	Non-Preferred Drug	4	10	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	92.00	184.00	276.00																			90.00	180.00	270.00																92.00				92.00		3.07			3.00			2.97	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3727	001	3	1	01	01	H3727_001_3	9		Y	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	20.00											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												
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	20.00											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										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											964.66	33						607.43	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3748	003	0	1	02	01	H3748_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								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					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	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	003	0	1	02	01	H3748_003_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	20.00											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												
H3748	003	0	1	02	01	H3748_003_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	20.00											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										1		
H3748	003	0	1	02	01	H3748_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	94.00	141.00				47.00	94.00	141.00					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	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	003	0	1	02	01	H3748_003_0	3			Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											724.89	33						376.39	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3748	004	0	1	02	01	H3748_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												
H3748	004	0	1	02	01	H3748_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		
H3748	004	0	1	02	01	H3748_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					5.00	10.00	10.00											20.00	40.00	60.00				5.00	10.00	10.00					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	004	0	1	02	01	H3748_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					5.00	10.00	10.00											20.00	40.00	60.00				5.00	10.00	10.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3748	004	0	1	02	01	H3748_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												
H3748	004	0	1	02	01	H3748_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												
H3748	004	0	1	02	01	H3748_004_0	3			Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1111.99	33						513.33	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3748	005	0	1	02	01	H3748_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												
H3748	005	0	1	02	01	H3748_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		
H3748	005	0	1	02	01	H3748_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	20.00											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												
H3748	005	0	1	02	01	H3748_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	20.00											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										1		
H3748	005	0	1	02	01	H3748_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												
H3748	005	0	1	02	01	H3748_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												
H3748	005	0	1	02	01	H3748_005_0	3			Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											990.80	33						562.37	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3748	006	0	1	02	01	H3748_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												
H3748	006	0	1	02	01	H3748_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		
H3748	006	0	1	02	01	H3748_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												
H3748	006	0	1	02	01	H3748_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		
H3748	006	0	1	02	01	H3748_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												
H3748	006	0	1	02	01	H3748_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												
H3748	006	0	1	02	01	H3748_006_0	3			Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											974.82	33						592.64	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3748	007	0	1	02	01	H3748_007_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												
H3748	007	0	1	02	01	H3748_007_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		
H3748	007	0	1	02	01	H3748_007_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												
H3748	007	0	1	02	01	H3748_007_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		
H3748	007	0	1	02	01	H3748_007_0	4			Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					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	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												
H3748	007	0	1	02	01	H3748_007_0	4			Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											938.51	33						528.41	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3748	008	0	1	02	01	H3748_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												
H3748	008	0	1	02	01	H3748_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								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00					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		
H3748	008	0	1	02	01	H3748_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	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												
H3748	008	0	1	02	01	H3748_008_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		
H3748	008	0	1	02	01	H3748_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												
H3748	008	0	1	02	01	H3748_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												
H3748	008	0	1	02	01	H3748_008_0	3			Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											921.13	33						520.17	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								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00					5.00			5.00			0.17	0.00		0.17	0.00	0.16	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								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00					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		
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								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												
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								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		
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											1307.91	33						648.29	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3748	010	0	1	02	01	H3748_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												
H3748	010	0	1	02	01	H3748_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		
H3748	010	0	1	02	01	H3748_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					10.00	20.00	20.00											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												
H3748	010	0	1	02	01	H3748_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					10.00	20.00	20.00											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										1		
H3748	010	0	1	02	01	H3748_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												
H3748	010	0	1	02	01	H3748_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												
H3748	010	0	1	02	01	H3748_010_0	3			Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1019.93	33						564.70	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3748	011	0	1	02	01	H3748_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												
H3748	011	0	1	02	01	H3748_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		
H3748	011	0	1	02	01	H3748_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					10.00	20.00	20.00											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												
H3748	011	0	1	02	01	H3748_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					10.00	20.00	20.00											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										1		
H3748	011	0	1	02	01	H3748_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												
H3748	011	0	1	02	01	H3748_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												
H3748	011	0	1	02	01	H3748_011_0	3			Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1019.93	33						564.70	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3749	001	0	1	02	01	H3749_001_0	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3749	001	0	1	02	01	H3749_001_0	3		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3749	001	0	1	02	01	H3749_001_0	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	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												
H3749	001	0	1	02	01	H3749_001_0	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	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
H3749	001	0	1	02	01	H3749_001_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3749	001	0	1	02	01	H3749_001_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		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	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				434.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3749	017	0	1	02	01	H3749_017_0	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3749	017	0	1	02	01	H3749_017_0	3		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3749	017	0	1	02	01	H3749_017_0	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3749	017	0	1	02	01	H3749_017_0	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H3749	017	0	1	02	01	H3749_017_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3749	017	0	1	02	01	H3749_017_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		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	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				400.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3749	018	0	1	02	01	H3749_018_0	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3749	018	0	1	02	01	H3749_018_0	3		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3749	018	0	1	02	01	H3749_018_0	3		Y	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												
H3749	018	0	1	02	01	H3749_018_0	3		Y	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
H3749	018	0	1	02	01	H3749_018_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3749	018	0	1	02	01	H3749_018_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		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	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				399.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3749	020	0	1	02	01	H3749_020_0	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3749	020	0	1	02	01	H3749_020_0	3		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3749	020	0	1	02	01	H3749_020_0	3		Y	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												
H3749	020	0	1	02	01	H3749_020_0	3		Y	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
H3749	020	0	1	02	01	H3749_020_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3749	020	0	1	02	01	H3749_020_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		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	3		Y	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												
H3755	001	0	1	01	01	H3755_001_0	7		Y	Preferred Generic	4	11	1	2	1	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3755	001	0	1	01	01	H3755_001_0	7		Y	Preferred Generic	4	11	1	2	1	3	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3755	001	0	1	01	01	H3755_001_0	7		Y	Generic	4	11	1	2	2	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	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												
H3755	001	0	1	01	01	H3755_001_0	7		Y	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	15.00																			0.00	0.00	0.00																5.00				5.00		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	7		Y	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	40.00	80.00	120.00																			40.00	80.00	80.00																40.00				40.00		1.33			1.33			1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3755	001	0	1	01	01	H3755_001_0	7		Y	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	95.00	190.00	285.00																			95.00	190.00	190.00																95.00				95.00		3.17			3.17			3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3755	001	0	1	01	01	H3755_001_0	7		Y	Specialty Tier	4	11	1	1	5	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31				1247.70	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		Y	Preferred Generic	4	11	1	2	1	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3755	004	0	1	01	01	H3755_004_0	7		Y	Preferred Generic	4	11	1	2	1	3	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3755	004	0	1	01	01	H3755_004_0	7		Y	Generic	4	11	1	2	2	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	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												
H3755	004	0	1	01	01	H3755_004_0	7		Y	Generic	4	11	1	2	2	3	111		01	111		1	30	60	100				1	2	30	60	100				30		31	5.00	10.00	15.00																			0.00	0.00	0.00																5.00				5.00		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		Y	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	40.00	80.00	120.00																			40.00	80.00	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		Y	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	95.00	190.00	285.00																			95.00	190.00	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		Y	Specialty Tier	4	11	1	1	5	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31				993.80	33	33	33																		33	33	33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3755	005	0	1	01	01	H3755_005_0	6		Y	Preferred Generic	4	11	1	2	1	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	5.00	10.00	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												
H3755	005	0	1	01	01	H3755_005_0	6		Y	Preferred Generic	4	11	1	2	1	3	111		01	111		1	30	60	100				1	2	30	60	100				30		31	5.00	10.00	15.00																			0.00	0.00	0.00																5.00				5.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3755	005	0	1	01	01	H3755_005_0	6		Y	Generic	4	11	1	2	2	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	10.00	20.00	30.00																			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												
H3755	005	0	1	01	01	H3755_005_0	6		Y	Generic	4	11	1	2	2	3	111		01	111		1	30	60	100				1	2	30	60	100				30		31	10.00	20.00	30.00																			0.00	0.00	0.00																10.00				10.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3755	005	0	1	01	01	H3755_005_0	6		Y	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	40.00	80.00	120.00																			40.00	80.00	80.00																40.00				40.00		1.33			1.33			1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3755	005	0	1	01	01	H3755_005_0	6		Y	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	95.00	190.00	285.00																			95.00	190.00	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	6		Y	Specialty Tier	4	11	1	1	5	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31				1103.10	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	7		Y	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3777	001	2	1	01	01	H3777_001_2	7		Y	Generic	4	11	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	5.00	10.00	15.00																			5.00	10.00	12.50																5.00				5.00		0.17			0.17			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3777	001	2	1	01	01	H3777_001_2	7		Y	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	45.00	90.00	135.00																			45.00	90.00	112.50																45.00				45.00		1.50			1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3777	001	2	1	01	01	H3777_001_2	7		Y	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	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	7		Y	Specialty Tier	4	11	1	1	5	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31				918.72	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	7		Y	Select Care Drugs	4	11	1	2	6	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3777	001	2	1	01	01	H3777_001_2	7		Y	Select Care Drugs	4	11	1	2	6	3	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H3777	001	3	1	01	01	H3777_001_3	7		Y	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3777	001	3	1	01	01	H3777_001_3	7		Y	Generic	4	11	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	5.00	10.00	15.00																			5.00	10.00	12.50																5.00				5.00		0.17			0.17			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3777	001	3	1	01	01	H3777_001_3	7		Y	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	45.00	90.00	135.00																			45.00	90.00	112.50																45.00				45.00		1.50			1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3777	001	3	1	01	01	H3777_001_3	7		Y	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	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	7		Y	Specialty Tier	4	11	1	1	5	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31				918.72	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	7		Y	Select Care Drugs	4	11	1	2	6	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3777	001	3	1	01	01	H3777_001_3	7		Y	Select Care Drugs	4	11	1	2	6	3	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H3777	001	4	1	01	01	H3777_001_4	7		Y	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3777	001	4	1	01	01	H3777_001_4	7		Y	Generic	4	11	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	5.00	10.00	15.00																			5.00	10.00	12.50																5.00				5.00		0.17			0.17			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3777	001	4	1	01	01	H3777_001_4	7		Y	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	45.00	90.00	135.00																			45.00	90.00	112.50																45.00				45.00		1.50			1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3777	001	4	1	01	01	H3777_001_4	7		Y	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	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	7		Y	Specialty Tier	4	11	1	1	5	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31				918.72	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	7		Y	Select Care Drugs	4	11	1	2	6	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3777	001	4	1	01	01	H3777_001_4	7		Y	Select Care Drugs	4	11	1	2	6	3	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H3805	001	0	1	02	01	H3805_001_0	2		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3805	001	0	1	02	01	H3805_001_0	2		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3805	001	0	1	02	01	H3805_001_0	2		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3805	001	0	1	02	01	H3805_001_0	2		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H3805	001	0	1	02	01	H3805_001_0	2		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3805	001	0	1	02	01	H3805_001_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3805	001	0	1	02	01	H3805_001_0	2		Y	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												
H3805	015	0	1	02	01	H3805_015_0	2		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3805	015	0	1	02	01	H3805_015_0	2		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3805	015	0	1	02	01	H3805_015_0	2		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3805	015	0	1	02	01	H3805_015_0	2		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H3805	015	0	1	02	01	H3805_015_0	2		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3805	015	0	1	02	01	H3805_015_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3805	015	0	1	02	01	H3805_015_0	2		Y	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												
H3805	017	0	1	02	01	H3805_017_0	2		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3805	017	0	1	02	01	H3805_017_0	2		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3805	017	0	1	02	01	H3805_017_0	2		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3805	017	0	1	02	01	H3805_017_0	2		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H3805	017	0	1	02	01	H3805_017_0	2		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3805	017	0	1	02	01	H3805_017_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3805	017	0	1	02	01	H3805_017_0	2		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				415.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3805	032	0	1	02	01	H3805_032_0	2		Y	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		100	2	2						100	30		31								10.00		30.00					0.00		0.00													30.00						0.00				10.00				10.00			0.33	0.00				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3805	032	0	1	02	01	H3805_032_0	2		Y	Preferred Generic	4	01	1	2	1	3		110	01		100	1				30		100	2	2						100	30		31								10.00		30.00					0.00		0.00													30.00						0.00				10.00				10.00			0.33	0.00				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3805	032	0	1	02	01	H3805_032_0	2		Y	Generic	4	01	3	2	2	1		110	01		100	1				30		100	2	2						100	30		31								20.00		60.00					0.00		0.00													60.00						0.00				20.00				20.00			0.66	0.00				0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3805	032	0	1	02	01	H3805_032_0	2		Y	Generic	4	01	3	2	2	3		110	01		100	1				30		100	2	2						100	30		31								20.00		60.00					0.00		0.00													60.00						0.00				20.00				20.00			0.66	0.00				0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H3805	032	0	1	02	01	H3805_032_0	2		Y	Preferred Brand	4	11	1	2	3	1		110	01		100	1				30		100	2	2						100	30		31								47.00		141.00					47.00		131.00													141.00						131.00				47.00				47.00			1.56	1.56				1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3805	032	0	1	02	01	H3805_032_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1		110	01		100	1				30		100	2	2						100	30		31								100.00		300.00					100.00		290.00													300.00						290.00				100.00				100.00			3.33	3.33				3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3805	032	0	1	02	01	H3805_032_0	2		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											499.00	33						384.00	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3805	033	0	1	02	01	H3805_033_0	2		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3805	033	0	1	02	01	H3805_033_0	2		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3805	033	0	1	02	01	H3805_033_0	2		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	8.00		24.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3805	033	0	1	02	01	H3805_033_0	2		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	8.00		24.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H3805	033	0	1	02	01	H3805_033_0	2		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3805	033	0	1	02	01	H3805_033_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3805	033	0	1	02	01	H3805_033_0	2		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				373.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3805	034	0	1	02	01	H3805_034_0	2		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3805	034	0	1	02	01	H3805_034_0	2		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3805	034	0	1	02	01	H3805_034_0	2		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	8.00		24.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3805	034	0	1	02	01	H3805_034_0	2		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	8.00		24.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H3805	034	0	1	02	01	H3805_034_0	2		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3805	034	0	1	02	01	H3805_034_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3805	034	0	1	02	01	H3805_034_0	2		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				612.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3805	036	0	1	02	01	H3805_036_0	2		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3805	036	0	1	02	01	H3805_036_0	2		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3805	036	0	1	02	01	H3805_036_0	2		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3805	036	0	1	02	01	H3805_036_0	2		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H3805	036	0	1	02	01	H3805_036_0	2		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3805	036	0	1	02	01	H3805_036_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3805	036	0	1	02	01	H3805_036_0	2		Y	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												
H3805	037	0	1	02	01	H3805_037_0	2		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3805	037	0	1	02	01	H3805_037_0	2		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3805	037	0	1	02	01	H3805_037_0	2		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3805	037	0	1	02	01	H3805_037_0	2		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H3805	037	0	1	02	01	H3805_037_0	2		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3805	037	0	1	02	01	H3805_037_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3805	037	0	1	02	01	H3805_037_0	2		Y	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												
H3810	003	0	1	01	01	H3810_003_0	8			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	8			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	8			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	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	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	8			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	8			Specialty Tier	4	11	1	1	5	1	111		01		100	1	30	60	100				1	2						100	30		31					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	8			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	8			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	8			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	8			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	8			Generic	4	01	1	2	2	1	111		01		100	1	30	60	100				1	2						100	30		31	15.00	30.00	45.00																											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	8			Preferred Brand	4	10	1	2	3	1	111		01		100	1	30	60	100				1	2						100	30		31	47.00	94.00	141.00																											141.00						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	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	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	8			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	8			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	8			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	2			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	2			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	2			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	2			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	2			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	2			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	2			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	2			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	2			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	2			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	2			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	2			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	2			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	2			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	2			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	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	10.00																			4.00	8.00	10.00																4.00				4.00		0.13			0.13			0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, 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	25.00																			10.00	20.00	25.00																10.00				10.00		0.33			0.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, 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	113.00																			45.00	90.00	113.00																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	250.00																			100.00	200.00	250.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, 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				280.00	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	11	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	10.00																			4.00	8.00	10.00																4.00				4.00		0.13			0.13			0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, 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	25.00																			10.00	20.00	25.00																10.00				10.00		0.33			0.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, 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	113.00																			45.00	90.00	113.00																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	250.00																			100.00	200.00	250.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, 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	24																				24																	24			24								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				280.00	29																				29																	29			29								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	11	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	10.00																			4.00	8.00	10.00																4.00				4.00		0.13			0.13			0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, 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	25.00																			10.00	20.00	25.00																10.00				10.00		0.33			0.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, 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	113.00																			45.00	90.00	113.00																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	250.00																			100.00	200.00	250.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, 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	24																				24																	24			24								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				280.00	29																				29																	29			29								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	11	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	10.00																			4.00	8.00	10.00																4.00				4.00		0.13			0.13			0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, 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	25.00																			10.00	20.00	25.00																10.00				10.00		0.33			0.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, 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	113.00																			45.00	90.00	113.00																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	250.00																			100.00	200.00	250.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, 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	24																				24																	24			24								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				280.00	29																				29																	29			29								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	11	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	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	13.00																			5.00	10.00	13.00																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	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	38.00																			15.00	30.00	38.00																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	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	118.00																			47.00	94.00	118.00																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	014	0	1	04	01	H3813_014_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	250.00																			100.00	200.00	250.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Preferred Specialty Tier, Specialty Tier, Vaccines												
H3813	014	0	1	04	01	H3813_014_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	014	0	1	04	01	H3813_014_0	7			Specialty Tier	4	11	1	1	6	1	010		01	010		1	30								30						30		31				280.00	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	7			Vaccines	4	11	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	016	0	1	04	01	H3813_016_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	13.00																			5.00	10.00	13.00																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	016	0	1	04	01	H3813_016_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	38.00																			15.00	30.00	38.00																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	016	0	1	04	01	H3813_016_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	118.00																			47.00	94.00	118.00																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	016	0	1	04	01	H3813_016_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	250.00																			100.00	200.00	250.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Preferred Specialty Tier, Specialty Tier, Vaccines												
H3813	016	0	1	04	01	H3813_016_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	016	0	1	04	01	H3813_016_0	7			Specialty Tier	4	11	1	1	6	1	010		01	010		1	30								30						30		31				280.00	28																				28																	28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Preferred Specialty Tier, Specialty Tier, Vaccines												
H3813	016	0	1	04	01	H3813_016_0	7			Vaccines	4	11	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	017	0	1	04	01	H3813_017_0	7			Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	5.00	10.00	13.00																			5.00	10.00	13.00																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	017	0	1	04	01	H3813_017_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	38.00																			15.00	30.00	38.00																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	017	0	1	04	01	H3813_017_0	7			Preferred Brand	4	10	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	47.00	94.00	118.00																			47.00	94.00	118.00																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	017	0	1	04	01	H3813_017_0	7			Non-Preferred Brand	4	10	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	100.00	200.00	250.00																			100.00	200.00	250.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Preferred Specialty Tier, Specialty Tier, Vaccines												
H3813	017	0	1	04	01	H3813_017_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	017	0	1	04	01	H3813_017_0	7			Specialty Tier	4	11	1	1	6	1	010		01	010		1	30								30						30		31				280.00	28																				28																	28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Preferred Specialty Tier, Specialty Tier, Vaccines												
H3813	017	0	1	04	01	H3813_017_0	7			Vaccines	4	11	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	9		N	Preferred Generic	4	11	1	2	1	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3815	001	0	1	01	01	H3815_001_0	9		N	Preferred Generic	4	11	1	2	1	3	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H3815	001	0	1	01	01	H3815_001_0	9		N	Generic	4	01	1	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, Select Care Drugs												
H3815	001	0	1	01	01	H3815_001_0	9		N	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	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	9		N	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	300.00																			100.00	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	9		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				1178.01	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	9		N	Select Care Drugs	4	01	1	2	6	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, Select Care Drugs												
H3815	001	0	1	01	01	H3815_001_0	9		N	Select Care Drugs	4	01	1	2	6	3	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, Select Care Drugs										1		
H3815	007	0	1	01	01	H3815_007_0	9		N	Preferred Generic	4	11	1	2	1	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3815	007	0	1	01	01	H3815_007_0	9		N	Generic	4	01	1	2	2	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	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	9		N	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	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	9		N	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	300.00																			100.00	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	9		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				809.89	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	9		N	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	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	9		N	Select Care Drugs	4	01	1	2	6	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, Select Care Drugs										1		
H3815	008	0	1	01	01	H3815_008_0	9		Y	Preferred Generic	4	11	1	2	1	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3815	008	0	1	01	01	H3815_008_0	9		Y	Preferred Generic	4	11	1	2	1	3	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H3815	008	0	1	01	01	H3815_008_0	9		Y	Generic	4	01	1	2	2	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	1.00	2.00	3.00																			1.00	2.00	3.00																1.00				1.00		0.03			0.03			0.03	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3815	008	0	1	01	01	H3815_008_0	9		Y	Generic	4	01	1	2	2	3	111		01	111		1	30	60	100				1	2	30	60	100				30		31	1.00	2.00	3.00																			1.00	2.00	3.00																1.00				1.00		0.03			0.03			0.03	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H3815	008	0	1	01	01	H3815_008_0	9		Y	Preferred Brand	4	11	3	2	3	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	30.00	60.00	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	9		Y	Non-Preferred Drug	4	11	3	2	4	1	111		01	111		1	30	60	100				1	2	30	60	100				30		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	9		Y	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				866.87	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	9		Y	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	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	9		Y	Select Care Drugs	4	01	1	2	6	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, Select Care Drugs										1		
H3815	010	0	1	01	01	H3815_010_0	7		Y	Preferred Generic	4	11	1	2	1	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3815	010	0	1	01	01	H3815_010_0	7		Y	Preferred Generic	4	11	1	2	1	3	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H3815	010	0	1	01	01	H3815_010_0	7		Y	Generic	4	01	1	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, Select Care Drugs												
H3815	010	0	1	01	01	H3815_010_0	7		Y	Preferred Brand	4	11	3	2	3	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	30.00	60.00	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	7		Y	Non-Preferred Drug	4	11	3	2	4	1	111		01	111		1	30	60	100				1	2	30	60	100				30		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	7		Y	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				914.30	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	7		Y	Select Care Drugs	4	01	1	2	6	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	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	7		Y	Select Care Drugs	4	01	1	2	6	3	111		01	111		1	30	60	100				1	2	30	60	100				30		31	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	7		N	Preferred Generic	4	11	1	2	1	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	3.00	6.00	9.00																			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	7		N	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	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	7		N	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	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	7		N	Non-Preferred Drug	4	11	3	2	4	1	111		01	111		1	30	60	100				1	2	30	60	100				30		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	7		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				922.88	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	7		N	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	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	7		N	Select Care Drugs	4	01	1	2	6	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, Select Care Drugs										1		
H3815	013	0	1	01	01	H3815_013_0	7		N	Preferred Generic	4	11	1	2	1	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																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	7		N	Preferred Generic	4	11	1	2	1	3	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H3815	013	0	1	01	01	H3815_013_0	7		N	Generic	4	01	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3815	013	0	1	01	01	H3815_013_0	7		N	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	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	7		N	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	300.00																			100.00	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	7		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				950.63	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	7		N	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	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	7		N	Select Care Drugs	4	01	1	2	6	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, Select Care Drugs										1		
H3815	015	0	1	01	01	H3815_015_0	6		N	Preferred Generic	4	11	1	2	1	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3815	015	0	1	01	01	H3815_015_0	6		N	Preferred Generic	4	11	1	2	1	3	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H3815	015	0	1	01	01	H3815_015_0	6		N	Generic	4	01	1	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	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	6		N	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	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	6		N	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	300.00																			100.00	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	6		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				822.25	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	6		N	Select Care Drugs	4	01	1	2	6	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, Select Care Drugs												
H3815	015	0	1	01	01	H3815_015_0	6		N	Select Care Drugs	4	01	1	2	6	3	111		01	111		1	30	60	100				1	2	30	60	100				30		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	7		N	Preferred Generic	4	11	1	2	1	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3815	016	0	1	01	01	H3815_016_0	7		N	Preferred Generic	4	11	1	2	1	3	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																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	7		N	Generic	4	01	1	2	2	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	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	7		N	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	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	7		N	Non-Preferred Drug	4	11	3	2	4	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	75.00	150.00	225.00																			75.00	150.00	225.00																75.00				75.00		2.50			2.50			2.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3815	016	0	1	01	01	H3815_016_0	7		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				851.36	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	7		N	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	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	7		N	Select Care Drugs	4	01	1	2	6	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, Select Care Drugs										1		
H3815	019	0	1	01	01	H3815_019_0	6		N	Preferred Generic	4	11	1	2	1	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3815	019	0	1	01	01	H3815_019_0	6		N	Generic	4	01	1	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	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	6		N	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	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	6		N	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	300.00																			100.00	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	6		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				987.43	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	6		N	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	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	6		N	Select Care Drugs	4	01	1	2	6	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, Select Care Drugs										1		
H3815	020	0	1	01	01	H3815_020_0	6		N	Preferred Generic	4	11	1	2	1	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3815	020	0	1	01	01	H3815_020_0	6		N	Generic	4	01	1	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	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	6		N	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	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	6		N	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	300.00																			100.00	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	6		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				730.00	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	6		N	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	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	6		N	Select Care Drugs	4	01	1	2	6	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, Select Care Drugs										1		
H3815	021	0	1	01	01	H3815_021_0	7		N	Preferred Generic	4	11	1	2	1	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																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	7		N	Generic	4	01	1	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	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	7		N	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	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	7		N	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	300.00																			100.00	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	7		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				637.24	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	7		N	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	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	7		N	Select Care Drugs	4	01	1	2	6	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, Select Care Drugs										1		
H3815	023	0	1	01	01	H3815_023_0	7		N	Preferred Generic	4	11	1	2	1	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																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	7		N	Generic	4	01	1	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	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	7		N	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	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	7		N	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	300.00																			100.00	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	7		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				1005.10	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	7		N	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	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	7		N	Select Care Drugs	4	01	1	2	6	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, Select Care Drugs										1		
H3815	026	0	1	02	01	H3815_026_0	7		N	Preferred Generic	4	11	1	2	1	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																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	02	01	H3815_026_0	7		N	Generic	4	01	1	2	2	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	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	02	01	H3815_026_0	7		N	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	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	02	01	H3815_026_0	7		N	Non-Preferred Drug	4	11	3	2	4	1	111		01	111		1	30	60	100				1	2	30	60	100				30		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	02	01	H3815_026_0	7		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				665.15	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3815	026	0	1	02	01	H3815_026_0	7		N	Select Care Drugs	4	01	1	2	6	1	111		01	111		1	30	60	100				1	2	30	60	100				30		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	02	01	H3815_026_0	7		N	Select Care Drugs	4	01	1	2	6	3	111		01	111		1	30	60	100				1	2	30	60	100				30		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	5		N	Preferred Generic	4	11	1	2	1	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3815	028	0	1	01	01	H3815_028_0	5		N	Generic	4	01	1	2	2	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	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	5		N	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	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	5		N	Non-Preferred Drug	4	11	3	2	4	1	111		01	111		1	30	60	100				1	2	30	60	100				30		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	5		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				976.44	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	5		N	Select Care Drugs	4	01	1	2	6	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, Select Care Drugs												
H3815	028	0	1	01	01	H3815_028_0	5		N	Select Care Drugs	4	01	1	2	6	3	111		01	111		1	30	60	100				1	2	30	60	100				30		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	5		N	Preferred Generic	4	11	1	2	1	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3815	029	0	1	01	01	H3815_029_0	5		N	Generic	4	01	1	2	2	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	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	5		N	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	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	5		N	Non-Preferred Drug	4	11	3	2	4	1	111		01	111		1	30	60	100				1	2	30	60	100				30		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	5		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				684.19	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	5		N	Select Care Drugs	4	01	1	2	6	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, Select Care Drugs												
H3815	029	0	1	01	01	H3815_029_0	5		N	Select Care Drugs	4	01	1	2	6	3	111		01	111		1	30	60	100				1	2	30	60	100				30		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	6		N	Preferred Generic	4	11	1	2	1	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3815	030	0	1	01	01	H3815_030_0	6		N	Generic	4	01	1	2	2	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	20.00	40.00	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	6		N	Preferred Brand	4	11	3	1	3	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31				82.26	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	6		N	Non-Preferred Drug	4	11	3	1	4	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31				58.17	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	6		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				550.31	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	6		N	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	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	10		Y	Preferred Generic	4	11	1	2	1	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3815	031	0	1	01	01	H3815_031_0	10		Y	Generic	4	01	1	2	2	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	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	10		Y	Preferred Brand	4	11	3	2	3	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	40.00	80.00	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	10		Y	Non-Preferred Drug	4	11	3	2	4	1	111		01	111		1	30	60	100				1	2	30	60	100				30		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	10		Y	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				665.14	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	10		Y	Select Care Drugs	4	01	1	2	6	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, Select Care Drugs												
H3815	031	0	1	01	01	H3815_031_0	10		Y	Select Care Drugs	4	01	1	2	6	3	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, Select Care Drugs										1		
H3815	032	0	1	01	01	H3815_032_0	6		N	Preferred Generic	4	11	1	2	1	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3815	032	0	1	01	01	H3815_032_0	6		N	Generic	4	01	1	2	2	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	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	6		N	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	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	6		N	Non-Preferred Drug	4	11	3	2	4	1	111		01	111		1	30	60	100				1	2	30	60	100				30		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	6		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				772.08	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	6		N	Select Care Drugs	4	01	1	2	6	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, Select Care Drugs												
H3815	032	0	1	01	01	H3815_032_0	6		N	Select Care Drugs	4	01	1	2	6	3	111		01	111		1	30	60	100				1	2	30	60	100				30		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	8		Y	Preferred Generic	4	11	1	2	1	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3815	033	0	1	01	01	H3815_033_0	8		Y	Generic	4	01	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3815	033	0	1	01	01	H3815_033_0	8		Y	Preferred Brand	4	11	3	2	3	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	40.00	80.00	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	8		Y	Non-Preferred Drug	4	11	3	2	4	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	100.00	200.00	300.00																			100.00	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	8		Y	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				523.21	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	8		Y	Select Care Drugs	4	01	1	2	6	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	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	8		Y	Select Care Drugs	4	01	1	2	6	3	111		01	111		1	30	60	100				1	2	30	60	100				30		31	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	6		N	Preferred Generic	4	11	1	2	1	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3815	034	0	1	01	01	H3815_034_0	6		N	Generic	4	01	1	2	2	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	1.00	2.00	3.00																			1.00	2.00	3.00																1.00				1.00		0.03			0.03			0.03	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3815	034	0	1	01	01	H3815_034_0	6		N	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	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	6		N	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	300.00																			100.00	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	6		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				829.44	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	6		N	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	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	6		N	Select Care Drugs	4	01	1	2	6	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, Select Care Drugs										1		
H3815	035	0	1	01	01	H3815_035_0	6		N	Preferred Generic	4	11	1	2	1	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3815	035	0	1	01	01	H3815_035_0	6		N	Preferred Generic	4	11	1	2	1	3	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H3815	035	0	1	01	01	H3815_035_0	6		N	Generic	4	01	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3815	035	0	1	01	01	H3815_035_0	6		N	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	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	035	0	1	01	01	H3815_035_0	6		N	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	300.00																			100.00	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	035	0	1	01	01	H3815_035_0	6		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				827.02	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3815	035	0	1	01	01	H3815_035_0	6		N	Select Care Drugs	4	01	1	2	6	1	111		01	111		1	30	60	100				1	2	30	60	100				30		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	035	0	1	01	01	H3815_035_0	6		N	Select Care Drugs	4	01	1	2	6	3	111		01	111		1	30	60	100				1	2	30	60	100				30		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	036	0	1	01	01	H3815_036_0	7		N	Preferred Generic	4	11	1	2	1	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3815	036	0	1	01	01	H3815_036_0	7		N	Generic	4	01	1	2	2	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	20.00	40.00	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	036	0	1	01	01	H3815_036_0	7		N	Preferred Brand	4	11	3	1	3	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31				86.66	25	25	25																		25	25	25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3815	036	0	1	01	01	H3815_036_0	7		N	Non-Preferred Drug	4	11	3	1	4	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31				58.92	25	25	25																		25	25	25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3815	036	0	1	01	01	H3815_036_0	7		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				569.48	25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3815	036	0	1	01	01	H3815_036_0	7		N	Select Care Drugs	4	01	1	2	6	1	111		01	111		1	30	60	100				1	2	30	60	100				30		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	037	0	1	01	01	H3815_037_0	7		N	Preferred Generic	4	11	1	2	1	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3815	037	0	1	01	01	H3815_037_0	7		N	Preferred Generic	4	11	1	2	1	3	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																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	037	0	1	01	01	H3815_037_0	7		N	Generic	4	01	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3815	037	0	1	01	01	H3815_037_0	7		N	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	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	037	0	1	01	01	H3815_037_0	7		N	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	300.00																			100.00	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	037	0	1	01	01	H3815_037_0	7		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				978.86	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3815	037	0	1	01	01	H3815_037_0	7		N	Select Care Drugs	4	01	1	2	6	1	111		01	111		1	30	60	100				1	2	30	60	100				30		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	037	0	1	01	01	H3815_037_0	7		N	Select Care Drugs	4	01	1	2	6	3	111		01	111		1	30	60	100				1	2	30	60	100				30		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	8		Y	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	8		Y	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	8		Y	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	100	1	2	30	60	100				30		31								47.00	94.00	117.50					40.00	80.00	100.00					40.00	80.00	100.00																47.00				47.00			1.57	1.33	1.33			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3817	008	1	1	04	01	H3817_008_1	8		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	100	1	2	30	60	100				30		31								100.00	200.00	250.00					100.00	200.00	250.00					100.00	200.00	250.00																100.00				100.00			3.33	3.33	3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3817	008	1	1	04	01	H3817_008_1	8		Y	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											1035.40	30						1035.40	30						30																	30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3817	008	2	1	04	01	H3817_008_2	8		Y	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	8		Y	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	8		Y	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	100	1	2	30	60	100				30		31								47.00	94.00	117.50					40.00	80.00	100.00					40.00	80.00	100.00																47.00				47.00			1.57	1.33	1.33			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3817	008	2	1	04	01	H3817_008_2	8		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	100	1	2	30	60	100				30		31								100.00	200.00	250.00					100.00	200.00	250.00					100.00	200.00	250.00																100.00				100.00			3.33	3.33	3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3817	008	2	1	04	01	H3817_008_2	8		Y	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											1035.40	30						1035.40	30						30																	30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3817	009	1	1	04	01	H3817_009_1	8		Y	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	8		Y	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	8		Y	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	100	1	2	30	60	100				30		31								47.00	94.00	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	8		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	100	1	2	30	60	100				30		31								100.00	200.00	250.00					100.00	200.00	250.00					100.00	200.00	250.00																100.00				100.00			3.33	3.33	3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3817	009	1	1	04	01	H3817_009_1	8		Y	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											1138.94	33						1138.94	33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3817	009	2	1	04	01	H3817_009_2	8		Y	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	8		Y	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	8		Y	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	100	1	2	30	60	100				30		31								47.00	94.00	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	8		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	100	1	2	30	60	100				30		31								100.00	200.00	250.00					100.00	200.00	250.00					100.00	200.00	250.00																100.00				100.00			3.33	3.33	3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3817	009	2	1	04	01	H3817_009_2	8		Y	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											1138.94	33						1138.94	33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3817	011	1	1	04	01	H3817_011_1	9		Y	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	9		Y	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	9		Y	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	100	1	2	30	60	100				30		31								47.00	94.00	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	9		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	100	1	2	30	60	100				30		31								100.00	200.00	300.00					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												
H3817	011	1	1	04	01	H3817_011_1	9		Y	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											966.38	28						966.38	28						28																	28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3817	011	2	1	04	01	H3817_011_2	9		Y	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	9		Y	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	9		Y	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	100	1	2	30	60	100				30		31								47.00	94.00	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	9		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	100	1	2	30	60	100				30		31								100.00	200.00	300.00					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												
H3817	011	2	1	04	01	H3817_011_2	9		Y	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											966.38	28						966.38	28						28																	28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3822	001	0	1	01	01	H3822_001_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											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												
H3822	001	0	1	01	01	H3822_001_0	8			Preferred Generic	4	01	1	2	1	3		111	01		111	1				30	60	100	1	2				30	60	100	30		31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	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		
H3822	001	0	1	01	01	H3822_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					10.00	20.00	30.00											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												
H3822	001	0	1	01	01	H3822_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	141.00											47.00	94.00	94.00				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												
H3822	001	0	1	01	01	H3822_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												
H3822	001	0	1	01	01	H3822_001_0	8			Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3822	002	0	1	01	01	H3822_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					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												
H3822	002	0	1	01	01	H3822_002_0	7			Preferred Generic	4	01	1	2	1	3		111	01		111	1				30	60	100	1	2				30	60	100	30		31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	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		
H3822	002	0	1	01	01	H3822_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											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												
H3822	002	0	1	01	01	H3822_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	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												
H3822	002	0	1	01	01	H3822_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	200.00	300.00				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	7			Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												29							29												29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3822	007	0	1	02	01	H3822_007_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											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												
H3822	007	0	1	02	01	H3822_007_0	8			Preferred Generic	4	01	1	2	1	3		111	01		111	1				30	60	100	1	2				30	60	100	30		31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	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		
H3822	007	0	1	02	01	H3822_007_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	20.00	30.00											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												
H3822	007	0	1	02	01	H3822_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	141.00											47.00	94.00	94.00				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												
H3822	007	0	1	02	01	H3822_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	300.00											100.00	200.00	300.00				100.00	200.00	300.00				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	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												
H3822	008	0	1	02	01	H3822_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	30.00					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												
H3822	008	0	1	02	01	H3822_008_0	8			Preferred Generic	4	01	1	2	1	3		111	01		111	1				30	60	100	1	2				30	60	100	30		31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	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		
H3822	008	0	1	02	01	H3822_008_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	20.00	30.00											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												
H3822	008	0	1	02	01	H3822_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								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	94.00				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												
H3822	008	0	1	02	01	H3822_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								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00				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	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												
H3822	012	0	1	01	01	H3822_012_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					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												
H3822	012	0	1	01	01	H3822_012_0	7			Preferred Generic	4	01	1	2	1	3		111	01		111	1				30	60	100	1	2				30	60	100	30		31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	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		
H3822	012	0	1	01	01	H3822_012_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											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												
H3822	012	0	1	01	01	H3822_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	141.00					47.00	94.00	141.00											47.00	94.00	94.00				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												
H3822	012	0	1	01	01	H3822_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	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00				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	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												
H3822	013	0	1	01	01	H3822_013_0	6			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											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												
H3822	013	0	1	01	01	H3822_013_0	6			Preferred Generic	4	01	1	2	1	3		111	01		111	1				30	60	100	1	2				30	60	100	30		31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	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		
H3822	013	0	1	01	01	H3822_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					10.00	20.00	30.00											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												
H3822	013	0	1	01	01	H3822_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	94.00				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												
H3822	013	0	1	01	01	H3822_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	300.00				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	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												
H3822	014	0	1	01	01	H3822_014_0	6			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											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												
H3822	014	0	1	01	01	H3822_014_0	6			Preferred Generic	4	01	1	2	1	3		111	01		111	1				30	60	100	1	2				30	60	100	30		31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	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		
H3822	014	0	1	01	01	H3822_014_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											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												
H3822	014	0	1	01	01	H3822_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	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												
H3822	014	0	1	01	01	H3822_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				100.00	200.00	300.00				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	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												
H3822	015	0	1	01	01	H3822_015_0	6			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											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												
H3822	015	0	1	01	01	H3822_015_0	6			Preferred Generic	4	01	1	2	1	3		111	01		111	1				30	60	100	1	2				30	60	100	30		31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	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		
H3822	015	0	1	01	01	H3822_015_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											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												
H3822	015	0	1	01	01	H3822_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								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	94.00				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												
H3822	015	0	1	01	01	H3822_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	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00				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	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												
H3828	001	0	1	04	01	H3828_001_0	5		N	Preferred Generic	4	11	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								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												
H3828	001	0	1	04	01	H3828_001_0	5		N	Preferred Generic	4	11	1	2	1	3		111	01	111		1				30	60	90	1	2	30	60	90				30		31								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		
H3828	001	0	1	04	01	H3828_001_0	5		N	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					10.00	20.00	30.00					0.00	0.00	0.00																20.00				20.00			0.67	0.33	0.00			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3828	001	0	1	04	01	H3828_001_0	5		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					45.00	90.00	135.00					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												
H3828	001	0	1	04	01	H3828_001_0	5		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	300.00					95.00	190.00	285.00					95.00	190.00	190.00																100.00				100.00			3.33	3.17	3.17			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3828	001	0	1	04	01	H3828_001_0	5		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											830.00	30						830.00	30						30																	30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3832	007	0	1	04	01	H3832_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	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	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																			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	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	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	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	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	6			Specialty Tier	4	11	1	1	5	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31					25	25	25																		25	25	25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3832	008	0	1	04	01	H3832_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	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	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			0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3832	008	0	1	04	01	H3832_008_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	008	0	1	04	01	H3832_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																			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	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	008	0	1	04	01	H3832_008_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												
H3832	009	0	1	04	01	H3832_009_0	6			Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	4.50	9.00	13.50																			4.50	4.50	4.50																4.50				4.50		0.15			0.15			0.15	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3832	009	0	1	04	01	H3832_009_0	6			Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	12.00	24.00	36.00																			12.00	12.00	12.00																12.00				12.00		0.40			0.40			0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3832	009	0	1	04	01	H3832_009_0	6			Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	47.00	94.00	141.00																			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	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	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	6			Specialty Tier	4	11	1	1	5	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31					25	25	25																		25	25	25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3832	010	0	1	04	01	H3832_010_0	6			Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	4.00	8.00	12.00																			4.00	4.00	4.00																4.00				4.00		0.13			0.13			0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3832	010	0	1	04	01	H3832_010_0	6			Preferred Generic	4	01	1	2	1	3	111		01	111		1	30	60	90				1	2	30	60	90				30		31	4.00	8.00	12.00																			4.00	4.00	4.00																4.00				4.00		0.13			0.13			0.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3832	010	0	1	04	01	H3832_010_0	6			Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	11.00	22.00	33.00																			11.00	11.00	11.00																11.00				11.00		0.37			0.37			0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3832	010	0	1	04	01	H3832_010_0	6			Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	45.00	90.00	135.00																			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											78.07	33	33	33				66.78	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												33							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	3			Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								8.00	16.00	24.00					3.00	6.00	9.00											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	3			Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								17.00	34.00	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	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	74.00				47.00				47.00			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	3			Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											71.83	33	33	33				60.25	31	31	31										33	33	33				31	31	31			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3864	014	0	1	02	01	H3864_014_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												
H3864	014	0	1	02	01	H3864_014_0	3			Select Care Drugs	4	01	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			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	3			Select Care Drugs	4	01	1	2	6	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H3864	024	0	1	02	01	H3864_024_0	3			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					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	024	0	1	02	01	H3864_024_0	3			Generic	4	01	1	2	2	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								17.00	34.00	51.00					12.00	24.00	36.00											17.00	34.00	51.00				12.00	24.00	24.00				17.00				17.00			0.57	0.40		0.57	0.40	0.55	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3864	024	0	1	02	01	H3864_024_0	3			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					39.00	78.00	117.00											47.00	94.00	141.00				39.00	78.00	78.00				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												
H3864	024	0	1	02	01	H3864_024_0	3			Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31											89.57	31	31	31				83.57	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	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												
H3864	024	0	1	02	01	H3864_024_0	3			Select Care Drugs	4	01	1	2	6	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3864	024	0	1	02	01	H3864_024_0	3			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	3			Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								8.00	16.00	24.00					3.00	6.00	9.00											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	3			Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								17.00	34.00	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	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	74.00				47.00				47.00			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	3			Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											91.02	32	32	32				88.80	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	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, Select Care Drugs												
H3864	027	0	1	01	01	H3864_027_0	3			Select Care Drugs	4	01	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			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	3			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	3			Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								8.00	16.00	24.00					3.00	6.00	9.00											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	3			Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								17.00	34.00	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	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	74.00				47.00				47.00			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	3			Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											82.03	33	33	33				76.31	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	029	0	1	02	01	H3864_029_0	3			Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												30							30												30						30					30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3864	029	0	1	02	01	H3864_029_0	3			Select Care Drugs	4	01	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			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	3			Select Care Drugs	4	01	1	2	6	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H3864	032	0	1	01	01	H3864_032_0	3			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					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	032	0	1	01	01	H3864_032_0	3			Generic	4	01	1	2	2	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								17.00	34.00	51.00					12.00	24.00	36.00											17.00	34.00	51.00				12.00	24.00	24.00				17.00				17.00			0.57	0.40		0.57	0.40	0.55	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3864	032	0	1	01	01	H3864_032_0	3			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					39.00	78.00	117.00											47.00	94.00	141.00				39.00	78.00	78.00				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												
H3864	032	0	1	01	01	H3864_032_0	3			Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31											79.26	33	33	33				71.25	31	31	31										33	33	33				31	31	31			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3864	032	0	1	01	01	H3864_032_0	3			Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3864	032	0	1	01	01	H3864_032_0	3			Select Care Drugs	4	01	1	2	6	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3864	032	0	1	01	01	H3864_032_0	3			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	034	0	1	02	01	H3864_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								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	3			Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								17.00	34.00	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	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					39.00	78.00	117.00											47.00	94.00	141.00				39.00	78.00	78.00				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												
H3864	034	0	1	02	01	H3864_034_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											76.39	33	33	33				69.57	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	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												
H3864	034	0	1	02	01	H3864_034_0	3			Select Care Drugs	4	01	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			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	3			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	02	01	H3864_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								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	02	01	H3864_036_0	3			Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								17.00	34.00	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	02	01	H3864_036_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					37.00	74.00	111.00											47.00	94.00	141.00				37.00	74.00	74.00				47.00				47.00			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	02	01	H3864_036_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											90.55	33	33	33				87.09	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	02	01	H3864_036_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												
H3864	036	0	1	02	01	H3864_036_0	3			Select Care Drugs	4	01	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			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	02	01	H3864_036_0	3			Select Care Drugs	4	01	1	2	6	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H3864	040	0	1	01	01	H3864_040_0	3			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	3			Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								17.00	34.00	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	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					39.00	78.00	117.00											47.00	94.00	141.00				39.00	78.00	78.00				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												
H3864	040	0	1	01	01	H3864_040_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											81.08	33	33	33				74.00	31	31	31										33	33	33				31	31	31			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3864	040	0	1	01	01	H3864_040_0	3			Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3864	040	0	1	01	01	H3864_040_0	3			Select Care Drugs	4	01	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3864	040	0	1	01	01	H3864_040_0	3			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	3			Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								8.00	16.00	24.00					3.00	6.00	9.00											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	3			Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								17.00	34.00	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	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	74.00				47.00				47.00			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	3			Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											78.33	33	33	33				70.47	31	31	31										33	33	33				31	31	31			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3864	041	0	1	01	01	H3864_041_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												
H3864	041	0	1	01	01	H3864_041_0	3			Select Care Drugs	4	01	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			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	3			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	02	01	H3864_042_0	3			Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								8.00	16.00	24.00					3.00	6.00	9.00											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	02	01	H3864_042_0	3			Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								17.00	34.00	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	02	01	H3864_042_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					37.00	74.00	111.00											47.00	94.00	141.00				37.00	74.00	74.00				47.00				47.00			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	02	01	H3864_042_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											86.55	33	33	33				82.52	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	02	01	H3864_042_0	3			Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												29							29												29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3864	042	0	1	02	01	H3864_042_0	3			Select Care Drugs	4	01	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			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	02	01	H3864_042_0	3			Select Care Drugs	4	01	1	2	6	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			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	6		N	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3864	043	0	1	01	01	H3864_043_0	6		N	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	20.00	40.00	60.00																			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	6		N	Preferred Brand	4	10	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	47.00	94.00	141.00																			47.00	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	6		N	Non-Preferred Drug	4	11	1	1	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31				93.97	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	6		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31					25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3864	043	0	1	01	01	H3864_043_0	6		N	Select Care Drugs	4	01	1	2	6	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3864	043	0	1	01	01	H3864_043_0	6		N	Select Care Drugs	4	01	1	2	6	3	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H3890	001	0	1	04	01	H3890_001_0	9		Y	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	001	0	1	04	01	H3890_001_0	9		Y	Generic	4	11	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	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	001	0	1	04	01	H3890_001_0	9		Y	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	47.00	94.00	141.00																			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	9		Y	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	100.00	200.00	300.00																			100.00	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	9		Y	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31					33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3890	002	0	1	04	01	H3890_002_0	10		Y	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	10		Y	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	10		Y	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	47.00	94.00	141.00																			47.00	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	10		Y	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	100.00	200.00	300.00																			100.00	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	10		Y	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31					33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3890	004	0	1	04	01	H3890_004_0	10		Y	Preferred Generic	4	11	1	2	1	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3890	004	0	1	04	01	H3890_004_0	10		Y	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	10		Y	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	10		Y	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	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	10		Y	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31					33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3890	005	0	1	04	01	H3890_005_0	10		Y	Preferred Generic	4	11	1	2	1	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	5.00	7.50	10.00																			5.00	7.50	10.00																5.00				5.00		0.17			0.17			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3890	005	0	1	04	01	H3890_005_0	10		Y	Generic	4	11	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	20.00	30.00	40.00																			20.00	30.00	40.00																20.00				20.00		0.67			0.67			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3890	005	0	1	04	01	H3890_005_0	10		Y	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	47.00	94.00	141.00																			47.00	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	005	0	1	04	01	H3890_005_0	10		Y	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	100.00	200.00	300.00																			100.00	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	005	0	1	04	01	H3890_005_0	10		Y	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31					33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3907	006	0	1	01	01	H3907_006_0	10		Y	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	10		Y	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	10		Y	Preferred Brand	4	11	1	2	3	1		111	01		100	1				30	60	90	1	2						90	30		31								47.00	94.00	141.00					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	10		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01		100	1				30	60	90	1	2						90	30		31								100.00	200.00	300.00					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	10		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											1287.60	33						827.93	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3907	029	0	1	01	01	H3907_029_0	8		Y	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	8		Y	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	8		Y	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	8		Y	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	8		Y	Preferred Brand	4	11	1	2	3	1		111	01		100	1				30	60	90	1	2						90	30		31								47.00	94.00	141.00					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	8		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01		100	1				30	60	90	1	2						90	30		31								100.00	200.00	300.00					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	8		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											1014.61	33						1071.65	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3907	037	0	1	01	01	H3907_037_0	8		Y	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	8		Y	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	8		Y	Preferred Brand	4	11	1	2	3	1		111	01		100	1				30	60	90	1	2						90	30		31								47.00	94.00	141.00					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	8		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01		100	1				30	60	90	1	2						90	30		31								100.00	200.00	300.00					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	8		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											1123.90	33						1075.85	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3907	046	0	1	01	01	H3907_046_0	8		Y	Preferred Generic	4	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	8		Y	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	8		Y	Preferred Brand	4	11	1	2	3	1		111	01		100	1				30	60	90	1	2						90	30		31								47.00	94.00	141.00					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	8		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01		100	1				30	60	90	1	2						90	30		31								100.00	200.00	300.00					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	8		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											937.37	33						973.29	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3907	049	0	1	01	01	H3907_049_0	8		Y	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	8		Y	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	8		Y	Preferred Brand	4	11	1	2	3	1		111	01		100	1				30	60	90	1	2						90	30		31								47.00	94.00	141.00					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	8		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01		100	1				30	60	90	1	2						90	30		31								100.00	200.00	300.00					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	8		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											1005.81	33						996.86	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3907	050	0	1	01	01	H3907_050_0	8		Y	Preferred Generic	4	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	8		Y	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	8		Y	Preferred Brand	4	11	1	2	3	1		111	01		100	1				30	60	90	1	2						90	30		31								47.00	94.00	141.00					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	8		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01		100	1				30	60	90	1	2						90	30		31								100.00	200.00	300.00					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	8		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											619.38	33						916.72	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3907	052	0	1	01	01	H3907_052_0	8		Y	Preferred Generic	4	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	8		Y	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	8		Y	Preferred Brand	4	11	1	2	3	1		111	01		100	1				30	60	90	1	2						90	30		31								47.00	94.00	141.00					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	8		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01		100	1				30	60	90	1	2						90	30		31								100.00	200.00	300.00					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	8		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											907.88	33						1272.90	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3909	001	0	1	04	01	H3909_001_0	4			Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								9.00	18.00	27.00					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	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	14.00					7.00	14.00	14.00																20.00				20.00			0.67	0.23	0.23			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3909	001	0	1	04	01	H3909_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												
H3909	001	0	1	04	01	H3909_001_0	4			Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	300.00					100.00	200.00	300.00					100.00	200.00	200.00																100.00				100.00			3.33	3.33	3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3909	001	0	1	04	01	H3909_001_0	4			Specialty Tier	4	11	1	1	5	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31												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	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	009	0	1	04	01	H3909_009_0	3			Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								20.00	40.00	60.00					7.00	14.00	14.00					7.00	14.00	14.00																20.00				20.00			0.67	0.23	0.23			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3909	009	0	1	04	01	H3909_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												
H3909	009	0	1	04	01	H3909_009_0	3			Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	300.00					100.00	200.00	300.00					100.00	200.00	200.00																100.00				100.00			3.33	3.33	3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3909	009	0	1	04	01	H3909_009_0	3			Specialty Tier	4	11	1	1	5	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31												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	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	014	0	1	04	01	H3909_014_0	3			Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								20.00	40.00	60.00					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												
H3909	014	0	1	04	01	H3909_014_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	014	0	1	04	01	H3909_014_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	014	0	1	04	01	H3909_014_0	3			Specialty Tier	4	11	1	1	5	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31												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	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												
H3909	015	0	1	04	01	H3909_015_0	4			Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								20.00	40.00	60.00					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												
H3909	015	0	1	04	01	H3909_015_0	4			Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					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	4			Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	300.00					100.00	200.00	300.00					100.00	200.00	200.00																100.00				100.00			3.33	3.33	3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3909	015	0	1	04	01	H3909_015_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												
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					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												
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					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												
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	7			Preferred Generic	4	01	1	2	1	1		110	01		100	1				31		90	1	2						90	31		31								5.00		15.00					0.00		0.00													15.00						0.00				5.00				5.00			0.16	0.00				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3916	001	0	1	04	01	H3916_001_0	7			Preferred Generic	4	01	1	2	1	3		110	01		100	1				31		90	1	2						90	31		31								5.00		15.00					0.00		0.00													15.00						0.00				5.00				5.00			0.16	0.00				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3916	001	0	1	04	01	H3916_001_0	7			Generic	4	01	1	2	2	1		110	01		100	1				31		90	1	2						90	31		31								19.00		57.00					13.00		39.00													57.00						27.00				19.00				19.00			0.61	0.42				0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3916	001	0	1	04	01	H3916_001_0	7			Generic	4	01	1	2	2	3		110	01		100	1				31		90	1	2						90	31		31								19.00		57.00					13.00		39.00													57.00						27.00				19.00				19.00			0.61	0.42				0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3916	001	0	1	04	01	H3916_001_0	7			Preferred Brand	4	11	1	2	3	1		110	01		100	1				31		90	1	2						90	31		31								47.00		141.00					45.00		135.00													141.00						115.00				47.00				47.00			1.52	1.45				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3916	001	0	1	04	01	H3916_001_0	7			Non-Preferred Drug	4	11	1	2	4	1		110	01		100	1				31		90	1	2						90	31		31								100.00		300.00					95.00		285.00													300.00						275.00				100.00				100.00			3.23	3.06				3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3916	001	0	1	04	01	H3916_001_0	7			Specialty Tier	4	11	1	1	5	1		010	01		010	1				31								31			31		31											905.06	33						905.06	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3916	002	0	1	04	01	H3916_002_0	7			Preferred Generic	4	01	1	2	1	1		110	01		100	1				31		90	1	2						90	31		31								5.00		15.00					0.00		0.00													15.00						0.00				5.00				5.00			0.16	0.00				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3916	002	0	1	04	01	H3916_002_0	7			Preferred Generic	4	01	1	2	1	3		110	01		100	1				31		90	1	2						90	31		31								5.00		15.00					0.00		0.00													15.00						0.00				5.00				5.00			0.16	0.00				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3916	002	0	1	04	01	H3916_002_0	7			Generic	4	01	1	2	2	1		110	01		100	1				31		90	1	2						90	31		31								19.00		57.00					13.00		39.00													57.00						27.00				19.00				19.00			0.61	0.42				0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3916	002	0	1	04	01	H3916_002_0	7			Generic	4	01	1	2	2	3		110	01		100	1				31		90	1	2						90	31		31								19.00		57.00					13.00		39.00													57.00						27.00				19.00				19.00			0.61	0.42				0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3916	002	0	1	04	01	H3916_002_0	7			Preferred Brand	4	11	1	2	3	1		110	01		100	1				31		90	1	2						90	31		31								47.00		141.00					45.00		135.00													141.00						115.00				47.00				47.00			1.52	1.45				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3916	002	0	1	04	01	H3916_002_0	7			Non-Preferred Drug	4	11	1	2	4	1		110	01		100	1				31		90	1	2						90	31		31								100.00		300.00					95.00		285.00													300.00						275.00				100.00				100.00			3.23	3.06				3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3916	002	0	1	04	01	H3916_002_0	7			Specialty Tier	4	11	1	1	5	1		010	01		010	1				31								31			31		31											913.37	33						913.37	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3916	005	0	1	04	01	H3916_005_0	7			Preferred Generic	4	01	1	2	1	1		110	01		100	1				31		90	1	2						90	31		31								5.00		15.00					0.00		0.00													15.00						0.00				5.00				5.00			0.16	0.00				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3916	005	0	1	04	01	H3916_005_0	7			Preferred Generic	4	01	1	2	1	3		110	01		100	1				31		90	1	2						90	31		31								5.00		15.00					0.00		0.00													15.00						0.00				5.00				5.00			0.16	0.00				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3916	005	0	1	04	01	H3916_005_0	7			Generic	4	01	1	2	2	1		110	01		100	1				31		90	1	2						90	31		31								19.00		57.00					13.00		39.00													57.00						27.00				19.00				19.00			0.61	0.42				0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3916	005	0	1	04	01	H3916_005_0	7			Generic	4	01	1	2	2	3		110	01		100	1				31		90	1	2						90	31		31								19.00		57.00					13.00		39.00													57.00						27.00				19.00				19.00			0.61	0.42				0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3916	005	0	1	04	01	H3916_005_0	7			Preferred Brand	4	11	1	2	3	1		110	01		100	1				31		90	1	2						90	31		31								47.00		141.00					45.00		135.00													141.00						115.00				47.00				47.00			1.52	1.45				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3916	005	0	1	04	01	H3916_005_0	7			Non-Preferred Drug	4	11	1	2	4	1		110	01		100	1				31		90	1	2						90	31		31								100.00		300.00					95.00		285.00													300.00						275.00				100.00				100.00			3.23	3.06				3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3916	005	0	1	04	01	H3916_005_0	7			Specialty Tier	4	11	1	1	5	1		010	01		010	1				31								31			31		31											1036.49	33						1036.49	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3916	015	0	1	04	01	H3916_015_0	7			Preferred Generic	4	01	1	2	1	1		110	01		100	1				31		90	1	2						90	31		31								5.00		15.00					0.00		0.00													15.00						0.00				5.00				5.00			0.16	0.00				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3916	015	0	1	04	01	H3916_015_0	7			Generic	4	01	1	2	2	1		110	01		100	1				31		90	1	2						90	31		31								19.00		57.00					13.00		39.00													57.00						27.00				19.00				19.00			0.61	0.42				0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3916	015	0	1	04	01	H3916_015_0	7			Preferred Brand	4	11	1	2	3	1		110	01		100	1				31		90	1	2						90	31		31								47.00		141.00					45.00		135.00													141.00						115.00				47.00				47.00			1.52	1.45				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3916	015	0	1	04	01	H3916_015_0	7			Non-Preferred Drug	4	11	1	2	4	1		110	01		100	1				31		90	1	2						90	31		31								100.00		300.00					95.00		285.00													300.00						275.00				100.00				100.00			3.23	3.06				3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3916	015	0	1	04	01	H3916_015_0	7			Specialty Tier	4	11	1	1	5	1		010	01		010	1				31								31			31		31											949.14	33						949.14	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3916	018	0	1	04	01	H3916_018_0	7			Preferred Generic	4	01	1	2	1	1		110	01		100	1				31		90	1	2						90	31		31								5.00		15.00					0.00		0.00													15.00						0.00				5.00				5.00			0.16	0.00				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3916	018	0	1	04	01	H3916_018_0	7			Generic	4	01	1	2	2	1		110	01		100	1				31		90	1	2						90	31		31								19.00		57.00					13.00		39.00													57.00						27.00				19.00				19.00			0.61	0.42				0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3916	018	0	1	04	01	H3916_018_0	7			Preferred Brand	4	11	1	2	3	1		110	01		100	1				31		90	1	2						90	31		31								47.00		141.00					45.00		135.00													141.00						115.00				47.00				47.00			1.52	1.45				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3916	018	0	1	04	01	H3916_018_0	7			Non-Preferred Drug	4	11	1	2	4	1		110	01		100	1				31		90	1	2						90	31		31								100.00		300.00					95.00		285.00													300.00						275.00				100.00				100.00			3.23	3.06				3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3916	018	0	1	04	01	H3916_018_0	7			Specialty Tier	4	11	1	1	5	1		010	01		010	1				31								31			31		31											1106.54	33						1106.54	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3916	022	0	1	04	01	H3916_022_0	7			Preferred Generic	4	01	1	2	1	1		110	01		100	1				31		90	1	2						90	31		31								5.00		15.00					0.00		0.00													15.00						0.00				5.00				5.00			0.16	0.00				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3916	022	0	1	04	01	H3916_022_0	7			Generic	4	01	1	2	2	1		110	01		100	1				31		90	1	2						90	31		31								19.00		57.00					13.00		39.00													57.00						27.00				19.00				19.00			0.61	0.42				0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3916	022	0	1	04	01	H3916_022_0	7			Preferred Brand	4	11	1	2	3	1		110	01		100	1				31		90	1	2						90	31		31								47.00		141.00					45.00		135.00													141.00						115.00				47.00				47.00			1.52	1.45				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3916	022	0	1	04	01	H3916_022_0	7			Non-Preferred Drug	4	11	1	2	4	1		110	01		100	1				31		90	1	2						90	31		31								100.00		300.00					95.00		285.00													300.00						275.00				100.00				100.00			3.23	3.06				3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3916	022	0	1	04	01	H3916_022_0	7			Specialty Tier	4	11	1	1	5	1		010	01		010	1				31								31			31		31											1064.14	33						1064.14	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3916	024	0	1	04	01	H3916_024_0	7			Preferred Generic	4	01	1	2	1	1		110	01		100	1				31		90	1	2						90	31		31								5.00		15.00					0.00		0.00													15.00						0.00				5.00				5.00			0.16	0.00				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3916	024	0	1	04	01	H3916_024_0	7			Generic	4	01	1	2	2	1		110	01		100	1				31		90	1	2						90	31		31								19.00		57.00					13.00		39.00													57.00						27.00				19.00				19.00			0.61	0.42				0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3916	024	0	1	04	01	H3916_024_0	7			Preferred Brand	4	11	1	2	3	1		110	01		100	1				31		90	1	2						90	31		31								47.00		141.00					45.00		135.00													141.00						115.00				47.00				47.00			1.52	1.45				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3916	024	0	1	04	01	H3916_024_0	7			Non-Preferred Drug	4	11	1	2	4	1		110	01		100	1				31		90	1	2						90	31		31								100.00		300.00					95.00		285.00													300.00						275.00				100.00				100.00			3.23	3.06				3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3916	024	0	1	04	01	H3916_024_0	7			Specialty Tier	4	11	1	1	5	1		010	01		010	1				31								31			31		31											972.15	33						972.15	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3916	032	0	1	04	01	H3916_032_0	7			Preferred Generic	4	01	1	2	1	1		110	01		100	1				31		90	1	2						90	31		31								5.00		15.00					0.00		0.00													15.00						0.00				5.00				5.00			0.16	0.00				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3916	032	0	1	04	01	H3916_032_0	7			Generic	4	01	1	2	2	1		110	01		100	1				31		90	1	2						90	31		31								19.00		57.00					13.00		39.00													57.00						27.00				19.00				19.00			0.61	0.42				0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3916	032	0	1	04	01	H3916_032_0	7			Preferred Brand	4	11	1	2	3	1		110	01		100	1				31		90	1	2						90	31		31								47.00		141.00					45.00		135.00													141.00						115.00				47.00				47.00			1.52	1.45				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3916	032	0	1	04	01	H3916_032_0	7			Non-Preferred Drug	4	11	1	2	4	1		110	01		100	1				31		90	1	2						90	31		31								100.00		300.00					95.00		285.00													300.00						275.00				100.00				100.00			3.23	3.06				3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3916	032	0	1	04	01	H3916_032_0	7			Specialty Tier	4	11	1	1	5	1		010	01		010	1				31								31			31		31											879.34	33						879.34	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3916	033	0	1	04	01	H3916_033_0	7			Preferred Generic	4	01	1	2	1	1		110	01		100	1				31		90	1	2						90	31		31								5.00		15.00					0.00		0.00													15.00						0.00				5.00				5.00			0.16	0.00				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3916	033	0	1	04	01	H3916_033_0	7			Generic	4	01	1	2	2	1		110	01		100	1				31		90	1	2						90	31		31								19.00		57.00					13.00		39.00													57.00						27.00				19.00				19.00			0.61	0.42				0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3916	033	0	1	04	01	H3916_033_0	7			Preferred Brand	4	11	1	2	3	1		110	01		100	1				31		90	1	2						90	31		31								47.00		141.00					45.00		135.00													141.00						115.00				47.00				47.00			1.52	1.45				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3916	033	0	1	04	01	H3916_033_0	7			Non-Preferred Drug	4	11	1	2	4	1		110	01		100	1				31		90	1	2						90	31		31								100.00		300.00					95.00		285.00													300.00						275.00				100.00				100.00			3.23	3.06				3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3916	033	0	1	04	01	H3916_033_0	7			Specialty Tier	4	11	1	1	5	1		010	01		010	1				31								31			31		31											1075.46	33						1075.46	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3916	034	1	1	04	01	H3916_034_1	7		Y	Preferred Generic	4	01	1	2	1	1		110	01		100	1				31		90	1	2						90	31		31								7.00		21.00					0.00		0.00													21.00						0.00				7.00				7.00			0.23	0.00				0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3916	034	1	1	04	01	H3916_034_1	7		Y	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													45.00						0.00				15.00				15.00			0.48	0.00				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3916	034	1	1	04	01	H3916_034_1	7		Y	Preferred Brand	4	11	1	2	3	1		110	01		100	1				31		90	1	2						90	31		31								47.00		141.00					42.00		126.00													141.00						120.00				47.00				47.00			1.52	1.35				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3916	034	1	1	04	01	H3916_034_1	7		Y	Non-Preferred Drug	4	11	1	2	4	1		110	01		100	1				31		90	1	2						90	31		31								100.00		300.00					100.00		300.00													300.00						275.00				100.00				100.00			3.23	3.23				3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3916	034	1	1	04	01	H3916_034_1	7		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				31								31			31		31											1009.83	33						1009.83	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3916	034	3	1	04	01	H3916_034_3	7		Y	Preferred Generic	4	01	1	2	1	1		110	01		100	1				31		90	1	2						90	31		31								7.00		21.00					0.00		0.00													21.00						0.00				7.00				7.00			0.23	0.00				0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3916	034	3	1	04	01	H3916_034_3	7		Y	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													45.00						0.00				15.00				15.00			0.48	0.00				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3916	034	3	1	04	01	H3916_034_3	7		Y	Preferred Brand	4	11	1	2	3	1		110	01		100	1				31		90	1	2						90	31		31								47.00		141.00					42.00		126.00													141.00						120.00				47.00				47.00			1.52	1.35				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3916	034	3	1	04	01	H3916_034_3	7		Y	Non-Preferred Drug	4	11	1	2	4	1		110	01		100	1				31		90	1	2						90	31		31								100.00		300.00					100.00		300.00													300.00						275.00				100.00				100.00			3.23	3.23				3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3916	034	3	1	04	01	H3916_034_3	7		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				31								31			31		31											1009.83	33						1009.83	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3916	034	4	1	04	01	H3916_034_4	7		Y	Preferred Generic	4	01	1	2	1	1		110	01		100	1				31		90	1	2						90	31		31								7.00		21.00					0.00		0.00													21.00						0.00				7.00				7.00			0.23	0.00				0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3916	034	4	1	04	01	H3916_034_4	7		Y	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													45.00						0.00				15.00				15.00			0.48	0.00				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3916	034	4	1	04	01	H3916_034_4	7		Y	Preferred Brand	4	11	1	2	3	1		110	01		100	1				31		90	1	2						90	31		31								47.00		141.00					42.00		126.00													141.00						120.00				47.00				47.00			1.52	1.35				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3916	034	4	1	04	01	H3916_034_4	7		Y	Non-Preferred Drug	4	11	1	2	4	1		110	01		100	1				31		90	1	2						90	31		31								100.00		300.00					100.00		300.00													300.00						275.00				100.00				100.00			3.23	3.23				3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3916	034	4	1	04	01	H3916_034_4	7		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				31								31			31		31											1009.83	33						1009.83	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3916	034	5	1	04	01	H3916_034_5	7		Y	Preferred Generic	4	01	1	2	1	1		110	01		100	1				31		90	1	2						90	31		31								7.00		21.00					0.00		0.00													21.00						0.00				7.00				7.00			0.23	0.00				0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3916	034	5	1	04	01	H3916_034_5	7		Y	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													45.00						0.00				15.00				15.00			0.48	0.00				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3916	034	5	1	04	01	H3916_034_5	7		Y	Preferred Brand	4	11	1	2	3	1		110	01		100	1				31		90	1	2						90	31		31								47.00		141.00					42.00		126.00													141.00						120.00				47.00				47.00			1.52	1.35				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3916	034	5	1	04	01	H3916_034_5	7		Y	Non-Preferred Drug	4	11	1	2	4	1		110	01		100	1				31		90	1	2						90	31		31								100.00		300.00					100.00		300.00													300.00						275.00				100.00				100.00			3.23	3.23				3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3916	034	5	1	04	01	H3916_034_5	7		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				31								31			31		31											1009.83	33						1009.83	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3916	035	1	1	04	01	H3916_035_1	7		Y	Preferred Generic	4	01	1	2	1	1		110	01		100	1				31		90	1	2						90	31		31								7.00		21.00					0.00		0.00													21.00						0.00				7.00				7.00			0.23	0.00				0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3916	035	1	1	04	01	H3916_035_1	7		Y	Generic	4	01	1	2	2	1		110	01		100	1				31		90	1	2						90	31		31								20.00		60.00					0.00		0.00													60.00						0.00				20.00				20.00			0.65	0.00				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3916	035	1	1	04	01	H3916_035_1	7		Y	Preferred Brand	4	11	1	2	3	1		110	01		100	1				31		90	1	2						90	31		31								47.00		141.00					42.00		126.00													141.00						120.00				47.00				47.00			1.52	1.35				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3916	035	1	1	04	01	H3916_035_1	7		Y	Non-Preferred Drug	4	11	1	2	4	1		110	01		100	1				31		90	1	2						90	31		31								100.00		300.00					100.00		300.00													300.00						280.00				100.00				100.00			3.23	3.23				3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3916	035	1	1	04	01	H3916_035_1	7		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				31								31			31		31											915.69	33						915.69	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3916	035	2	1	04	01	H3916_035_2	7		Y	Preferred Generic	4	01	1	2	1	1		110	01		100	1				31		90	1	2						90	31		31								7.00		21.00					0.00		0.00													21.00						0.00				7.00				7.00			0.23	0.00				0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3916	035	2	1	04	01	H3916_035_2	7		Y	Generic	4	01	1	2	2	1		110	01		100	1				31		90	1	2						90	31		31								20.00		60.00					0.00		0.00													60.00						0.00				20.00				20.00			0.65	0.00				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3916	035	2	1	04	01	H3916_035_2	7		Y	Preferred Brand	4	11	1	2	3	1		110	01		100	1				31		90	1	2						90	31		31								47.00		141.00					42.00		126.00													141.00						120.00				47.00				47.00			1.52	1.35				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3916	035	2	1	04	01	H3916_035_2	7		Y	Non-Preferred Drug	4	11	1	2	4	1		110	01		100	1				31		90	1	2						90	31		31								100.00		300.00					100.00		300.00													300.00						280.00				100.00				100.00			3.23	3.23				3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3916	035	2	1	04	01	H3916_035_2	7		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				31								31			31		31											915.69	33						915.69	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3916	035	4	1	04	01	H3916_035_4	7		Y	Preferred Generic	4	01	1	2	1	1		110	01		100	1				31		90	1	2						90	31		31								7.00		21.00					0.00		0.00													21.00						0.00				7.00				7.00			0.23	0.00				0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3916	035	4	1	04	01	H3916_035_4	7		Y	Generic	4	01	1	2	2	1		110	01		100	1				31		90	1	2						90	31		31								20.00		60.00					0.00		0.00													60.00						0.00				20.00				20.00			0.65	0.00				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3916	035	4	1	04	01	H3916_035_4	7		Y	Preferred Brand	4	11	1	2	3	1		110	01		100	1				31		90	1	2						90	31		31								47.00		141.00					42.00		126.00													141.00						120.00				47.00				47.00			1.52	1.35				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3916	035	4	1	04	01	H3916_035_4	7		Y	Non-Preferred Drug	4	11	1	2	4	1		110	01		100	1				31		90	1	2						90	31		31								100.00		300.00					100.00		300.00													300.00						280.00				100.00				100.00			3.23	3.23				3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3916	035	4	1	04	01	H3916_035_4	7		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				31								31			31		31											915.69	33						915.69	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3916	036	0	1	04	01	H3916_036_0	7		Y	Preferred Generic	4	01	1	2	1	1		110	01		100	1				31		90	1	2						90	31		31								7.00		21.00					0.00		0.00													21.00						0.00				7.00				7.00			0.23	0.00				0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3916	036	0	1	04	01	H3916_036_0	7		Y	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													45.00						0.00				15.00				15.00			0.48	0.00				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3916	036	0	1	04	01	H3916_036_0	7		Y	Preferred Brand	4	11	1	2	3	1		110	01		100	1				31		90	1	2						90	31		31								47.00		141.00					42.00		126.00													141.00						120.00				47.00				47.00			1.52	1.35				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3916	036	0	1	04	01	H3916_036_0	7		Y	Non-Preferred Drug	4	11	1	2	4	1		110	01		100	1				31		90	1	2						90	31		31								100.00		300.00					100.00		300.00													300.00						275.00				100.00				100.00			3.23	3.23				3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3916	036	0	1	04	01	H3916_036_0	7		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				31								31			31		31											1038.82	33						1038.82	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3916	037	1	1	04	01	H3916_037_1	8			Preferred Generic	4	01	1	2	1	1		110	01		100	1				31		90	1	2						90	31		31								7.00		21.00					0.00		0.00													21.00						0.00				7.00				7.00			0.23	0.00				0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3916	037	1	1	04	01	H3916_037_1	8			Generic	4	01	1	2	2	1		110	01		100	1				31		90	1	2						90	31		31								15.00		45.00					5.00		15.00													45.00						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	8			Preferred Brand	4	11	1	2	3	1		110	01		100	1				31		90	1	2						90	31		31								47.00		141.00					47.00		141.00													141.00						120.00				47.00				47.00			1.52	1.52				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3916	037	1	1	04	01	H3916_037_1	8			Non-Preferred Drug	4	11	1	2	4	1		110	01		100	1				31		90	1	2						90	31		31								100.00		300.00					100.00		300.00													300.00						275.00				100.00				100.00			3.23	3.23				3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3916	037	1	1	04	01	H3916_037_1	8			Specialty Tier	4	11	1	1	5	1		010	01		010	1				31								31			31		31											841.24	33						841.24	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3916	037	2	1	04	01	H3916_037_2	7			Preferred Generic	4	01	1	2	1	1		110	01		100	1				31		90	1	2						90	31		31								7.00		21.00					0.00		0.00													21.00						0.00				7.00				7.00			0.23	0.00				0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3916	037	2	1	04	01	H3916_037_2	7			Generic	4	01	1	2	2	1		110	01		100	1				31		90	1	2						90	31		31								15.00		45.00					5.00		15.00													45.00						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	7			Preferred Brand	4	11	1	2	3	1		110	01		100	1				31		90	1	2						90	31		31								47.00		141.00					47.00		141.00													141.00						120.00				47.00				47.00			1.52	1.52				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3916	037	2	1	04	01	H3916_037_2	7			Non-Preferred Drug	4	11	1	2	4	1		110	01		100	1				31		90	1	2						90	31		31								100.00		300.00					100.00		300.00													300.00						275.00				100.00				100.00			3.23	3.23				3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3916	037	2	1	04	01	H3916_037_2	7			Specialty Tier	4	11	1	1	5	1		010	01		010	1				31								31			31		31											841.24	33						841.24	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3916	037	3	1	04	01	H3916_037_3	7			Preferred Generic	4	01	1	2	1	1		110	01		100	1				31		90	1	2						90	31		31								7.00		21.00					0.00		0.00													21.00						0.00				7.00				7.00			0.23	0.00				0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3916	037	3	1	04	01	H3916_037_3	7			Generic	4	01	1	2	2	1		110	01		100	1				31		90	1	2						90	31		31								15.00		45.00					5.00		15.00													45.00						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	7			Preferred Brand	4	11	1	2	3	1		110	01		100	1				31		90	1	2						90	31		31								47.00		141.00					47.00		141.00													141.00						120.00				47.00				47.00			1.52	1.52				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3916	037	3	1	04	01	H3916_037_3	7			Non-Preferred Drug	4	11	1	2	4	1		110	01		100	1				31		90	1	2						90	31		31								100.00		300.00					100.00		300.00													300.00						275.00				100.00				100.00			3.23	3.23				3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3916	037	3	1	04	01	H3916_037_3	7			Specialty Tier	4	11	1	1	5	1		010	01		010	1				31								31			31		31											841.24	33						841.24	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3916	037	4	1	04	01	H3916_037_4	7			Preferred Generic	4	01	1	2	1	1		110	01		100	1				31		90	1	2						90	31		31								7.00		21.00					0.00		0.00													21.00						0.00				7.00				7.00			0.23	0.00				0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3916	037	4	1	04	01	H3916_037_4	7			Generic	4	01	1	2	2	1		110	01		100	1				31		90	1	2						90	31		31								15.00		45.00					5.00		15.00													45.00						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	7			Preferred Brand	4	11	1	2	3	1		110	01		100	1				31		90	1	2						90	31		31								47.00		141.00					47.00		141.00													141.00						120.00				47.00				47.00			1.52	1.52				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3916	037	4	1	04	01	H3916_037_4	7			Non-Preferred Drug	4	11	1	2	4	1		110	01		100	1				31		90	1	2						90	31		31								100.00		300.00					100.00		300.00													300.00						275.00				100.00				100.00			3.23	3.23				3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3916	037	4	1	04	01	H3916_037_4	7			Specialty Tier	4	11	1	1	5	1		010	01		010	1				31								31			31		31											841.24	33						841.24	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3916	038	0	1	04	01	H3916_038_0	7			Preferred Generic	4	01	1	2	1	1		110	01		100	1				31		90	1	2						90	31		31								7.00		21.00					0.00		0.00													21.00						0.00				7.00				7.00			0.23	0.00				0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3916	038	0	1	04	01	H3916_038_0	7			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													45.00						0.00				15.00				15.00			0.48	0.00				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3916	038	0	1	04	01	H3916_038_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					47.00		141.00													141.00						120.00				47.00				47.00			1.52	1.52				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3916	038	0	1	04	01	H3916_038_0	7			Non-Preferred Drug	4	11	1	2	4	1		110	01		100	1				31		90	1	2						90	31		31								100.00		300.00					100.00		300.00													300.00						275.00				100.00				100.00			3.23	3.23				3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3916	038	0	1	04	01	H3916_038_0	7			Specialty Tier	4	11	1	1	5	1		010	01		010	1				31								31			31		31											897.28	33						897.28	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3916	039	0	1	04	01	H3916_039_0	7			Preferred Generic	4	01	1	2	1	1		110	01		100	1				31		90	1	2						90	31		31								7.00		21.00					0.00		0.00													21.00						0.00				7.00				7.00			0.23	0.00				0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3916	039	0	1	04	01	H3916_039_0	7			Generic	4	01	1	2	2	1		110	01		100	1				31		90	1	2						90	31		31								15.00		45.00					5.00		15.00													45.00						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	7			Preferred Brand	4	11	1	2	3	1		110	01		100	1				31		90	1	2						90	31		31								47.00		141.00					47.00		141.00													141.00						120.00				47.00				47.00			1.52	1.52				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3916	039	0	1	04	01	H3916_039_0	7			Non-Preferred Drug	4	11	1	2	4	1		110	01		100	1				31		90	1	2						90	31		31								100.00		300.00					100.00		300.00													300.00						275.00				100.00				100.00			3.23	3.23				3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3916	039	0	1	04	01	H3916_039_0	7			Specialty Tier	4	11	1	1	5	1		010	01		010	1				31								31			31		31											1236.25	33						1236.25	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3916	041	1	1	04	01	H3916_041_1	7			Preferred Generic	4	01	1	2	1	1		110	01		100	1				31		90	1	2						90	31		31								7.00		21.00					0.00		0.00													21.00						0.00				7.00				7.00			0.23	0.00				0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3916	041	1	1	04	01	H3916_041_1	7			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													45.00						0.00				15.00				15.00			0.48	0.00				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3916	041	1	1	04	01	H3916_041_1	7			Preferred Brand	4	11	1	2	3	1		110	01		100	1				31		90	1	2						90	31		31								47.00		141.00					47.00		141.00													141.00						120.00				47.00				47.00			1.52	1.52				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3916	041	1	1	04	01	H3916_041_1	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					100.00		300.00													300.00						275.00				100.00				100.00			3.23	3.23				3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3916	041	1	1	04	01	H3916_041_1	7			Specialty Tier	4	11	1	1	5	1		010	01		010	1				31								31			31		31											903.66	33						903.66	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3916	041	2	1	04	01	H3916_041_2	7			Preferred Generic	4	01	1	2	1	1		110	01		100	1				31		90	1	2						90	31		31								7.00		21.00					0.00		0.00													21.00						0.00				7.00				7.00			0.23	0.00				0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3916	041	2	1	04	01	H3916_041_2	7			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													45.00						0.00				15.00				15.00			0.48	0.00				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3916	041	2	1	04	01	H3916_041_2	7			Preferred Brand	4	11	1	2	3	1		110	01		100	1				31		90	1	2						90	31		31								47.00		141.00					47.00		141.00													141.00						120.00				47.00				47.00			1.52	1.52				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3916	041	2	1	04	01	H3916_041_2	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					100.00		300.00													300.00						275.00				100.00				100.00			3.23	3.23				3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3916	041	2	1	04	01	H3916_041_2	7			Specialty Tier	4	11	1	1	5	1		010	01		010	1				31								31			31		31											903.66	33						903.66	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3923	013	0	1	04	01	H3923_013_0	3		Y	Preferred Generic	4	01	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												
H3923	013	0	1	04	01	H3923_013_0	3		Y	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								20.00	40.00	60.00					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												
H3923	013	0	1	04	01	H3923_013_0	3		Y	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					40.00	80.00	120.00					40.00	80.00	120.00																47.00				47.00			1.57	1.33	1.33			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3923	013	0	1	04	01	H3923_013_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	300.00					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												
H3923	013	0	1	04	01	H3923_013_0	3		Y	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3923	017	0	1	04	01	H3923_017_0	3		Y	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								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												
H3923	017	0	1	04	01	H3923_017_0	3		Y	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								20.00	40.00	60.00					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												
H3923	017	0	1	04	01	H3923_017_0	3		Y	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					40.00	80.00	120.00					40.00	80.00	120.00																47.00				47.00			1.57	1.33	1.33			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3923	017	0	1	04	01	H3923_017_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	300.00					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												
H3923	017	0	1	04	01	H3923_017_0	3		Y	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3923	028	0	1	04	01	H3923_028_0	3		Y	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								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												
H3923	028	0	1	04	01	H3923_028_0	3		Y	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								20.00	40.00	60.00					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												
H3923	028	0	1	04	01	H3923_028_0	3		Y	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					40.00	80.00	120.00					40.00	80.00	120.00																47.00				47.00			1.57	1.33	1.33			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3923	028	0	1	04	01	H3923_028_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	300.00					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												
H3923	028	0	1	04	01	H3923_028_0	3		Y	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3923	029	0	1	04	01	H3923_029_0	4		Y	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								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												
H3923	029	0	1	04	01	H3923_029_0	4		Y	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								20.00	40.00	60.00					10.00	20.00	30.00					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												
H3923	029	0	1	04	01	H3923_029_0	4		Y	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					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												
H3923	029	0	1	04	01	H3923_029_0	4		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	300.00					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												
H3923	029	0	1	04	01	H3923_029_0	4		Y	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3923	030	0	1	04	01	H3923_030_0	4		Y	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								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												
H3923	030	0	1	04	01	H3923_030_0	4		Y	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								20.00	40.00	60.00					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												
H3923	030	0	1	04	01	H3923_030_0	4		Y	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					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												
H3923	030	0	1	04	01	H3923_030_0	4		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	300.00					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												
H3923	030	0	1	04	01	H3923_030_0	4		Y	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3923	031	0	1	04	01	H3923_031_0	3		Y	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								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												
H3923	031	0	1	04	01	H3923_031_0	3		Y	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								20.00	40.00	60.00					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												
H3923	031	0	1	04	01	H3923_031_0	3		Y	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					40.00	80.00	120.00					40.00	80.00	120.00																47.00				47.00			1.57	1.33	1.33			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3923	031	0	1	04	01	H3923_031_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	300.00					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												
H3923	031	0	1	04	01	H3923_031_0	3		Y	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3923	032	0	1	04	01	H3923_032_0	3		Y	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								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												
H3923	032	0	1	04	01	H3923_032_0	3		Y	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								20.00	40.00	60.00					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												
H3923	032	0	1	04	01	H3923_032_0	3		Y	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					40.00	80.00	120.00					40.00	80.00	120.00																47.00				47.00			1.57	1.33	1.33			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3923	032	0	1	04	01	H3923_032_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	300.00					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												
H3923	032	0	1	04	01	H3923_032_0	3		Y	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3923	033	0	1	04	01	H3923_033_0	4		Y	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								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												
H3923	033	0	1	04	01	H3923_033_0	4		Y	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								20.00	40.00	60.00					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												
H3923	033	0	1	04	01	H3923_033_0	4		Y	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					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												
H3923	033	0	1	04	01	H3923_033_0	4		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	300.00					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												
H3923	033	0	1	04	01	H3923_033_0	4		Y	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3923	034	0	1	04	01	H3923_034_0	3		Y	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								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												
H3923	034	0	1	04	01	H3923_034_0	3		Y	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								20.00	40.00	60.00					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												
H3923	034	0	1	04	01	H3923_034_0	3		Y	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					40.00	80.00	120.00					40.00	80.00	120.00																47.00				47.00			1.57	1.33	1.33			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3923	034	0	1	04	01	H3923_034_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	300.00					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												
H3923	034	0	1	04	01	H3923_034_0	3		Y	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3923	035	0	1	04	01	H3923_035_0	3		Y	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								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												
H3923	035	0	1	04	01	H3923_035_0	3		Y	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								20.00	40.00	60.00					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												
H3923	035	0	1	04	01	H3923_035_0	3		Y	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					40.00	80.00	120.00					40.00	80.00	120.00																47.00				47.00			1.57	1.33	1.33			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3923	035	0	1	04	01	H3923_035_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	300.00					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												
H3923	035	0	1	04	01	H3923_035_0	3		Y	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3923	036	0	1	04	01	H3923_036_0	4		Y	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								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												
H3923	036	0	1	04	01	H3923_036_0	4		Y	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								20.00	40.00	60.00					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												
H3923	036	0	1	04	01	H3923_036_0	4		Y	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					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												
H3923	036	0	1	04	01	H3923_036_0	4		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	300.00					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												
H3923	036	0	1	04	01	H3923_036_0	4		Y	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3923	037	0	1	04	01	H3923_037_0	3		Y	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								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												
H3923	037	0	1	04	01	H3923_037_0	3		Y	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								20.00	40.00	60.00					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												
H3923	037	0	1	04	01	H3923_037_0	3		Y	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					40.00	80.00	120.00					40.00	80.00	120.00																47.00				47.00			1.57	1.33	1.33			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3923	037	0	1	04	01	H3923_037_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	300.00					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												
H3923	037	0	1	04	01	H3923_037_0	3		Y	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3924	059	21	1	04	01	H3924_059_21	5		Y	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		Y	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		Y	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		Y	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		Y	Non-Preferred Brand	4	11	1	2	4	1	111		01	111		1	30	60	100				2	2	30	60	100				30		31	100.00	200.00	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		Y	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31					33																																					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3924	059	21	1	04	01	H3924_059_21	5		Y	Vaccines	4	11	1	2	6	1	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3924	059	21	1	04	01	H3924_059_21	5		Y	Vaccines	4	11	1	2	6	3	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H3924	059	22	1	04	01	H3924_059_22	5		Y	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		Y	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		Y	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		Y	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		Y	Non-Preferred Brand	4	11	1	2	4	1	111		01	111		1	30	60	100				2	2	30	60	100				30		31	100.00	200.00	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		Y	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31					33																																					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3924	059	22	1	04	01	H3924_059_22	5		Y	Vaccines	4	11	1	2	6	1	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3924	059	22	1	04	01	H3924_059_22	5		Y	Vaccines	4	11	1	2	6	3	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H3924	062	21	1	04	01	H3924_062_21	4		Y	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	4		Y	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	4		Y	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	4		Y	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	4		Y	Non-Preferred Brand	4	11	1	2	4	1	111		01	111		1	30	60	100				2	2	30	60	100				30		31	100.00	200.00	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	4		Y	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31					33																																					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3924	062	21	1	04	01	H3924_062_21	4		Y	Vaccines	4	11	1	2	6	1	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3924	062	21	1	04	01	H3924_062_21	4		Y	Vaccines	4	11	1	2	6	3	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H3924	062	22	1	04	01	H3924_062_22	4		Y	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	4		Y	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	4		Y	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	4		Y	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	4		Y	Non-Preferred Brand	4	11	1	2	4	1	111		01	111		1	30	60	100				2	2	30	60	100				30		31	100.00	200.00	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	4		Y	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31					33																																					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3924	062	22	1	04	01	H3924_062_22	4		Y	Vaccines	4	11	1	2	6	1	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3924	062	22	1	04	01	H3924_062_22	4		Y	Vaccines	4	11	1	2	6	3	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H3924	062	23	1	04	01	H3924_062_23	4		Y	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	4		Y	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	4		Y	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	4		Y	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	4		Y	Non-Preferred Brand	4	11	1	2	4	1	111		01	111		1	30	60	100				2	2	30	60	100				30		31	100.00	200.00	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	4		Y	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31					33																																					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3924	062	23	1	04	01	H3924_062_23	4		Y	Vaccines	4	11	1	2	6	1	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3924	062	23	1	04	01	H3924_062_23	4		Y	Vaccines	4	11	1	2	6	3	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H3924	065	0	1	04	01	H3924_065_0	5		Y	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		Y	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		Y	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		Y	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		Y	Non-Preferred Brand	4	11	1	2	4	1	111		01	111		1	30	60	100				2	2	30	60	100				30		31	100.00	200.00	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		Y	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31					33																																					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3924	065	0	1	04	01	H3924_065_0	5		Y	Vaccines	4	11	1	2	6	1	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3924	065	0	1	04	01	H3924_065_0	5		Y	Vaccines	4	11	1	2	6	3	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H3924	066	0	1	04	01	H3924_066_0	4		Y	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	4		Y	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	4		Y	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	4		Y	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	4		Y	Non-Preferred Brand	4	11	1	2	4	1	111		01	111		1	30	60	100				2	2	30	60	100				30		31	100.00	200.00	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	4		Y	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31					33																																					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3924	066	0	1	04	01	H3924_066_0	4		Y	Vaccines	4	11	1	2	6	1	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3924	066	0	1	04	01	H3924_066_0	4		Y	Vaccines	4	11	1	2	6	3	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H3928	001	0	1	01	01	H3928_001_0	7		Y	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												
H3928	001	0	1	01	01	H3928_001_0	7		Y	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		
H3928	001	0	1	01	01	H3928_001_0	7		Y	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												
H3928	001	0	1	01	01	H3928_001_0	7		Y	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		
H3928	001	0	1	01	01	H3928_001_0	7		Y	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					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	7		Y	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					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	7		Y	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1008.31	33						638.38	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3928	002	0	1	01	01	H3928_002_0	2		Y	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					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	2		Y	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3928	002	0	1	01	01	H3928_002_0	2		Y	Generic	4	01	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	2		Y	Generic	4	01	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	2		Y	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3928	002	0	1	01	01	H3928_002_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3928	002	0	1	01	01	H3928_002_0	2		Y	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											632.94	30						477.06	30												30						30						30		30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3931	004	0	1	02	01	H3931_004_0	2		N	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	02	01	H3931_004_0	2		N	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	02	01	H3931_004_0	2		N	Generic	4	01	3	2	2	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					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	02	01	H3931_004_0	2		N	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	02	01	H3931_004_0	2		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					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	02	01	H3931_004_0	2		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					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	02	01	H3931_004_0	2		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1051.11	33						657.55	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3931	064	0	1	02	01	H3931_064_0	3		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					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	3		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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	3		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					5.00	10.00	10.00											20.00	40.00	60.00				5.00	10.00	10.00					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	3		N	Generic	4	01	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	3		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					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	3		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					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	3		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											980.35	33						818.53	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		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					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		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3931	070	0	1	01	01	H3931_070_0	2		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	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		N	Generic	4	01	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		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					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		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					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		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											915.75	33						773.67	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		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					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		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3931	091	0	1	01	01	H3931_091_0	2		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					10.00	20.00	20.00											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												
H3931	091	0	1	01	01	H3931_091_0	2		N	Generic	4	01	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	20.00											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										1		
H3931	091	0	1	01	01	H3931_091_0	2		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					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		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					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		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											876.95	33						578.91	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3931	092	0	1	02	01	H3931_092_0	3		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					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	02	01	H3931_092_0	3		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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	02	01	H3931_092_0	3		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3931	092	0	1	02	01	H3931_092_0	3		N	Generic	4	01	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	092	0	1	02	01	H3931_092_0	3		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					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	02	01	H3931_092_0	3		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					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	02	01	H3931_092_0	3		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											745.83	33						564.21	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3931	094	0	1	02	01	H3931_094_0	4		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					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	4		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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	4		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					10.00	20.00	20.00											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												
H3931	094	0	1	02	01	H3931_094_0	4		N	Generic	4	01	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	20.00											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										1		
H3931	094	0	1	02	01	H3931_094_0	4		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					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	4		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					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	4		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											980.78	33						654.33	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3931	095	0	1	02	01	H3931_095_0	5		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					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	5		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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	5		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					10.00	20.00	20.00											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												
H3931	095	0	1	02	01	H3931_095_0	5		N	Generic	4	01	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	20.00											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										1		
H3931	095	0	1	02	01	H3931_095_0	5		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					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	5		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					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	5		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											953.78	33						659.89	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		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					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		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					10.00	20.00	20.00											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												
H3931	096	0	1	02	01	H3931_096_0	5		N	Generic	4	01	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	20.00											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										1		
H3931	096	0	1	02	01	H3931_096_0	5		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					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		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					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		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											819.91	28						676.59	28												28						28						28		28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3931	097	0	1	01	01	H3931_097_0	5		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					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	5		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3931	097	0	1	01	01	H3931_097_0	5		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					10.00	20.00	20.00											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												
H3931	097	0	1	01	01	H3931_097_0	5		N	Generic	4	01	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	20.00											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										1		
H3931	097	0	1	01	01	H3931_097_0	5		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					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	5		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					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	5		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											801.66	28						374.51	28												28						28						28		28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3931	098	0	1	02	01	H3931_098_0	5		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					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	5		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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	5		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					10.00	20.00	20.00											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												
H3931	098	0	1	02	01	H3931_098_0	5		N	Generic	4	01	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	20.00											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										1		
H3931	098	0	1	02	01	H3931_098_0	5		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					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	5		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					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	5		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											942.05	33						544.43	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3931	099	0	1	02	01	H3931_099_0	4		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					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	4		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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	4		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					10.00	20.00	20.00											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												
H3931	099	0	1	02	01	H3931_099_0	4		N	Generic	4	01	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	20.00											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										1		
H3931	099	0	1	02	01	H3931_099_0	4		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					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	4		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					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	4		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1038.82	33						629.63	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3931	100	0	1	02	01	H3931_100_0	4		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					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	4		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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	4		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					10.00	20.00	20.00											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												
H3931	100	0	1	02	01	H3931_100_0	4		N	Generic	4	01	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	20.00											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										1		
H3931	100	0	1	02	01	H3931_100_0	4		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					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	4		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					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	4		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											944.04	33						620.84	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3931	101	0	1	02	01	H3931_101_0	4		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					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	4		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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	4		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					10.00	20.00	20.00											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												
H3931	101	0	1	02	01	H3931_101_0	4		N	Generic	4	01	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	20.00											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										1		
H3931	101	0	1	02	01	H3931_101_0	4		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					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	4		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					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	4		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											976.73	33						644.18	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		Y	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		Y	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		Y	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		Y	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		Y	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					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		Y	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					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		Y	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											995.33	33						737.28	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3931	104	0	1	02	01	H3931_104_0	2		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					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	02	01	H3931_104_0	2		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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	02	01	H3931_104_0	2		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					10.00	20.00	20.00											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												
H3931	104	0	1	02	01	H3931_104_0	2		N	Generic	4	01	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	20.00											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										1		
H3931	104	0	1	02	01	H3931_104_0	2		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					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	02	01	H3931_104_0	2		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					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	02	01	H3931_104_0	2		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											795.24	31						599.13	31												31						31						31		31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3931	105	0	1	02	01	H3931_105_0	2		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					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	02	01	H3931_105_0	2		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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	02	01	H3931_105_0	2		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					5.00	10.00	10.00											20.00	40.00	60.00				5.00	10.00	10.00					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	02	01	H3931_105_0	2		N	Generic	4	01	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	02	01	H3931_105_0	2		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					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	02	01	H3931_105_0	2		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					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	02	01	H3931_105_0	2		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1028.90	30						523.03	30												30						30						30		30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3931	107	0	1	02	01	H3931_107_0	4		N	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	107	0	1	02	01	H3931_107_0	4		N	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	107	0	1	02	01	H3931_107_0	4		N	Generic	4	01	3	2	2	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					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	107	0	1	02	01	H3931_107_0	4		N	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	107	0	1	02	01	H3931_107_0	4		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					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	4		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					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	4		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											877.90	33						577.21	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3931	108	0	1	01	01	H3931_108_0	4		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					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	4		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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	4		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					10.00	20.00	20.00											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												
H3931	108	0	1	01	01	H3931_108_0	4		N	Generic	4	01	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	20.00											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										1		
H3931	108	0	1	01	01	H3931_108_0	4		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					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	4		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					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	4		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1048.97	30						658.30	30												30						30						30		30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3931	109	0	1	02	01	H3931_109_0	4		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					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	4		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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	4		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					10.00	20.00	20.00											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												
H3931	109	0	1	02	01	H3931_109_0	4		N	Generic	4	01	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	20.00											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										1		
H3931	109	0	1	02	01	H3931_109_0	4		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					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	4		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					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	4		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											790.68	30						608.25	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		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					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		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					10.00	20.00	20.00											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												
H3931	115	0	1	02	01	H3931_115_0	2		N	Generic	4	01	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	20.00											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										1		
H3931	115	0	1	02	01	H3931_115_0	2		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					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		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					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		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											853.27	33						617.33	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3931	124	0	1	02	01	H3931_124_0	5		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					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	5		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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	5		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					10.00	20.00	20.00											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												
H3931	124	0	1	02	01	H3931_124_0	5		N	Generic	4	01	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	20.00											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										1		
H3931	124	0	1	02	01	H3931_124_0	5		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					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	5		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					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	5		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											861.15	27						532.41	27												27						27						27		27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3931	126	0	1	02	01	H3931_126_0	3		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					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	3		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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	3		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					10.00	20.00	20.00											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												
H3931	126	0	1	02	01	H3931_126_0	3		N	Generic	4	01	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	20.00											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										1		
H3931	126	0	1	02	01	H3931_126_0	3		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					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	3		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					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	3		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1069.14	33						508.27	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		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					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		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					10.00	20.00	20.00											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												
H3931	129	0	1	02	01	H3931_129_0	3		N	Generic	4	01	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	20.00											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										1		
H3931	129	0	1	02	01	H3931_129_0	3		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					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		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					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		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											979.28	33						667.39	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3931	143	0	1	02	01	H3931_143_0	4		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					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	143	0	1	02	01	H3931_143_0	4		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3931	143	0	1	02	01	H3931_143_0	4		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					10.00	20.00	20.00											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												
H3931	143	0	1	02	01	H3931_143_0	4		N	Generic	4	01	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	20.00											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										1		
H3931	143	0	1	02	01	H3931_143_0	4		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					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	4		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					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	4		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											878.55	30						529.89	30												30						30						30		30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3931	145	0	1	02	01	H3931_145_0	3		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					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	145	0	1	02	01	H3931_145_0	3		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3931	145	0	1	02	01	H3931_145_0	3		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					10.00	20.00	20.00											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												
H3931	145	0	1	02	01	H3931_145_0	3		N	Generic	4	01	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	20.00											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										1		
H3931	145	0	1	02	01	H3931_145_0	3		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					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	145	0	1	02	01	H3931_145_0	3		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					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	145	0	1	02	01	H3931_145_0	3		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1010.98	33						563.80	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3931	146	0	1	02	01	H3931_146_0	3		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					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	146	0	1	02	01	H3931_146_0	3		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3931	146	0	1	02	01	H3931_146_0	3		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					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	146	0	1	02	01	H3931_146_0	3		N	Generic	4	01	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	146	0	1	02	01	H3931_146_0	3		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					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	146	0	1	02	01	H3931_146_0	3		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					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	146	0	1	02	01	H3931_146_0	3		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1011.05	33						563.81	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3931	147	0	1	02	01	H3931_147_0	3		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					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	147	0	1	02	01	H3931_147_0	3		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3931	147	0	1	02	01	H3931_147_0	3		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					10.00	20.00	20.00											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												
H3931	147	0	1	02	01	H3931_147_0	3		N	Generic	4	01	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	20.00											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										1		
H3931	147	0	1	02	01	H3931_147_0	3		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					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	147	0	1	02	01	H3931_147_0	3		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					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	147	0	1	02	01	H3931_147_0	3		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1013.45	33						563.74	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3931	148	0	1	02	01	H3931_148_0	3		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					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	148	0	1	02	01	H3931_148_0	3		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3931	148	0	1	02	01	H3931_148_0	3		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					10.00	20.00	20.00											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												
H3931	148	0	1	02	01	H3931_148_0	3		N	Generic	4	01	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	20.00											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										1		
H3931	148	0	1	02	01	H3931_148_0	3		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					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	148	0	1	02	01	H3931_148_0	3		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					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	148	0	1	02	01	H3931_148_0	3		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											906.76	29						511.45	29												29						29						29		29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3931	149	0	1	02	01	H3931_149_0	2		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					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	149	0	1	02	01	H3931_149_0	2		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3931	149	0	1	02	01	H3931_149_0	2		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					10.00	20.00	20.00											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												
H3931	149	0	1	02	01	H3931_149_0	2		N	Generic	4	01	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	20.00											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										1		
H3931	149	0	1	02	01	H3931_149_0	2		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					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	149	0	1	02	01	H3931_149_0	2		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					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	149	0	1	02	01	H3931_149_0	2		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1019.93	33						564.70	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3931	151	0	1	02	01	H3931_151_0	3		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					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	151	0	1	02	01	H3931_151_0	3		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3931	151	0	1	02	01	H3931_151_0	3		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					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	151	0	1	02	01	H3931_151_0	3		N	Generic	4	01	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	151	0	1	02	01	H3931_151_0	3		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					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	151	0	1	02	01	H3931_151_0	3		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					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	151	0	1	02	01	H3931_151_0	3		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											992.85	33						559.78	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3931	152	0	1	02	01	H3931_152_0	3		N	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												
H3931	152	0	1	02	01	H3931_152_0	3		N	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		
H3931	152	0	1	02	01	H3931_152_0	3		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								12.00	24.00	36.00					10.00	20.00	20.00											12.00	24.00	36.00				10.00	20.00	20.00					12.00			12.00			0.40	0.33		0.40	0.33	0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3931	152	0	1	02	01	H3931_152_0	3		N	Generic	4	01	1	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								12.00	24.00	36.00					10.00	20.00	20.00											12.00	24.00	36.00				10.00	20.00	20.00					12.00			12.00			0.40	0.33		0.40	0.33	0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3931	152	0	1	02	01	H3931_152_0	3		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					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	152	0	1	02	01	H3931_152_0	3		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					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	152	0	1	02	01	H3931_152_0	3		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											965.25	33						556.32	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3931	153	0	1	02	01	H3931_153_0	5		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					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	153	0	1	02	01	H3931_153_0	5		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3931	153	0	1	02	01	H3931_153_0	5		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					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	153	0	1	02	01	H3931_153_0	5		N	Generic	4	01	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	153	0	1	02	01	H3931_153_0	5		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					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	153	0	1	02	01	H3931_153_0	5		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					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	153	0	1	02	01	H3931_153_0	5		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											994.58	33						563.45	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3931	154	0	1	02	01	H3931_154_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	154	0	1	02	01	H3931_154_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	154	0	1	02	01	H3931_154_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	154	0	1	02	01	H3931_154_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	154	0	1	02	01	H3931_154_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	154	0	1	02	01	H3931_154_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	154	0	1	02	01	H3931_154_0	2			Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											958.63	33						552.52	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		Y	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		Y	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		Y	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								15.00	30.00	30.00					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		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3949	013	0	1	01	01	H3949_013_0	4		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								100.00	200.00	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		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											844.70	33						746.09	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											821.70	33						605.17	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		Y	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		Y	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		Y	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								15.00	30.00	30.00					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		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3949	030	0	1	01	01	H3949_030_0	4		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								100.00	200.00	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		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											801.87	33						702.33	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		Y	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		Y	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		Y	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								15.00	30.00	30.00					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		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3949	031	0	1	01	01	H3949_031_0	4		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								100.00	200.00	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		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											805.05	33						682.19	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		Y	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		Y	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		Y	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								15.00	30.00	30.00					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		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3949	032	0	1	01	01	H3949_032_0	4		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								100.00	200.00	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		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											830.23	33						675.66	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		Y	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		Y	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		Y	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								15.00	30.00	30.00					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		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3949	034	0	1	01	01	H3949_034_0	4		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								100.00	200.00	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		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											730.07	33						609.73	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3949	035	0	1	01	01	H3949_035_0	4		Y	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								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	4		Y	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	4		Y	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								15.00	30.00	30.00					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	4		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3949	035	0	1	01	01	H3949_035_0	4		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								100.00	200.00	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	4		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											821.06	33						628.74	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3949	045	0	1	01	01	H3949_045_0	4		Y	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								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	045	0	1	01	01	H3949_045_0	4		Y	Preferred Generic	4	01	1	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								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	045	0	1	01	01	H3949_045_0	4		Y	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								15.00	30.00	30.00					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	045	0	1	01	01	H3949_045_0	4		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3949	045	0	1	01	01	H3949_045_0	4		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								100.00	200.00	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	045	0	1	01	01	H3949_045_0	4		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											791.54	33						698.96	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3949	046	0	1	01	01	H3949_046_0	4		Y	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								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	046	0	1	01	01	H3949_046_0	4		Y	Preferred Generic	4	01	1	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								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	046	0	1	01	01	H3949_046_0	4		Y	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								15.00	30.00	30.00					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	046	0	1	01	01	H3949_046_0	4		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3949	046	0	1	01	01	H3949_046_0	4		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								100.00	200.00	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	046	0	1	01	01	H3949_046_0	4		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											791.54	33						698.96	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3949	047	0	1	01	01	H3949_047_0	4		Y	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00				10.00				10.00			0.33	0.00		0.33	0.00	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3949	047	0	1	01	01	H3949_047_0	4		Y	Preferred Generic	4	01	1	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00				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		
H3949	047	0	1	01	01	H3949_047_0	4		Y	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00				20.00				20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3949	047	0	1	01	01	H3949_047_0	4		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					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												
H3949	047	0	1	01	01	H3949_047_0	4		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								100.00	200.00	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	047	0	1	01	01	H3949_047_0	4		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											791.58	33						698.87	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3949	048	0	1	01	01	H3949_048_0	4		Y	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00				10.00				10.00			0.33	0.00		0.33	0.00	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3949	048	0	1	01	01	H3949_048_0	4		Y	Preferred Generic	4	01	1	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00				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		
H3949	048	0	1	01	01	H3949_048_0	4		Y	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00				20.00				20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3949	048	0	1	01	01	H3949_048_0	4		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					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												
H3949	048	0	1	01	01	H3949_048_0	4		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								100.00	200.00	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	048	0	1	01	01	H3949_048_0	4		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											791.58	33						698.87	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3949	049	0	1	01	01	H3949_049_0	4		Y	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00				10.00				10.00			0.33	0.00		0.33	0.00	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3949	049	0	1	01	01	H3949_049_0	4		Y	Preferred Generic	4	01	1	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00				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		
H3949	049	0	1	01	01	H3949_049_0	4		Y	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00				20.00				20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3949	049	0	1	01	01	H3949_049_0	4		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					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												
H3949	049	0	1	01	01	H3949_049_0	4		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								100.00	200.00	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	049	0	1	01	01	H3949_049_0	4		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											791.58	33						698.87	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3949	050	0	1	01	01	H3949_050_0	4		Y	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00				10.00				10.00			0.33	0.00		0.33	0.00	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3949	050	0	1	01	01	H3949_050_0	4		Y	Preferred Generic	4	01	1	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00				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		
H3949	050	0	1	01	01	H3949_050_0	4		Y	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00				20.00				20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3949	050	0	1	01	01	H3949_050_0	4		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					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												
H3949	050	0	1	01	01	H3949_050_0	4		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								100.00	200.00	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	050	0	1	01	01	H3949_050_0	4		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											791.58	33						698.87	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		Y	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		Y	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								20.00	40.00	60.00					7.00	14.00	14.00					7.00	14.00	14.00																20.00				20.00			0.67	0.23	0.23			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3952	020	0	1	01	01	H3952_020_0	4		Y	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					47.00	94.00	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		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	300.00					100.00	200.00	300.00					100.00	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		Y	Specialty Tier	4	11	1	1	5	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31												33	33	33					33	33	33				33	33	33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3952	045	0	1	01	01	H3952_045_0	4		Y	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								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	4		Y	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								20.00	40.00	60.00					7.00	14.00	14.00					7.00	14.00	14.00																20.00				20.00			0.67	0.23	0.23			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3952	045	0	1	01	01	H3952_045_0	4		Y	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					47.00	94.00	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	4		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	300.00					100.00	200.00	300.00					100.00	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	4		Y	Specialty Tier	4	11	1	1	5	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31												33	33	33					33	33	33				33	33	33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3952	049	0	1	01	01	H3952_049_0	4		Y	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								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	4		Y	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								20.00	40.00	60.00					7.00	14.00	14.00					7.00	14.00	14.00																20.00				20.00			0.67	0.23	0.23			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3952	049	0	1	01	01	H3952_049_0	4		Y	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					47.00	94.00	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	4		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	300.00					100.00	200.00	300.00					100.00	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	4		Y	Specialty Tier	4	11	1	1	5	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31												33	33	33					33	33	33				33	33	33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3952	051	0	1	01	01	H3952_051_0	3		Y	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								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	3		Y	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								20.00	40.00	60.00					7.00	14.00	14.00					7.00	14.00	14.00																20.00				20.00			0.67	0.23	0.23			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3952	051	0	1	01	01	H3952_051_0	3		Y	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					47.00	94.00	141.00					47.00	94.00	94.00																47.00				47.00			1.57	1.57	1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3952	051	0	1	01	01	H3952_051_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	300.00					100.00	200.00	300.00					100.00	200.00	200.00																100.00				100.00			3.33	3.33	3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3952	051	0	1	01	01	H3952_051_0	3		Y	Specialty Tier	4	11	1	1	5	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31												33	33	33					33	33	33				33	33	33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3952	053	0	1	02	01	H3952_053_0	3		Y	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								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		Y	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								20.00	40.00	60.00					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												
H3952	053	0	1	02	01	H3952_053_0	3		Y	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					47.00	94.00	141.00					47.00	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		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	300.00					100.00	200.00	300.00					100.00	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		Y	Specialty Tier	4	11	1	1	5	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31												33	33	33					33	33	33				33	33	33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3952	054	0	1	02	01	H3952_054_0	3		Y	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								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	3		Y	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								20.00	40.00	60.00					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												
H3952	054	0	1	02	01	H3952_054_0	3		Y	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					47.00	94.00	141.00					47.00	94.00	94.00																47.00				47.00			1.57	1.57	1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3952	054	0	1	02	01	H3952_054_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	300.00					100.00	200.00	300.00					100.00	200.00	200.00																100.00				100.00			3.33	3.33	3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3952	054	0	1	02	01	H3952_054_0	3		Y	Specialty Tier	4	11	1	1	5	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31												33	33	33					33	33	33				33	33	33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3952	055	0	1	01	01	H3952_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								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	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	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												
H3952	055	0	1	01	01	H3952_055_0	4			Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	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	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	055	0	1	01	01	H3952_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												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					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												
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		Y	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		Y	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		Y	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		Y	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		Y	Non-Preferred Brand	4	11	1	2	4	1	111		01	111		1	30	60	100				2	2	30	60	100				30		31	100.00	200.00	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		Y	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31					33																																					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3954	157	21	1	01	01	H3954_157_21	5		Y	Vaccines	4	11	1	2	6	1	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3954	157	21	1	01	01	H3954_157_21	5		Y	Vaccines	4	11	1	2	6	3	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H3954	157	22	1	01	01	H3954_157_22	5		Y	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		Y	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		Y	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		Y	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		Y	Non-Preferred Brand	4	11	1	2	4	1	111		01	111		1	30	60	100				2	2	30	60	100				30		31	100.00	200.00	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		Y	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31					33																																					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3954	157	22	1	01	01	H3954_157_22	5		Y	Vaccines	4	11	1	2	6	1	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3954	157	22	1	01	01	H3954_157_22	5		Y	Vaccines	4	11	1	2	6	3	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H3954	157	23	1	01	01	H3954_157_23	5		Y	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		Y	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		Y	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		Y	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		Y	Non-Preferred Brand	4	11	1	2	4	1	111		01	111		1	30	60	100				2	2	30	60	100				30		31	100.00	200.00	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		Y	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31					33																																					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3954	157	23	1	01	01	H3954_157_23	5		Y	Vaccines	4	11	1	2	6	1	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3954	157	23	1	01	01	H3954_157_23	5		Y	Vaccines	4	11	1	2	6	3	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H3954	158	13	1	01	01	H3954_158_13	4		Y	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	4		Y	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	4		Y	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	4		Y	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	4		Y	Non-Preferred Brand	4	11	1	2	4	1	111		01	111		1	30	60	100				2	2	30	60	100				30		31	100.00	200.00	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	4		Y	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31					33																																					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3954	158	13	1	01	01	H3954_158_13	4		Y	Vaccines	4	11	1	2	6	1	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3954	158	13	1	01	01	H3954_158_13	4		Y	Vaccines	4	11	1	2	6	3	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H3954	158	14	1	01	01	H3954_158_14	4		Y	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	4		Y	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	4		Y	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	4		Y	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	4		Y	Non-Preferred Brand	4	11	1	2	4	1	111		01	111		1	30	60	100				2	2	30	60	100				30		31	100.00	200.00	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	4		Y	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31					33																																					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3954	158	14	1	01	01	H3954_158_14	4		Y	Vaccines	4	11	1	2	6	1	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3954	158	14	1	01	01	H3954_158_14	4		Y	Vaccines	4	11	1	2	6	3	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H3954	160	0	1	01	01	H3954_160_0	4		Y	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	4		Y	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	4		Y	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	4		Y	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	4		Y	Non-Preferred Brand	4	11	1	2	4	1	111		01	111		1	30	60	100				2	2	30	60	100				30		31	100.00	200.00	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	4		Y	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31					33																																					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3954	160	0	1	01	01	H3954_160_0	4		Y	Vaccines	4	11	1	2	6	1	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3954	160	0	1	01	01	H3954_160_0	4		Y	Vaccines	4	11	1	2	6	3	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H3954	161	0	1	01	01	H3954_161_0	4		Y	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	4		Y	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	4		Y	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	4		Y	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	4		Y	Non-Preferred Brand	4	11	1	2	4	1	111		01	111		1	30	60	100				2	2	30	60	100				30		31	100.00	200.00	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	4		Y	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31					33																																					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3954	161	0	1	01	01	H3954_161_0	4		Y	Vaccines	4	11	1	2	6	1	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3954	161	0	1	01	01	H3954_161_0	4		Y	Vaccines	4	11	1	2	6	3	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H3957	031	0	1	02	01	H3957_031_0	12		N	Preferred Generic	4	01	1	2	1	1		110	01		100	1				31		90	1	2						90	31		31								5.00		15.00					0.00		0.00													15.00						0.00				5.00				5.00			0.16	0.00				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3957	031	0	1	02	01	H3957_031_0	12		N	Generic	4	01	1	2	2	1		110	01		100	1				31		90	1	2						90	31		31								19.00		57.00					13.00		39.00													57.00						27.00				19.00				19.00			0.61	0.42				0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3957	031	0	1	02	01	H3957_031_0	12		N	Preferred Brand	4	11	1	2	3	1		110	01		100	1				31		90	1	2						90	31		31								47.00		141.00					45.00		135.00													141.00						115.00				47.00				47.00			1.52	1.45				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3957	031	0	1	02	01	H3957_031_0	12		N	Non-Preferred Drug	4	11	1	2	4	1		110	01		100	1				31		90	1	2						90	31		31								100.00		300.00					95.00		285.00													300.00						275.00				100.00				100.00			3.23	3.06				3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3957	031	0	1	02	01	H3957_031_0	12		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				31								31			31		31											922.90	33						922.90	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3957	039	0	1	01	01	H3957_039_0	10		Y	Preferred Generic	4	01	1	2	1	1		110	01		100	1				31		90	1	2						90	31		31								5.00		15.00					0.00		0.00													15.00						0.00				5.00				5.00			0.16	0.00				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3957	039	0	1	01	01	H3957_039_0	10		Y	Preferred Generic	4	01	1	2	1	3		110	01		100	1				31		90	1	2						90	31		31								5.00		15.00					0.00		0.00													15.00						0.00				5.00				5.00			0.16	0.00				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3957	039	0	1	01	01	H3957_039_0	10		Y	Generic	4	01	1	2	2	1		110	01		100	1				31		90	1	2						90	31		31								19.00		57.00					0.00		0.00													57.00						0.00				19.00				19.00			0.61	0.00				0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3957	039	0	1	01	01	H3957_039_0	10		Y	Generic	4	01	1	2	2	3		110	01		100	1				31		90	1	2						90	31		31								19.00		57.00					0.00		0.00													57.00						0.00				19.00				19.00			0.61	0.00				0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3957	039	0	1	01	01	H3957_039_0	10		Y	Preferred Brand	4	11	1	2	3	1		110	01		100	1				31		90	1	2						90	31		31								47.00		141.00					40.00		120.00													141.00						92.50				47.00				47.00			1.52	1.29				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3957	039	0	1	01	01	H3957_039_0	10		Y	Non-Preferred Drug	4	11	1	2	4	1		110	01		100	1				31		90	1	2						90	31		31								100.00		300.00					95.00		285.00													300.00						275.00				100.00				100.00			3.23	3.06				3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3957	039	0	1	01	01	H3957_039_0	10		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				31								31			31		31											961.03	33						961.03	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3957	042	1	1	01	01	H3957_042_1	10		Y	Preferred Generic	4	01	1	2	1	1		110	01		100	1				31		90	1	2						90	31		31								7.00		21.00					0.00		0.00													21.00						0.00				7.00				7.00			0.23	0.00				0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3957	042	1	1	01	01	H3957_042_1	10		Y	Generic	4	01	1	2	2	1		110	01		100	1				31		90	1	2						90	31		31								15.00		45.00					5.00		15.00													45.00						12.00				15.00				15.00			0.48	0.16				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3957	042	1	1	01	01	H3957_042_1	10		Y	Preferred Brand	4	11	1	2	3	1		110	01		100	1				31		90	1	2						90	31		31								47.00		141.00					47.00		141.00													141.00						120.00				47.00				47.00			1.52	1.52				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3957	042	1	1	01	01	H3957_042_1	10		Y	Non-Preferred Drug	4	11	1	2	4	1		110	01		100	1				31		90	1	2						90	31		31								100.00		300.00					100.00		300.00													300.00						275.00				100.00				100.00			3.23	3.23				3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3957	042	1	1	01	01	H3957_042_1	10		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				31								31			31		31											1041.38	33						1041.38	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3957	042	2	1	01	01	H3957_042_2	10		Y	Preferred Generic	4	01	1	2	1	1		110	01		100	1				31		90	1	2						90	31		31								7.00		21.00					0.00		0.00													21.00						0.00				7.00				7.00			0.23	0.00				0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3957	042	2	1	01	01	H3957_042_2	10		Y	Generic	4	01	1	2	2	1		110	01		100	1				31		90	1	2						90	31		31								15.00		45.00					5.00		15.00													45.00						12.00				15.00				15.00			0.48	0.16				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3957	042	2	1	01	01	H3957_042_2	10		Y	Preferred Brand	4	11	1	2	3	1		110	01		100	1				31		90	1	2						90	31		31								47.00		141.00					47.00		141.00													141.00						120.00				47.00				47.00			1.52	1.52				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3957	042	2	1	01	01	H3957_042_2	10		Y	Non-Preferred Drug	4	11	1	2	4	1		110	01		100	1				31		90	1	2						90	31		31								100.00		300.00					100.00		300.00													300.00						275.00				100.00				100.00			3.23	3.23				3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3957	042	2	1	01	01	H3957_042_2	10		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				31								31			31		31											1041.38	33						1041.38	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3957	042	4	1	01	01	H3957_042_4	10		Y	Preferred Generic	4	01	1	2	1	1		110	01		100	1				31		90	1	2						90	31		31								7.00		21.00					0.00		0.00													21.00						0.00				7.00				7.00			0.23	0.00				0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3957	042	4	1	01	01	H3957_042_4	10		Y	Generic	4	01	1	2	2	1		110	01		100	1				31		90	1	2						90	31		31								15.00		45.00					5.00		15.00													45.00						12.00				15.00				15.00			0.48	0.16				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3957	042	4	1	01	01	H3957_042_4	10		Y	Preferred Brand	4	11	1	2	3	1		110	01		100	1				31		90	1	2						90	31		31								47.00		141.00					47.00		141.00													141.00						120.00				47.00				47.00			1.52	1.52				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3957	042	4	1	01	01	H3957_042_4	10		Y	Non-Preferred Drug	4	11	1	2	4	1		110	01		100	1				31		90	1	2						90	31		31								100.00		300.00					100.00		300.00													300.00						275.00				100.00				100.00			3.23	3.23				3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3957	042	4	1	01	01	H3957_042_4	10		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				31								31			31		31											1041.38	33						1041.38	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3957	042	5	1	01	01	H3957_042_5	10		Y	Preferred Generic	4	01	1	2	1	1		110	01		100	1				31		90	1	2						90	31		31								7.00		21.00					0.00		0.00													21.00						0.00				7.00				7.00			0.23	0.00				0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3957	042	5	1	01	01	H3957_042_5	10		Y	Generic	4	01	1	2	2	1		110	01		100	1				31		90	1	2						90	31		31								15.00		45.00					5.00		15.00													45.00						12.00				15.00				15.00			0.48	0.16				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3957	042	5	1	01	01	H3957_042_5	10		Y	Preferred Brand	4	11	1	2	3	1		110	01		100	1				31		90	1	2						90	31		31								47.00		141.00					47.00		141.00													141.00						120.00				47.00				47.00			1.52	1.52				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3957	042	5	1	01	01	H3957_042_5	10		Y	Non-Preferred Drug	4	11	1	2	4	1		110	01		100	1				31		90	1	2						90	31		31								100.00		300.00					100.00		300.00													300.00						275.00				100.00				100.00			3.23	3.23				3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3957	042	5	1	01	01	H3957_042_5	10		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				31								31			31		31											1041.38	33						1041.38	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3957	044	1	1	02	01	H3957_044_1	10		N	Preferred Generic	4	01	1	2	1	1		110	01		100	1				31		90	1	2						90	31		31								5.00		15.00					0.00		0.00													15.00						0.00				5.00				5.00			0.16	0.00				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3957	044	1	1	02	01	H3957_044_1	10		N	Generic	4	01	1	2	2	1		110	01		100	1				31		90	1	2						90	31		31								19.00		57.00					13.00		39.00													57.00						27.00				19.00				19.00			0.61	0.42				0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3957	044	1	1	02	01	H3957_044_1	10		N	Preferred Brand	4	11	1	2	3	1		110	01		100	1				31		90	1	2						90	31		31								47.00		141.00					45.00		135.00													141.00						115.00				47.00				47.00			1.52	1.45				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3957	044	1	1	02	01	H3957_044_1	10		N	Non-Preferred Drug	4	11	1	2	4	1		110	01		100	1				31		90	1	2						90	31		31								100.00		300.00					95.00		285.00													300.00						275.00				100.00				100.00			3.23	3.06				3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3957	044	1	1	02	01	H3957_044_1	10		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				31								31			31		31											1092.34	33						1092.34	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3957	044	4	1	02	01	H3957_044_4	10		N	Preferred Generic	4	01	1	2	1	1		110	01		100	1				31		90	1	2						90	31		31								5.00		15.00					0.00		0.00													15.00						0.00				5.00				5.00			0.16	0.00				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3957	044	4	1	02	01	H3957_044_4	10		N	Generic	4	01	1	2	2	1		110	01		100	1				31		90	1	2						90	31		31								19.00		57.00					13.00		39.00													57.00						27.00				19.00				19.00			0.61	0.42				0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3957	044	4	1	02	01	H3957_044_4	10		N	Preferred Brand	4	11	1	2	3	1		110	01		100	1				31		90	1	2						90	31		31								47.00		141.00					45.00		135.00													141.00						115.00				47.00				47.00			1.52	1.45				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3957	044	4	1	02	01	H3957_044_4	10		N	Non-Preferred Drug	4	11	1	2	4	1		110	01		100	1				31		90	1	2						90	31		31								100.00		300.00					95.00		285.00													300.00						275.00				100.00				100.00			3.23	3.06				3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3957	044	4	1	02	01	H3957_044_4	10		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				31								31			31		31											1092.34	33						1092.34	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3957	045	1	1	02	01	H3957_045_1	10		N	Preferred Generic	4	01	1	2	1	1	110		01	100		1	31		90				1	2			90				31		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3957	045	1	1	02	01	H3957_045_1	10		N	Generic	4	01	1	2	2	1	110		01	100		1	31		90				1	2			90				31		31	13.00		39.00																					32.50																13.00				13.00		0.42						0.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3957	045	1	1	02	01	H3957_045_1	10		N	Preferred Brand	4	11	1	2	3	1	110		01	100		1	31		90				1	2			90				31		31	44.00		132.00																					110.00																44.00				44.00		1.42						1.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3957	045	1	1	02	01	H3957_045_1	10		N	Non-Preferred Drug	4	11	1	2	4	1	110		01	100		1	31		90				1	2			90				31		31	100.00		300.00																					250.00																100.00				100.00		3.23						3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3957	045	1	1	02	01	H3957_045_1	10		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	31								31						31		31				868.26	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3957	045	2	1	02	01	H3957_045_2	10		N	Preferred Generic	4	01	1	2	1	1	110		01	100		1	31		90				1	2			90				31		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3957	045	2	1	02	01	H3957_045_2	10		N	Generic	4	01	1	2	2	1	110		01	100		1	31		90				1	2			90				31		31	13.00		39.00																					32.50																13.00				13.00		0.42						0.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3957	045	2	1	02	01	H3957_045_2	10		N	Preferred Brand	4	11	1	2	3	1	110		01	100		1	31		90				1	2			90				31		31	44.00		132.00																					110.00																44.00				44.00		1.42						1.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3957	045	2	1	02	01	H3957_045_2	10		N	Non-Preferred Drug	4	11	1	2	4	1	110		01	100		1	31		90				1	2			90				31		31	100.00		300.00																					250.00																100.00				100.00		3.23						3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3957	045	2	1	02	01	H3957_045_2	10		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	31								31						31		31				868.26	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3957	046	1	1	02	01	H3957_046_1	10		N	Preferred Generic	4	01	1	2	1	1	110		01	100		1	31		90				1	2			90				31		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3957	046	1	1	02	01	H3957_046_1	10		N	Preferred Generic	4	01	1	2	1	3	110		01	100		1	31		90				1	2			90				31		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3957	046	1	1	02	01	H3957_046_1	10		N	Generic	4	01	1	2	2	1	110		01	100		1	31		90				1	2			90				31		31	13.00		39.00																					32.50																13.00				13.00		0.42						0.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3957	046	1	1	02	01	H3957_046_1	10		N	Generic	4	01	1	2	2	3	110		01	100		1	31		90				1	2			90				31		31	13.00		39.00																					32.50																13.00				13.00		0.42						0.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3957	046	1	1	02	01	H3957_046_1	10		N	Preferred Brand	4	11	1	2	3	1	110		01	100		1	31		90				1	2			90				31		31	42.00		126.00																					105.00																42.00				42.00		1.35						1.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3957	046	1	1	02	01	H3957_046_1	10		N	Non-Preferred Drug	4	11	1	2	4	1	110		01	100		1	31		90				1	2			90				31		31	100.00		300.00																					250.00																100.00				100.00		3.23						3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3957	046	1	1	02	01	H3957_046_1	10		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	31								31						31		31				970.42	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3957	046	2	1	02	01	H3957_046_2	10		N	Preferred Generic	4	01	1	2	1	1	110		01	100		1	31		90				1	2			90				31		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3957	046	2	1	02	01	H3957_046_2	10		N	Preferred Generic	4	01	1	2	1	3	110		01	100		1	31		90				1	2			90				31		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3957	046	2	1	02	01	H3957_046_2	10		N	Generic	4	01	1	2	2	1	110		01	100		1	31		90				1	2			90				31		31	13.00		39.00																					32.50																13.00				13.00		0.42						0.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3957	046	2	1	02	01	H3957_046_2	10		N	Generic	4	01	1	2	2	3	110		01	100		1	31		90				1	2			90				31		31	13.00		39.00																					32.50																13.00				13.00		0.42						0.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3957	046	2	1	02	01	H3957_046_2	10		N	Preferred Brand	4	11	1	2	3	1	110		01	100		1	31		90				1	2			90				31		31	42.00		126.00																					105.00																42.00				42.00		1.35						1.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3957	046	2	1	02	01	H3957_046_2	10		N	Non-Preferred Drug	4	11	1	2	4	1	110		01	100		1	31		90				1	2			90				31		31	100.00		300.00																					250.00																100.00				100.00		3.23						3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3957	046	2	1	02	01	H3957_046_2	10		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	31								31						31		31				970.42	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3957	047	1	1	01	01	H3957_047_1	10		N	Preferred Generic	4	01	1	2	1	1		110	01		100	1				31		90	1	2						90	31		31								7.00		21.00					0.00		0.00													21.00						0.00				7.00				7.00			0.23	0.00				0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3957	047	1	1	01	01	H3957_047_1	10		N	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													45.00						0.00				15.00				15.00			0.48	0.00				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3957	047	1	1	01	01	H3957_047_1	10		N	Preferred Brand	4	11	1	2	3	1		110	01		100	1				31		90	1	2						90	31		31								47.00		141.00					42.00		126.00													141.00						120.00				47.00				47.00			1.52	1.35				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3957	047	1	1	01	01	H3957_047_1	10		N	Non-Preferred Drug	4	11	1	2	4	1		110	01		100	1				31		90	1	2						90	31		31								100.00		300.00					100.00		300.00													300.00						275.00				100.00				100.00			3.23	3.23				3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3957	047	1	1	01	01	H3957_047_1	10		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				31								31			31		31											849.63	33						849.63	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3957	047	2	1	01	01	H3957_047_2	10		N	Preferred Generic	4	01	1	2	1	1		110	01		100	1				31		90	1	2						90	31		31								7.00		21.00					0.00		0.00													21.00						0.00				7.00				7.00			0.23	0.00				0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3957	047	2	1	01	01	H3957_047_2	10		N	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													45.00						0.00				15.00				15.00			0.48	0.00				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3957	047	2	1	01	01	H3957_047_2	10		N	Preferred Brand	4	11	1	2	3	1		110	01		100	1				31		90	1	2						90	31		31								47.00		141.00					42.00		126.00													141.00						120.00				47.00				47.00			1.52	1.35				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3957	047	2	1	01	01	H3957_047_2	10		N	Non-Preferred Drug	4	11	1	2	4	1		110	01		100	1				31		90	1	2						90	31		31								100.00		300.00					100.00		300.00													300.00						275.00				100.00				100.00			3.23	3.23				3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3957	047	2	1	01	01	H3957_047_2	10		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				31								31			31		31											849.63	33						849.63	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3957	047	3	1	01	01	H3957_047_3	10		N	Preferred Generic	4	01	1	2	1	1		110	01		100	1				31		90	1	2						90	31		31								7.00		21.00					0.00		0.00													21.00						0.00				7.00				7.00			0.23	0.00				0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3957	047	3	1	01	01	H3957_047_3	10		N	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													45.00						0.00				15.00				15.00			0.48	0.00				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3957	047	3	1	01	01	H3957_047_3	10		N	Preferred Brand	4	11	1	2	3	1		110	01		100	1				31		90	1	2						90	31		31								47.00		141.00					42.00		126.00													141.00						120.00				47.00				47.00			1.52	1.35				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3957	047	3	1	01	01	H3957_047_3	10		N	Non-Preferred Drug	4	11	1	2	4	1		110	01		100	1				31		90	1	2						90	31		31								100.00		300.00					100.00		300.00													300.00						275.00				100.00				100.00			3.23	3.23				3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3957	047	3	1	01	01	H3957_047_3	10		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				31								31			31		31											849.63	33						849.63	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3957	048	0	1	01	01	H3957_048_0	9		N	Preferred Generic	4	01	1	2	1	1		110	01		100	1				31		90	1	2						90	31		31								7.00		21.00					0.00		0.00													21.00						0.00				7.00				7.00			0.23	0.00				0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3957	048	0	1	01	01	H3957_048_0	9		N	Generic	4	01	1	2	2	1		110	01		100	1				31		90	1	2						90	31		31								15.00		45.00					5.00		15.00													45.00						0.00				15.00				15.00			0.48	0.16				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3957	048	0	1	01	01	H3957_048_0	9		N	Preferred Brand	4	11	1	2	3	1		110	01		100	1				31		90	1	2						90	31		31								47.00		141.00					47.00		141.00													141.00						120.00				47.00				47.00			1.52	1.52				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3957	048	0	1	01	01	H3957_048_0	9		N	Non-Preferred Drug	4	11	1	2	4	1		110	01		100	1				31		90	1	2						90	31		31								100.00		300.00					100.00		300.00													300.00						275.00				100.00				100.00			3.23	3.23				3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3957	048	0	1	01	01	H3957_048_0	9		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				31								31			31		31											1125.45	33						1125.45	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3959	001	0	1	01	01	H3959_001_0	2		Y	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	2		Y	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	2		Y	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	2		Y	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	2		Y	Preferred Brand	4	11	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	2		Y	Non-Preferred Drug	4	11	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	2		Y	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1074.46	33						611.79	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3959	002	0	1	01	01	H3959_002_0	2		Y	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	2		Y	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	2		Y	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	2		Y	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	2		Y	Preferred Brand	4	11	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	2		Y	Non-Preferred Drug	4	11	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	2		Y	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1068.19	33						498.28	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3959	010	0	1	02	01	H3959_010_0	3		N	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	02	01	H3959_010_0	3		N	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	02	01	H3959_010_0	3		N	Generic	4	01	3	2	2	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					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	02	01	H3959_010_0	3		N	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	02	01	H3959_010_0	3		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00					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	02	01	H3959_010_0	3		N	Non-Preferred Drug	4	11	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	02	01	H3959_010_0	3		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											864.26	33						692.92	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3959	011	0	1	02	01	H3959_011_0	3		N	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	02	01	H3959_011_0	3		N	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	02	01	H3959_011_0	3		N	Generic	4	01	3	2	2	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					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	02	01	H3959_011_0	3		N	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	02	01	H3959_011_0	3		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00					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	02	01	H3959_011_0	3		N	Non-Preferred Drug	4	11	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	02	01	H3959_011_0	3		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											860.76	33						547.66	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3959	032	0	1	02	01	H3959_032_0	3		N	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	3		N	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	3		N	Generic	4	01	3	2	2	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					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	3		N	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	3		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					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	3		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					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	3		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1110.19	33						457.38	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		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					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		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3959	033	0	1	01	01	H3959_033_0	2		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					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		N	Generic	4	01	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		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					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		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					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		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											986.04	33						641.34	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3959	037	0	1	02	01	H3959_037_0	2		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					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	2		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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	2		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					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	2		N	Generic	4	01	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	2		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					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	2		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					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	2		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											892.61	33						712.06	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		N	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		N	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		N	Generic	4	01	3	2	2	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					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		N	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		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					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		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					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		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											828.66	33						628.82	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		Y	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		Y	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		Y	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		Y	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		Y	Preferred Brand	4	11	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		Y	Non-Preferred Drug	4	11	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		Y	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											704.53	33						723.47	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3959	046	0	1	01	01	H3959_046_0	2		N	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	2		N	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	2		N	Generic	4	01	3	2	2	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3959	046	0	1	01	01	H3959_046_0	2		N	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	2		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	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	2		N	Non-Preferred Drug	4	11	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	2		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1081.71	33						710.86	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3959	047	0	1	01	01	H3959_047_0	2		Y	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	2		Y	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	2		Y	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	2		Y	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	2		Y	Preferred Brand	4	11	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	2		Y	Non-Preferred Drug	4	11	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	2		Y	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1024.57	33						594.99	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3959	049	0	1	02	01	H3959_049_0	2		N	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	02	01	H3959_049_0	2		N	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	02	01	H3959_049_0	2		N	Generic	4	01	3	2	2	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					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	02	01	H3959_049_0	2		N	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	02	01	H3959_049_0	2		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00					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	02	01	H3959_049_0	2		N	Non-Preferred Drug	4	11	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	02	01	H3959_049_0	2		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											937.90	33						508.46	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3959	051	0	1	01	01	H3959_051_0	2		Y	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	2		Y	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	2		Y	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	2		Y	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	2		Y	Preferred Brand	4	11	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	2		Y	Non-Preferred Drug	4	11	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	2		Y	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1173.31	33						843.78	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		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					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		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3959	052	0	1	01	01	H3959_052_0	2		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					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		N	Generic	4	01	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		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					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		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					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		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											893.43	33						568.17	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3959	053	0	1	01	01	H3959_053_0	2		Y	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	2		Y	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	2		Y	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	2		Y	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	2		Y	Preferred Brand	4	11	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	2		Y	Non-Preferred Drug	4	11	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	2		Y	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											969.74	33						659.04	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		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					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		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					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		N	Generic	4	01	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		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					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		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					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		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1005.36	33						605.04	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3962	001	0	1	01	01	H3962_001_0	3		Y	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								7.00	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												
H3962	001	0	1	01	01	H3962_001_0	3		Y	Preferred Generic	4	01	1	2	1	3		111	01	111		1				30	60	90	1	2	30	60	90				30		31								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										1		
H3962	001	0	1	01	01	H3962_001_0	3		Y	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												
H3962	001	0	1	01	01	H3962_001_0	3		Y	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										1		
H3962	001	0	1	01	01	H3962_001_0	3		Y	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	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												
H3962	001	0	1	01	01	H3962_001_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	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												
H3962	001	0	1	01	01	H3962_001_0	3		Y	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3962	004	0	1	01	01	H3962_004_0	3		Y	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								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												
H3962	004	0	1	01	01	H3962_004_0	3		Y	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								15.00	30.00	45.00					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												
H3962	004	0	1	01	01	H3962_004_0	3		Y	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					40.00	80.00	120.00					40.00	80.00	120.00																47.00				47.00			1.57	1.33	1.33			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3962	004	0	1	01	01	H3962_004_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	300.00					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												
H3962	004	0	1	01	01	H3962_004_0	3		Y	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3962	007	0	1	01	01	H3962_007_0	3		Y	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								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												
H3962	007	0	1	01	01	H3962_007_0	3		Y	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								20.00	40.00	60.00					10.00	20.00	30.00					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												
H3962	007	0	1	01	01	H3962_007_0	3		Y	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					40.00	80.00	120.00					40.00	80.00	120.00																47.00				47.00			1.57	1.33	1.33			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3962	007	0	1	01	01	H3962_007_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	300.00					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												
H3962	007	0	1	01	01	H3962_007_0	3		Y	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3962	021	0	1	01	01	H3962_021_0	3		Y	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								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												
H3962	021	0	1	01	01	H3962_021_0	3		Y	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								15.00	30.00	45.00					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												
H3962	021	0	1	01	01	H3962_021_0	3		Y	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					40.00	80.00	120.00					40.00	80.00	120.00																47.00				47.00			1.57	1.33	1.33			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3962	021	0	1	01	01	H3962_021_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	300.00					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												
H3962	021	0	1	01	01	H3962_021_0	3		Y	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
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			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
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											75.73	45	45	45				72.37	43	43	43										45	45	45				43	43	43			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
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		111	01		111	1				30	60	100	1	2				30	60	100	30		31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	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												
H3979	001	0	1	01	01	H3979_001_0	6			Preferred Generic	4	01	1	2	1	3		111	01		111	1				30	60	100	1	2				30	60	100	30		31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	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		
H3979	001	0	1	01	01	H3979_001_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											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												
H3979	001	0	1	01	01	H3979_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	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												
H3979	001	0	1	01	01	H3979_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	300.00				100.00	200.00	300.00				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												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3979	005	0	1	01	01	H3979_005_0	6			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											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												
H3979	005	0	1	01	01	H3979_005_0	6			Preferred Generic	4	01	1	2	1	3		111	01		111	1				30	60	100	1	2				30	60	100	30		31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	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		
H3979	005	0	1	01	01	H3979_005_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											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												
H3979	005	0	1	01	01	H3979_005_0	6			Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	94.00				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												
H3979	005	0	1	01	01	H3979_005_0	6			Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00				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	005	0	1	01	01	H3979_005_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												
H4003	009	0	1	01	01	H4003_009_0	8		Y	Preferred Generic	4	01	1	2	1	1	110		01	100		1	30		90				2	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H4003	009	0	1	01	01	H4003_009_0	8		Y	Preferred Generic	4	01	1	2	1	3	110		01	100		1	30		90				2	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										2		
H4003	009	0	1	01	01	H4003_009_0	8		Y	Generic	4	01	1	2	2	1	110		01	100		1	30		90				2	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H4003	009	0	1	01	01	H4003_009_0	8		Y	Generic	4	01	1	2	2	3	110		01	100		1	30		90				2	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										2		
H4003	009	0	1	01	01	H4003_009_0	8		Y	Preferred Brand	4	10	1	2	3	1	110		01	100		1	30		90				2	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H4003	009	0	1	01	01	H4003_009_0	8		Y	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	8		Y	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31				474.47	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	8		Y	Select Care Drugs	4	10	1	2	6	1	110		01	100		1	30		90				2	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H4003	009	0	1	01	01	H4003_009_0	8		Y	Select Care Drugs	4	10	1	2	6	3	110		01	100		1	30		90				2	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										2		
H4003	019	0	1	02	01	H4003_019_0	9		Y	Preferred Generic	4	01	3	2	1	1	110		01	100		1	30		90				2	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H4003	019	0	1	02	01	H4003_019_0	9		Y	Preferred Generic	4	01	3	2	1	3	110		01	100		1	30		90				2	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										2		1
H4003	019	0	1	02	01	H4003_019_0	9		Y	Generic	4	01	1	2	2	1	110		01	100		1	30		90				2	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H4003	019	0	1	02	01	H4003_019_0	9		Y	Generic	4	01	1	2	2	3	110		01	100		1	30		90				2	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										2		
H4003	019	0	1	02	01	H4003_019_0	9		Y	Preferred Brand	4	10	3	2	3	1	110		01	100		1	30		90				2	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H4003	019	0	1	02	01	H4003_019_0	9		Y	Non-Preferred Brand	4	10	1	2	4	1	110		01	100		1	30		90				2	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H4003	019	0	1	02	01	H4003_019_0	9		Y	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31				151.88	25																																					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H4003	019	0	1	02	01	H4003_019_0	9		Y	Select Care Drugs	4	10	1	2	6	1	110		01	100		1	30		90				2	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H4003	019	0	1	02	01	H4003_019_0	9		Y	Select Care Drugs	4	10	1	2	6	3	110		01	100		1	30		90				2	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										2		
H4003	034	0	1	02	01	H4003_034_0	8		Y	Preferred Generic	4	01	3	2	1	1	110		01	100		1	30		90				2	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H4003	034	0	1	02	01	H4003_034_0	8		Y	Preferred Generic	4	01	3	2	1	3	110		01	100		1	30		90				2	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										2		1
H4003	034	0	1	02	01	H4003_034_0	8		Y	Generic	4	01	1	2	2	1	110		01	100		1	30		90				2	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H4003	034	0	1	02	01	H4003_034_0	8		Y	Generic	4	01	1	2	2	3	110		01	100		1	30		90				2	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										2		
H4003	034	0	1	02	01	H4003_034_0	8		Y	Preferred Brand	4	10	3	2	3	1	110		01	100		1	30		90				2	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H4003	034	0	1	02	01	H4003_034_0	8		Y	Non-Preferred Brand	4	10	1	2	4	1	110		01	100		1	30		90				2	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H4003	034	0	1	02	01	H4003_034_0	8		Y	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31				299.06	25																																					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H4003	034	0	1	02	01	H4003_034_0	8		Y	Select Care Drugs	4	10	1	2	6	1	110		01	100		1	30		90				2	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H4003	034	0	1	02	01	H4003_034_0	8		Y	Select Care Drugs	4	10	1	2	6	3	110		01	100		1	30		90				2	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										2		
H4003	051	0	1	02	01	H4003_051_0	12		Y	Preferred Generic	4	01	1	2	1	1	110		01	100		1	30		90				2	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H4003	051	0	1	02	01	H4003_051_0	12		Y	Preferred Generic	4	01	1	2	1	3	110		01	100		1	30		90				2	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										2		
H4003	051	0	1	02	01	H4003_051_0	12		Y	Generic	4	01	1	2	2	1	110		01	100		1	30		90				2	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H4003	051	0	1	02	01	H4003_051_0	12		Y	Generic	4	01	1	2	2	3	110		01	100		1	30		90				2	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										2		
H4003	051	0	1	02	01	H4003_051_0	12		Y	Preferred Brand	4	10	1	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, Select Care Drugs												
H4003	051	0	1	02	01	H4003_051_0	12		Y	Non-Preferred Brand	4	10	1	2	4	1	110		01	100		1	30		90				2	2			90				30		31	16.00		32.00																					32.00																16.00				16.00		0.53						0.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H4003	051	0	1	02	01	H4003_051_0	12		Y	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31				402.51	33																																					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H4003	051	0	1	02	01	H4003_051_0	12		Y	Select Care Drugs	4	10	1	2	6	1	110		01	100		1	30		90				2	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H4003	051	0	1	02	01	H4003_051_0	12		Y	Select Care Drugs	4	10	1	2	6	3	110		01	100		1	30		90				2	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										2		
H4003	052	0	1	01	01	H4003_052_0	8		Y	Preferred Generic	4	01	1	2	1	1	110		01	100		1	30		90				2	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H4003	052	0	1	01	01	H4003_052_0	8		Y	Preferred Generic	4	01	1	2	1	3	110		01	100		1	30		90				2	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										2		
H4003	052	0	1	01	01	H4003_052_0	8		Y	Generic	4	01	1	2	2	1	110		01	100		1	30		90				2	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H4003	052	0	1	01	01	H4003_052_0	8		Y	Generic	4	01	1	2	2	3	110		01	100		1	30		90				2	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										2		
H4003	052	0	1	01	01	H4003_052_0	8		Y	Preferred Brand	4	10	1	2	3	1	110		01	100		1	30		90				2	2			90				30		31	10.00		20.00																					20.00																10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H4003	052	0	1	01	01	H4003_052_0	8		Y	Non-Preferred Brand	4	10	1	2	4	1	110		01	100		1	30		90				2	2			90				30		31	25.00		50.00																					50.00																25.00				25.00		0.83						0.81	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H4003	052	0	1	01	01	H4003_052_0	8		Y	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31				466.54	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		Y	Select Care Drugs	4	10	1	2	6	1	110		01	100		1	30		90				2	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H4003	052	0	1	01	01	H4003_052_0	8		Y	Select Care Drugs	4	10	1	2	6	3	110		01	100		1	30		90				2	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										2		
H4003	053	0	1	01	01	H4003_053_0	10		Y	Preferred Generic	4	01	1	2	1	1	110		01	100		1	30		90				2	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H4003	053	0	1	01	01	H4003_053_0	10		Y	Preferred Generic	4	01	1	2	1	3	110		01	100		1	30		90				2	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										2		
H4003	053	0	1	01	01	H4003_053_0	10		Y	Generic	4	01	1	2	2	1	110		01	100		1	30		90				2	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H4003	053	0	1	01	01	H4003_053_0	10		Y	Generic	4	01	1	2	2	3	110		01	100		1	30		90				2	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										2		
H4003	053	0	1	01	01	H4003_053_0	10		Y	Preferred Brand	4	10	1	2	3	1	110		01	100		1	30		90				2	2			90				30		31	10.00		20.00																					20.00																10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H4003	053	0	1	01	01	H4003_053_0	10		Y	Non-Preferred Brand	4	10	1	2	4	1	110		01	100		1	30		90				2	2			90				30		31	25.00		50.00																					50.00																25.00				25.00		0.83						0.81	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H4003	053	0	1	01	01	H4003_053_0	10		Y	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31				393.32	25																																					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H4003	053	0	1	01	01	H4003_053_0	10		Y	Select Care Drugs	4	10	1	2	6	1	110		01	100		1	30		90				2	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H4003	053	0	1	01	01	H4003_053_0	10		Y	Select Care Drugs	4	10	1	2	6	3	110		01	100		1	30		90				2	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										2		
H4003	054	0	1	02	01	H4003_054_0	10		Y	Preferred Generic	4	01	3	2	1	1	110		01	100		1	30		90				2	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H4003	054	0	1	02	01	H4003_054_0	10		Y	Preferred Generic	4	01	3	2	1	3	110		01	100		1	30		90				2	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										2		1
H4003	054	0	1	02	01	H4003_054_0	10		Y	Generic	4	01	1	2	2	1	110		01	100		1	30		90				2	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H4003	054	0	1	02	01	H4003_054_0	10		Y	Generic	4	01	1	2	2	3	110		01	100		1	30		90				2	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										2		
H4003	054	0	1	02	01	H4003_054_0	10		Y	Preferred Brand	4	10	3	2	3	1	110		01	100		1	30		90				2	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H4003	054	0	1	02	01	H4003_054_0	10		Y	Non-Preferred Brand	4	10	1	2	4	1	110		01	100		1	30		90				2	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H4003	054	0	1	02	01	H4003_054_0	10		Y	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31				619.79	25																																					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H4003	054	0	1	02	01	H4003_054_0	10		Y	Select Care Drugs	4	10	1	2	6	1	110		01	100		1	30		90				2	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H4003	054	0	1	02	01	H4003_054_0	10		Y	Select Care Drugs	4	10	1	2	6	3	110		01	100		1	30		90				2	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										2		
H4003	055	0	1	02	01	H4003_055_0	9		Y	Preferred Generic	4	01	1	2	1	1	110		01	100		1	30		90				2	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H4003	055	0	1	02	01	H4003_055_0	9		Y	Preferred Generic	4	01	1	2	1	3	110		01	100		1	30		90				2	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										2		
H4003	055	0	1	02	01	H4003_055_0	9		Y	Generic	4	01	1	2	2	1	110		01	100		1	30		90				2	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H4003	055	0	1	02	01	H4003_055_0	9		Y	Generic	4	01	1	2	2	3	110		01	100		1	30		90				2	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										2		
H4003	055	0	1	02	01	H4003_055_0	9		Y	Preferred Brand	4	10	1	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, Select Care Drugs												
H4003	055	0	1	02	01	H4003_055_0	9		Y	Non-Preferred Brand	4	10	1	2	4	1	110		01	100		1	30		90				2	2			90				30		31	10.00		20.00																					20.00																10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H4003	055	0	1	02	01	H4003_055_0	9		Y	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31				293.12	25																																					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H4003	055	0	1	02	01	H4003_055_0	9		Y	Select Care Drugs	4	10	1	2	6	1	110		01	100		1	30		90				2	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H4003	055	0	1	02	01	H4003_055_0	9		Y	Select Care Drugs	4	10	1	2	6	3	110		01	100		1	30		90				2	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										2		
H4003	057	0	1	02	01	H4003_057_0	9		Y	Preferred Generic	4	01	1	2	1	1	110		01	100		1	30		90				2	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H4003	057	0	1	02	01	H4003_057_0	9		Y	Preferred Generic	4	01	1	2	1	3	110		01	100		1	30		90				2	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										2		
H4003	057	0	1	02	01	H4003_057_0	9		Y	Generic	4	01	1	2	2	1	110		01	100		1	30		90				2	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H4003	057	0	1	02	01	H4003_057_0	9		Y	Generic	4	01	1	2	2	3	110		01	100		1	30		90				2	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										2		
H4003	057	0	1	02	01	H4003_057_0	9		Y	Preferred Brand	4	10	1	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, Select Care Drugs												
H4003	057	0	1	02	01	H4003_057_0	9		Y	Non-Preferred Brand	4	10	1	2	4	1	110		01	100		1	30		90				2	2			90				30		31	10.00		20.00																					20.00																10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H4003	057	0	1	02	01	H4003_057_0	9		Y	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31				293.12	25																																					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H4003	057	0	1	02	01	H4003_057_0	9		Y	Select Care Drugs	4	10	1	2	6	1	110		01	100		1	30		90				2	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H4003	057	0	1	02	01	H4003_057_0	9		Y	Select Care Drugs	4	10	1	2	6	3	110		01	100		1	30		90				2	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										2		
H4004	056	0	1	02	01	H4004_056_0	9		Y	Preferred Generic	4	01	3	2	1	1	110		01	100		1	30		90				2	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H4004	056	0	1	02	01	H4004_056_0	9		Y	Preferred Generic	4	01	3	2	1	3	110		01	100		1	30		90				2	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										2		1
H4004	056	0	1	02	01	H4004_056_0	9		Y	Generic	4	01	1	2	2	1	110		01	100		1	30		90				2	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H4004	056	0	1	02	01	H4004_056_0	9		Y	Generic	4	01	1	2	2	3	110		01	100		1	30		90				2	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										2		
H4004	056	0	1	02	01	H4004_056_0	9		Y	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, Select Care Drugs												
H4004	056	0	1	02	01	H4004_056_0	9		Y	Non-Preferred Brand	4	10	1	2	4	1	110		01	100		1	30		90				2	2			90				30		31	10.00		20.00																					20.00																10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H4004	056	0	1	02	01	H4004_056_0	9		Y	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31				858.52	25																																					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H4004	056	0	1	02	01	H4004_056_0	9		Y	Select Care Drugs	4	10	1	2	6	1	110		01	100		1	30		90				2	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H4004	056	0	1	02	01	H4004_056_0	9		Y	Select Care Drugs	4	10	1	2	6	3	110		01	100		1	30		90				2	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										2		
H4004	063	0	1	02	01	H4004_063_0	9		Y	Preferred Generic	4	01	1	2	1	1	110		01	100		1	30		90				2	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H4004	063	0	1	02	01	H4004_063_0	9		Y	Preferred Generic	4	01	1	2	1	3	110		01	100		1	30		90				2	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										2		
H4004	063	0	1	02	01	H4004_063_0	9		Y	Generic	4	01	1	2	2	1	110		01	100		1	30		90				2	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H4004	063	0	1	02	01	H4004_063_0	9		Y	Generic	4	01	1	2	2	3	110		01	100		1	30		90				2	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										2		
H4004	063	0	1	02	01	H4004_063_0	9		Y	Preferred Brand	4	10	1	2	3	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, Select Care Drugs												
H4004	063	0	1	02	01	H4004_063_0	9		Y	Non-Preferred Brand	4	10	1	2	4	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 Brand, Specialty Tier, Select Care Drugs												
H4004	063	0	1	02	01	H4004_063_0	9		Y	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31				293.38	25																																					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H4004	063	0	1	02	01	H4004_063_0	9		Y	Select Care Drugs	4	10	1	2	6	1	110		01	100		1	30		90				2	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H4004	063	0	1	02	01	H4004_063_0	9		Y	Select Care Drugs	4	10	1	2	6	3	110		01	100		1	30		90				2	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										2		
H4004	065	0	1	02	01	H4004_065_0	8		Y	Preferred Generic	4	01	3	2	1	1	110		01	100		1	30		90				2	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H4004	065	0	1	02	01	H4004_065_0	8		Y	Preferred Generic	4	01	3	2	1	3	110		01	100		1	30		90				2	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										2		1
H4004	065	0	1	02	01	H4004_065_0	8		Y	Generic	4	01	1	2	2	1	110		01	100		1	30		90				2	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H4004	065	0	1	02	01	H4004_065_0	8		Y	Generic	4	01	1	2	2	3	110		01	100		1	30		90				2	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										2		
H4004	065	0	1	02	01	H4004_065_0	8		Y	Preferred Brand	4	10	3	2	3	1	110		01	100		1	30		90				2	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H4004	065	0	1	02	01	H4004_065_0	8		Y	Non-Preferred Brand	4	10	1	2	4	1	110		01	100		1	30		90				2	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H4004	065	0	1	02	01	H4004_065_0	8		Y	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31				293.82	25																																					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H4004	065	0	1	02	01	H4004_065_0	8		Y	Select Care Drugs	4	10	1	2	6	1	110		01	100		1	30		90				2	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H4004	065	0	1	02	01	H4004_065_0	8		Y	Select Care Drugs	4	10	1	2	6	3	110		01	100		1	30		90				2	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										2		
H4005	004	0	1	04	01	H4005_004_0	7		N	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	7		N	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	7		N	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	7		N	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	7		N	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	7		N	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	7		N	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	7		N	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	7		N	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		
H4005	007	0	1	04	01	H4005_007_0	7		N	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	007	0	1	04	01	H4005_007_0	7		N	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	007	0	1	04	01	H4005_007_0	7		N	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	007	0	1	04	01	H4005_007_0	7		N	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	007	0	1	04	01	H4005_007_0	7		N	Preferred Brand	4	10	3	2	3	1		110	01	100		1				30		90	1	2			90				30		31								40.00		80.00					15.00		30.00							30.00																40.00				15.00			1.33	0.50				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H4005	007	0	1	04	01	H4005_007_0	7		N	Non-Preferred Brand	4	10	3	2	4	1		110	01	100		1				30		90	1	1			90				30		31								55.00		110.00					30.00		60.00							60.00																55.00				30.00			1.83	1.00				0.97	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H4005	007	0	1	04	01	H4005_007_0	7		N	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	007	0	1	04	01	H4005_007_0	7		N	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	007	0	1	04	01	H4005_007_0	7		N	Select Care Drugs	4	11	1	2	6	3		110	01	100		1				30		90	1	2			90				30		31								3.00		6.00					0.00		0.00							0.00																3.00				0.00			0.10	0.00				0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H4007	012	0	1	01	01	H4007_012_0	6		Y	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				2	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0				0	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4007	012	0	1	01	01	H4007_012_0	6		Y	Generic	4	11	1	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0				0	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4007	012	0	1	01	01	H4007_012_0	6		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0				0	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4007	012	0	1	01	01	H4007_012_0	6		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	10.00		30.00																									11.00		30.00				10.00		20.00				10.00				10.00		0.33				0.37	0.33	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4007	012	0	1	01	01	H4007_012_0	6		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4007	012	0	1	01	01	H4007_012_0	6		Y	Select Care Drugs	4	11	1	2	6	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0				0	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4007	020	0	1	01	01	H4007_020_0	4		Y	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				2	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0				0	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4007	020	0	1	01	01	H4007_020_0	4		Y	Generic	4	11	1	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0				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	4		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0				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	4		Y	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																									16.00		45.00				15.00		35.00				15.00				15.00		0.50				0.53	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	4		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4007	020	0	1	01	01	H4007_020_0	4		Y	Select Care Drugs	4	11	1	2	6	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0				0	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4007	021	0	1	01	01	H4007_021_0	5		Y	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				2	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0				0	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4007	021	0	1	01	01	H4007_021_0	5		Y	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	5		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0				0	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4007	021	0	1	01	01	H4007_021_0	5		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	15.00		45.00																									16.00		45.00				15.00		35.00				15.00				15.00		0.50				0.53	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	5		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4007	021	0	1	01	01	H4007_021_0	5		Y	Select Care Drugs	4	11	1	2	6	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0				0	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4007	024	0	1	01	01	H4007_024_0	4		Y	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				2	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0				0	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4007	024	0	1	01	01	H4007_024_0	4		Y	Generic	4	11	1	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0				0	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4007	024	0	1	01	01	H4007_024_0	4		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0				0	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4007	024	0	1	01	01	H4007_024_0	4		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	0.00		0.00																									1.00		3.00				0.00		0.00				0.00				0.00		0				0.03	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4007	024	0	1	01	01	H4007_024_0	4		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4007	024	0	1	01	01	H4007_024_0	4		Y	Select Care Drugs	4	11	1	2	6	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0				0	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4007	025	0	1	01	01	H4007_025_0	4		Y	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				2	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0				0	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4007	025	0	1	01	01	H4007_025_0	4		Y	Generic	4	11	1	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0				0	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4007	025	0	1	01	01	H4007_025_0	4		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0				0	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4007	025	0	1	01	01	H4007_025_0	4		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	0.00		0.00																									1.00		3.00				0.00		0.00				0.00				0.00		0				0.03	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4007	025	0	1	01	01	H4007_025_0	4		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4007	025	0	1	01	01	H4007_025_0	4		Y	Select Care Drugs	4	11	1	2	6	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0				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	5		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								10.00	20.00	30.00					5.00	10.00	15.00					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	5		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								20.00	40.00	60.00					15.00	30.00	45.00					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	5		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00	84.00	84.00																47.00				47.00			1.57	1.40	1.40			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4036	008	0	1	04	01	H4036_008_0	5		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	190.00	190.00																100.00				100.00			3.33	3.17	3.17			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4036	008	0	1	04	01	H4036_008_0	5		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												31							31						31																	31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4036	008	0	1	04	01	H4036_008_0	5		N	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4036	008	0	1	04	01	H4036_008_0	5		N	Select Care Drugs	4	01	1	2	6	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H4036	017	0	1	04	01	H4036_017_0	5		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								9.00	18.00	27.00					4.00	8.00	12.00					0.00	0.00	0.00																9.00				9.00			0.30	0.13	0.00			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4036	017	0	1	04	01	H4036_017_0	5		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								20.00	40.00	60.00					15.00	30.00	45.00					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	5		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00	84.00	84.00																47.00				47.00			1.57	1.40	1.40			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4036	017	0	1	04	01	H4036_017_0	5		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	190.00	190.00																100.00				100.00			3.33	3.17	3.17			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4036	017	0	1	04	01	H4036_017_0	5		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												32							32						32																	32			32								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4036	017	0	1	04	01	H4036_017_0	5		N	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4036	017	0	1	04	01	H4036_017_0	5		N	Select Care Drugs	4	01	1	2	6	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H4036	020	0	1	04	01	H4036_020_0	5		Y	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	5		Y	Preferred Generic	4	01	1	2	1	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								10.00	20.00	30.00					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										1		
H4036	020	0	1	04	01	H4036_020_0	5		Y	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	5		Y	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00	84.00	84.00																47.00				47.00			1.57	1.40	1.40			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4036	020	0	1	04	01	H4036_020_0	5		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	190.00	190.00																100.00				100.00			3.33	3.17	3.17			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4036	020	0	1	04	01	H4036_020_0	5		Y	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												
H4036	020	0	1	04	01	H4036_020_0	5		Y	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4036	020	0	1	04	01	H4036_020_0	5		Y	Select Care Drugs	4	01	1	2	6	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				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		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								10.00	20.00	30.00					5.00	10.00	15.00					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		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								20.00	40.00	60.00					15.00	30.00	45.00					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		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00	84.00	84.00																47.00				47.00			1.57	1.40	1.40			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4036	023	0	1	04	01	H4036_023_0	7		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								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		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												30							30						30																	30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4036	023	0	1	04	01	H4036_023_0	7		N	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4036	023	0	1	04	01	H4036_023_0	7		N	Select Care Drugs	4	01	1	2	6	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H4036	025	0	1	04	01	H4036_025_0	5		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								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	5		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								20.00	40.00	60.00					15.00	30.00	45.00					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	5		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00	84.00	84.00																47.00				47.00			1.57	1.40	1.40			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4036	025	0	1	04	01	H4036_025_0	5		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	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	5		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4036	025	0	1	04	01	H4036_025_0	5		N	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4036	025	0	1	04	01	H4036_025_0	5		N	Select Care Drugs	4	01	1	2	6	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H4036	026	0	1	04	01	H4036_026_0	5		Y	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	026	0	1	04	01	H4036_026_0	5		Y	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	026	0	1	04	01	H4036_026_0	5		Y	Preferred Brand	4	11	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	026	0	1	04	01	H4036_026_0	5		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				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	026	0	1	04	01	H4036_026_0	5		Y	Specialty Tier	4	11	1	1	5	1		010	01	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	026	0	1	04	01	H4036_026_0	5		Y	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4036	026	0	1	04	01	H4036_026_0	5		Y	Select Care Drugs	4	01	1	2	6	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				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	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												
H4073	001	0	1	01	01	H4073_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												
H4073	001	0	1	01	01	H4073_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												
H4073	001	0	1	01	01	H4073_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	47	47	47				86.06	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	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												
H4073	001	0	1	01	01	H4073_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												
H4091	003	0	1	04	01	H4091_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	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	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												
H4091	003	0	1	04	01	H4091_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												
H4091	003	0	1	04	01	H4091_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												
H4091	003	0	1	04	01	H4091_003_0	6			Specialty Tier	4	11	1	1	5	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31					30	30	30																		30	30	30																30		30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4140	001	0	1	02	01	H4140_001_0	5		Y	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	1	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Supplemental Drugs												
H4140	001	0	1	02	01	H4140_001_0	5		Y	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, Supplemental Drugs										1		
H4140	001	0	1	02	01	H4140_001_0	5		Y	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, Supplemental Drugs												
H4140	001	0	1	02	01	H4140_001_0	5		Y	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, Supplemental Drugs										1		
H4140	001	0	1	02	01	H4140_001_0	5		Y	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, Supplemental Drugs												
H4140	001	0	1	02	01	H4140_001_0	5		Y	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, Supplemental Drugs												
H4140	001	0	1	02	01	H4140_001_0	5		Y	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				728.64	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Supplemental Drugs												
H4140	001	0	1	02	01	H4140_001_0	5		Y	Supplemental Drugs	4	01	2	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, Supplemental Drugs												
H4140	001	0	1	02	01	H4140_001_0	5		Y	Supplemental Drugs	4	01	2	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, Supplemental Drugs										1		
H4140	002	0	1	02	01	H4140_002_0	5		N	Preferred Generic	4	01	1	1	1	1	111		01	111		1	30	60	90				1	1	30	60	90				30		31					25	25	25																		25	25	25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Supplemental Drugs												
H4140	002	0	1	02	01	H4140_002_0	5		N	Generic	4	11	1	1	2	1	111		01	111		1	30	60	90				1	1	30	60	90				30		31					25	25	25																		25	25	25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Supplemental Drugs												
H4140	002	0	1	02	01	H4140_002_0	5		N	Preferred Brand	4	11	1	1	3	1	111		01	111		1	30	60	90				1	1	30	60	90				30		31					25	25	25																		25	25	25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Supplemental Drugs												
H4140	002	0	1	02	01	H4140_002_0	5		N	Non-Preferred Drug	4	11	1	1	4	1	111		01	111		1	30	60	90				1	1	30	60	90				30		31					25	25	25																		25	25	25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Supplemental Drugs												
H4140	002	0	1	02	01	H4140_002_0	5		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31					25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Supplemental Drugs												
H4140	002	0	1	02	01	H4140_002_0	5		N	Supplemental Drugs	4	01	2	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, Supplemental Drugs												
H4140	002	0	1	02	01	H4140_002_0	5		N	Supplemental Drugs	4	01	2	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, Supplemental Drugs										1		
H4140	004	0	1	02	01	H4140_004_0	5		Y	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	1	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Supplemental Drugs												
H4140	004	0	1	02	01	H4140_004_0	5		Y	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, Supplemental Drugs										1		
H4140	004	0	1	02	01	H4140_004_0	5		Y	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, Supplemental Drugs												
H4140	004	0	1	02	01	H4140_004_0	5		Y	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, Supplemental Drugs										1		
H4140	004	0	1	02	01	H4140_004_0	5		Y	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, Supplemental Drugs												
H4140	004	0	1	02	01	H4140_004_0	5		Y	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, Supplemental Drugs												
H4140	004	0	1	02	01	H4140_004_0	5		Y	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				860.13	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Supplemental Drugs												
H4140	004	0	1	02	01	H4140_004_0	5		Y	Supplemental Drugs	4	01	2	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, Supplemental Drugs												
H4140	004	0	1	02	01	H4140_004_0	5		Y	Supplemental Drugs	4	01	2	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, Supplemental Drugs										1		
H4140	005	0	1	02	01	H4140_005_0	5		N	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, Supplemental Drugs												
H4140	005	0	1	02	01	H4140_005_0	5		N	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, Supplemental Drugs										1		
H4140	005	0	1	02	01	H4140_005_0	5		N	Generic	4	11	1	2	2	1	111		01	111		1	30	60	90				1	1	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Supplemental Drugs												
H4140	005	0	1	02	01	H4140_005_0	5		N	Generic	4	11	1	2	2	3	111		01	111		1	30	60	90				1	1	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Supplemental Drugs										1		
H4140	005	0	1	02	01	H4140_005_0	5		N	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				1	1	30	60	90				30		31	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, Supplemental Drugs												
H4140	005	0	1	02	01	H4140_005_0	5		N	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	90				1	1	30	60	90				30		31	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, Supplemental Drugs												
H4140	005	0	1	02	01	H4140_005_0	5		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				717.19	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Supplemental Drugs												
H4140	005	0	1	02	01	H4140_005_0	5		N	Supplemental Drugs	4	01	2	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, Supplemental Drugs												
H4140	005	0	1	02	01	H4140_005_0	5		N	Supplemental Drugs	4	01	2	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, Supplemental Drugs										1		
H4140	009	0	1	02	01	H4140_009_0	5		Y	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	1	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Supplemental Drugs												
H4140	009	0	1	02	01	H4140_009_0	5		Y	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, Supplemental Drugs										1		
H4140	009	0	1	02	01	H4140_009_0	5		Y	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, Supplemental Drugs												
H4140	009	0	1	02	01	H4140_009_0	5		Y	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, Supplemental Drugs										1		
H4140	009	0	1	02	01	H4140_009_0	5		Y	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, Supplemental Drugs												
H4140	009	0	1	02	01	H4140_009_0	5		Y	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, Supplemental Drugs												
H4140	009	0	1	02	01	H4140_009_0	5		Y	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				584.27	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Supplemental Drugs												
H4140	009	0	1	02	01	H4140_009_0	5		Y	Supplemental Drugs	4	01	2	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, Supplemental Drugs												
H4140	009	0	1	02	01	H4140_009_0	5		Y	Supplemental Drugs	4	01	2	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, Supplemental Drugs										1		
H4140	010	0	1	02	01	H4140_010_0	5		N	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, Supplemental Drugs												
H4140	010	0	1	02	01	H4140_010_0	5		N	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, Supplemental Drugs										1		
H4140	010	0	1	02	01	H4140_010_0	5		N	Generic	4	11	1	2	2	1	111		01	111		1	30	60	90				1	1	30	60	90				30		31	0.00	0.00	0.00																			0.00	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												
H4140	010	0	1	02	01	H4140_010_0	5		N	Generic	4	11	1	2	2	3	111		01	111		1	30	60	90				1	1	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Supplemental Drugs										1		
H4140	010	0	1	02	01	H4140_010_0	5		N	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				1	1	30	60	90				30		31	0.00	0.00	0.00																			0.00	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												
H4140	010	0	1	02	01	H4140_010_0	5		N	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	90				1	1	30	60	90				30		31	35.00	70.00	105.00																			35.00	70.00	105.00																35.00				35.00		1.17			1.17			1.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Supplemental Drugs												
H4140	010	0	1	02	01	H4140_010_0	5		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				743.20	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Supplemental Drugs												
H4140	010	0	1	02	01	H4140_010_0	5		N	Supplemental Drugs	4	01	2	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, Supplemental Drugs												
H4140	010	0	1	02	01	H4140_010_0	5		N	Supplemental Drugs	4	01	2	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, Supplemental Drugs										1		
H4140	011	0	1	02	01	H4140_011_0	5		N	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, Supplemental Drugs												
H4140	011	0	1	02	01	H4140_011_0	5		N	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, Supplemental Drugs										1		
H4140	011	0	1	02	01	H4140_011_0	5		N	Generic	4	11	1	2	2	1	111		01	111		1	30	60	90				1	1	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Supplemental Drugs												
H4140	011	0	1	02	01	H4140_011_0	5		N	Generic	4	11	1	2	2	3	111		01	111		1	30	60	90				1	1	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Supplemental Drugs										1		
H4140	011	0	1	02	01	H4140_011_0	5		N	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				1	1	30	60	90				30		31	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, Supplemental Drugs												
H4140	011	0	1	02	01	H4140_011_0	5		N	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	90				1	1	30	60	90				30		31	95.00	190.00	285.00																			95.00	190.00	285.00																95.00				95.00		3.17			3.17			3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Supplemental Drugs												
H4140	011	0	1	02	01	H4140_011_0	5		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				799.10	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Supplemental Drugs												
H4140	011	0	1	02	01	H4140_011_0	5		N	Supplemental Drugs	4	01	2	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, Supplemental Drugs												
H4140	011	0	1	02	01	H4140_011_0	5		N	Supplemental Drugs	4	01	2	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, Supplemental Drugs										1		
H4141	015	0	1	01	01	H4141_015_0	3		Y	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4141	015	0	1	01	01	H4141_015_0	3		Y	Preferred Generic	4	11	3	2	1	3	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H4141	015	0	1	01	01	H4141_015_0	3		Y	Generic	4	11	3	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	0.00		0.00																									20.00		60.00				0.00		0.00				0.00				0.00		0				0.67	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4141	015	0	1	01	01	H4141_015_0	3		Y	Generic	4	11	3	2	2	3	110		01		110	1	30		90				2	2				30		90	30		31	0.00		0.00																									20.00		60.00				0.00		0.00				0.00				0.00		0				0.67	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H4141	015	0	1	01	01	H4141_015_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		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	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		290.00				100.00				100.00		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	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4141	017	3	1	01	01	H4141_017_3	3		Y	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4141	017	3	1	01	01	H4141_017_3	3		Y	Preferred Generic	4	11	3	2	1	3	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H4141	017	3	1	01	01	H4141_017_3	3		Y	Generic	4	11	3	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	0.00		0.00																									20.00		60.00				0.00		0.00				0.00				0.00		0				0.67	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4141	017	3	1	01	01	H4141_017_3	3		Y	Generic	4	11	3	2	2	3	110		01		110	1	30		90				2	2				30		90	30		31	0.00		0.00																									20.00		60.00				0.00		0.00				0.00				0.00		0				0.67	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H4141	017	3	1	01	01	H4141_017_3	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		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		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	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												
H4141	017	3	1	01	01	H4141_017_3	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4141	017	5	1	01	01	H4141_017_5	3		Y	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4141	017	5	1	01	01	H4141_017_5	3		Y	Preferred Generic	4	11	3	2	1	3	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H4141	017	5	1	01	01	H4141_017_5	3		Y	Generic	4	11	3	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	0.00		0.00																									20.00		60.00				0.00		0.00				0.00				0.00		0				0.67	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4141	017	5	1	01	01	H4141_017_5	3		Y	Generic	4	11	3	2	2	3	110		01		110	1	30		90				2	2				30		90	30		31	0.00		0.00																									20.00		60.00				0.00		0.00				0.00				0.00		0				0.67	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H4141	017	5	1	01	01	H4141_017_5	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		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		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	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												
H4141	017	5	1	01	01	H4141_017_5	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4152	005	0	1	01	01	H4152_005_0	10		Y	Preferred Generic	4	01	1	2	1	1		111	01	101		1				30	60	90	1	2		60	90				30		31								11.00	22.00	33.00					3.00	6.00	9.00						0.00	0.00																11.00				3.00			0.37	0.10				0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4152	005	0	1	01	01	H4152_005_0	10		Y	Generic	4	01	1	2	2	1		111	01	101		1				30	60	90	1	2		60	90				30		31								14.00	28.00	42.00					6.00	12.00	18.00						0.00	0.00																14.00				6.00			0.47	0.20				0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4152	005	0	1	01	01	H4152_005_0	10		Y	Preferred Brand	4	11	1	2	3	1		111	01	101		1				30	60	90	1	2		60	90				30		31								47.00	94.00	141.00					47.00	94.00	141.00						94.00	117.50																47.00				47.00			1.57	1.57				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4152	005	0	1	01	01	H4152_005_0	10		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01	101		1				30	60	90	1	2		60	90				30		31								100.00	200.00	300.00					100.00	200.00	300.00						200.00	250.00																100.00				100.00			3.33	3.33				3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4152	005	0	1	01	01	H4152_005_0	10		Y	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4152	007	0	1	02	01	H4152_007_0	11		Y	Preferred Generic	4	01	1	2	1	1		111	01	101		1				30	60	90	1	2		60	90				30		31								11.00	22.00	33.00					3.00	6.00	9.00						0.00	0.00																11.00				3.00			0.37	0.10				0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4152	007	0	1	02	01	H4152_007_0	11		Y	Preferred Generic	4	01	1	2	1	3		111	01	101		1				30	60	90	1	2		60	90				30		31								11.00	22.00	33.00					3.00	6.00	9.00						0.00	0.00																11.00				3.00			0.37	0.10				0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H4152	007	0	1	02	01	H4152_007_0	11		Y	Generic	4	01	1	2	2	1		111	01	101		1				30	60	90	1	2		60	90				30		31								14.00	28.00	42.00					6.00	12.00	18.00						0.00	0.00																14.00				6.00			0.47	0.20				0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4152	007	0	1	02	01	H4152_007_0	11		Y	Generic	4	01	1	2	2	3		111	01	101		1				30	60	90	1	2		60	90				30		31								14.00	28.00	42.00					6.00	12.00	18.00						0.00	0.00																14.00				6.00			0.47	0.20				0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H4152	007	0	1	02	01	H4152_007_0	11		Y	Preferred Brand	4	11	1	2	3	1		111	01	101		1				30	60	90	1	2		60	90				30		31								47.00	94.00	141.00					47.00	94.00	141.00						94.00	117.50																47.00				47.00			1.57	1.57				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4152	007	0	1	02	01	H4152_007_0	11		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01	101		1				30	60	90	1	2		60	90				30		31								100.00	200.00	300.00					100.00	200.00	300.00						200.00	250.00																100.00				100.00			3.33	3.33				3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4152	007	0	1	02	01	H4152_007_0	11		Y	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4152	013	0	1	01	01	H4152_013_0	11		Y	Preferred Generic	4	01	1	2	1	1		111	01	101		1				30	60	90	1	2		60	90				30		31								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	013	0	1	01	01	H4152_013_0	11		Y	Generic	4	01	1	2	2	1		111	01	101		1				30	60	90	1	2		60	90				30		31								16.00	32.00	48.00					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	013	0	1	01	01	H4152_013_0	11		Y	Preferred Brand	4	11	1	2	3	1		111	01	101		1				30	60	90	1	2		60	90				30		31								47.00	94.00	141.00					47.00	94.00	141.00						94.00	117.50																47.00				47.00			1.57	1.57				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4152	013	0	1	01	01	H4152_013_0	11		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01	101		1				30	60	90	1	2		60	90				30		31								100.00	200.00	300.00					100.00	200.00	300.00						200.00	250.00																100.00				100.00			3.33	3.33				3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4152	013	0	1	01	01	H4152_013_0	11		Y	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4152	018	0	1	02	01	H4152_018_0	10		Y	Preferred Generic	4	01	1	2	1	1		111	01	101		1				30	60	90	1	2		60	90				30		31								8.00	16.00	24.00					0.00	0.00	0.00						0.00	0.00																8.00				0.00			0.27	0.00				0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4152	018	0	1	02	01	H4152_018_0	10		Y	Generic	4	01	1	2	2	1		111	01	101		1				30	60	90	1	2		60	90				30		31								12.00	24.00	36.00					4.00	8.00	12.00						0.00	0.00																12.00				4.00			0.40	0.13				0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4152	018	0	1	02	01	H4152_018_0	10		Y	Preferred Brand	4	11	1	2	3	1		111	01	101		1				30	60	90	1	2		60	90				30		31								47.00	94.00	141.00					47.00	94.00	141.00						94.00	117.50																47.00				47.00			1.57	1.57				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4152	018	0	1	02	01	H4152_018_0	10		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01	101		1				30	60	90	1	2		60	90				30		31								100.00	200.00	300.00					100.00	200.00	300.00						200.00	250.00																100.00				100.00			3.33	3.33				3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4152	018	0	1	02	01	H4152_018_0	10		Y	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4152	020	0	1	02	01	H4152_020_0	10		Y	Preferred Generic	4	01	1	2	1	1		111	01	101		1				30	60	90	1	2		60	90				30		31								8.00	16.00	24.00					0.00	0.00	0.00						0.00	0.00																8.00				0.00			0.27	0.00				0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4152	020	0	1	02	01	H4152_020_0	10		Y	Generic	4	01	1	2	2	1		111	01	101		1				30	60	90	1	2		60	90				30		31								16.00	32.00	48.00					0.00	0.00	0.00						0.00	0.00																16.00				0.00			0.53	0.00				0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4152	020	0	1	02	01	H4152_020_0	10		Y	Preferred Brand	4	11	1	2	3	1		111	01	101		1				30	60	90	1	2		60	90				30		31								47.00	94.00	141.00					47.00	94.00	141.00						94.00	117.50																47.00				47.00			1.57	1.57				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4152	020	0	1	02	01	H4152_020_0	10		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01	101		1				30	60	90	1	2		60	90				30		31								100.00	200.00	300.00					100.00	200.00	300.00						200.00	250.00																100.00				100.00			3.33	3.33				3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4152	020	0	1	02	01	H4152_020_0	10		Y	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4152	021	0	1	01	01	H4152_021_0	10		N	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	10		N	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	10		N	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	10		N	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	10		N	Preferred Brand	4	11	1	1	3	1	111		01	101		1	30	60	90				1	2		60	90				30		31				70.35	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	10		N	Non-Preferred Drug	4	11	1	1	4	1	111		01	101		1	30	60	90				1	2		60	90				30		31				91.62	35	35	35																			35	35															35			35								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4152	021	0	1	01	01	H4152_021_0	10		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31					25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4161	001	0	1	01	01	H4161_001_0	7		N	Preferred Generic	4	01	3	2	1	1		111	01	111		1				30	60	100	1	2	30	60	100				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												
H4161	001	0	1	01	01	H4161_001_0	7		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								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												
H4161	001	0	1	01	01	H4161_001_0	7		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								47.00	94.00	141.00					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												
H4161	001	0	1	01	01	H4161_001_0	7		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	285.00	285.00																100.00				100.00			3.33	3.17	3.17			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4161	001	0	1	01	01	H4161_001_0	7		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												25							25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4161	002	0	1	01	01	H4161_002_0	7		Y	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												
H4161	002	0	1	01	01	H4161_002_0	7		Y	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
H4161	002	0	1	01	01	H4161_002_0	7		Y	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												
H4161	002	0	1	01	01	H4161_002_0	7		Y	Generic	4	01	1	2	2	3		111	01	111		1				30	60	90	2	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H4161	002	0	1	01	01	H4161_002_0	7		Y	Preferred Brand	4	11	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												
H4161	002	0	1	01	01	H4161_002_0	7		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		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												
H4161	002	0	1	01	01	H4161_002_0	7		Y	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4161	003	0	1	01	01	H4161_003_0	5		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4161	003	0	1	01	01	H4161_003_0	5		N	Preferred Generic	4	01	1	2	1	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H4161	003	0	1	01	01	H4161_003_0	5		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								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												
H4161	003	0	1	01	01	H4161_003_0	5		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								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												
H4161	003	0	1	01	01	H4161_003_0	5		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	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												
H4161	003	0	1	01	01	H4161_003_0	5		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4161	004	0	1	01	01	H4161_004_0	5		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								5.00	10.00	15.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.15	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4161	004	0	1	01	01	H4161_004_0	5		N	Preferred Generic	4	01	1	2	1	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								5.00	10.00	15.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.15	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H4161	004	0	1	01	01	H4161_004_0	5		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								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												
H4161	004	0	1	01	01	H4161_004_0	5		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00	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												
H4161	004	0	1	01	01	H4161_004_0	5		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	285.00	285.00																100.00				100.00			3.33	3.17	3.17			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4161	004	0	1	01	01	H4161_004_0	5		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4161	005	0	1	01	01	H4161_005_0	5		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4161	005	0	1	01	01	H4161_005_0	5		N	Preferred Generic	4	01	1	2	1	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H4161	005	0	1	01	01	H4161_005_0	5		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								15.00	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												
H4161	005	0	1	01	01	H4161_005_0	5		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00	84.00	84.00																47.00				47.00			1.57	1.40	1.40			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4161	005	0	1	01	01	H4161_005_0	5		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	190.00	190.00																100.00				100.00			3.33	3.17	3.17			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4161	005	0	1	01	01	H4161_005_0	5		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4161	006	0	1	01	01	H4161_006_0	5		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								5.00	10.00	15.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.15	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4161	006	0	1	01	01	H4161_006_0	5		N	Preferred Generic	4	01	1	2	1	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								5.00	10.00	15.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.15	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H4161	006	0	1	01	01	H4161_006_0	5		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								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												
H4161	006	0	1	01	01	H4161_006_0	5		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00	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												
H4161	006	0	1	01	01	H4161_006_0	5		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	285.00	285.00																100.00				100.00			3.33	3.17	3.17			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4161	006	0	1	01	01	H4161_006_0	5		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4161	007	0	1	01	01	H4161_007_0	5		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4161	007	0	1	01	01	H4161_007_0	5		N	Preferred Generic	4	01	1	2	1	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H4161	007	0	1	01	01	H4161_007_0	5		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								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												
H4161	007	0	1	01	01	H4161_007_0	5		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00	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												
H4161	007	0	1	01	01	H4161_007_0	5		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	285.00	285.00																100.00				100.00			3.33	3.17	3.17			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4161	007	0	1	01	01	H4161_007_0	5		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4198	008	0	1	01	01	H4198_008_0	5		Y	Preferred Generic	4	11	1	2	1	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4198	008	0	1	01	01	H4198_008_0	5		Y	Preferred Generic	4	11	1	2	1	3	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H4198	008	0	1	01	01	H4198_008_0	5		Y	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	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												
H4198	008	0	1	01	01	H4198_008_0	5		Y	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	15.00																			0.00	0.00	0.00																5.00				5.00		0.17			0.00			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H4198	008	0	1	01	01	H4198_008_0	5		Y	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	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	5		Y	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	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	5		Y	Specialty Tier	4	11	1	1	5	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31				1382.40	33	33	33																		33	33	33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4198	009	0	1	01	01	H4198_009_0	5		Y	Preferred Generic	4	11	1	2	1	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4198	009	0	1	01	01	H4198_009_0	5		Y	Preferred Generic	4	11	1	2	1	3	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H4198	009	0	1	01	01	H4198_009_0	5		Y	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	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												
H4198	009	0	1	01	01	H4198_009_0	5		Y	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	15.00																			0.00	0.00	0.00																5.00				5.00		0.17			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H4198	009	0	1	01	01	H4198_009_0	5		Y	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	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	5		Y	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	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	5		Y	Specialty Tier	4	11	1	1	5	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31				1445.10	33	33	33																		33	33	33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4213	017	1	1	09	04	H4213_017_1	3			Preferred Generic	3	01	1	2	1	1	110		01	110		1	30		100				1	2	30		100				30		31	15.00		37.50																			15.00		37.50																15.00				15.00		0.50			0.50			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4213	017	1	1	09	04	H4213_017_1	3			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, Select Care Drugs												
H4213	017	1	1	09	04	H4213_017_1	3			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, Select Care Drugs												
H4213	017	1	1	09	04	H4213_017_1	3			Non-Preferred Drug	3	11	1	1	4	1	110		01	110		1	30		100				1	2	30		100				30		31				99.19	32		32																		32		32															32			32								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4213	017	1	1	09	04	H4213_017_1	3			Specialty Tier	3	11	1	1	5	1	010		01	010		1	30								30						30		31				971.39	25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4213	017	1	1	09	04	H4213_017_1	3			Select Care Drugs	3	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												
H4213	017	5	1	09	04	H4213_017_5	3			Preferred Generic	3	01	1	2	1	1	110		01	110		1	30		100				1	2	30		100				30		31	15.00		37.50																			15.00		37.50																15.00				15.00		0.50			0.50			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4213	017	5	1	09	04	H4213_017_5	3			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, Select Care Drugs												
H4213	017	5	1	09	04	H4213_017_5	3			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, Select Care Drugs												
H4213	017	5	1	09	04	H4213_017_5	3			Non-Preferred Drug	3	11	1	1	4	1	110		01	110		1	30		100				1	2	30		100				30		31				99.19	32		32																		32		32															32			32								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4213	017	5	1	09	04	H4213_017_5	3			Specialty Tier	3	11	1	1	5	1	010		01	010		1	30								30						30		31				971.39	25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4213	017	5	1	09	04	H4213_017_5	3			Select Care Drugs	3	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												
H4213	017	6	1	09	04	H4213_017_6	3			Preferred Generic	3	01	1	2	1	1	110		01	110		1	30		100				1	2	30		100				30		31	15.00		37.50																			15.00		37.50																15.00				15.00		0.50			0.50			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4213	017	6	1	09	04	H4213_017_6	3			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, Select Care Drugs												
H4213	017	6	1	09	04	H4213_017_6	3			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, Select Care Drugs												
H4213	017	6	1	09	04	H4213_017_6	3			Non-Preferred Drug	3	11	1	1	4	1	110		01	110		1	30		100				1	2	30		100				30		31				99.19	32		32																		32		32															32			32								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4213	017	6	1	09	04	H4213_017_6	3			Specialty Tier	3	11	1	1	5	1	010		01	010		1	30								30						30		31				971.39	25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4213	017	6	1	09	04	H4213_017_6	3			Select Care Drugs	3	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												
H4227	001	0	1	01	01	H4227_001_0	7		N	Generic	2	01	1	2	1	1	111		01	100		1	30	60	100				1	2			100				30		31	7.75	15.50	23.25																					23.25																7.75				7.75		0.26						0.25	Generic, Brand												
H4227	001	0	1	01	01	H4227_001_0	7		N	Brand	2	11	1	1	2	1	111		01	100		1	30	60	100				1	2			100				30		31				92.28	25	25	25																				25															25			25								Generic, Brand												
H4227	002	0	1	01	01	H4227_002_0	6		N	Generic	2	01	1	2	1	1	111		01	100		1	30	60	100				1	2			100				30		31	8.00	16.00	24.00																					24.00																8.00				8.00		0.27						0.26	Generic, Brand												
H4227	002	0	1	01	01	H4227_002_0	6		N	Brand	2	11	1	1	2	1	111		01	100		1	30	60	100				1	2			100				30		31				90.79	25	25	25																				25															25			25								Generic, Brand												
H4232	002	0	1	01	01	H4232_002_0	4			Preferred Generic	4	01	1	2	1	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	0.00	0.00	0.00																			0.00	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	4			Generic	4	01	1	2	2	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	15.00	30.00	45.00																			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	4			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	4			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	4			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												
H4277	001	0	1	04	01	H4277_001_0	7		Y	Preferred Generic	4	11	1	2	1	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4277	001	0	1	04	01	H4277_001_0	7		Y	Preferred Generic	4	11	1	2	1	3	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H4277	001	0	1	04	01	H4277_001_0	7		Y	Generic	4	11	1	2	2	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	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												
H4277	001	0	1	04	01	H4277_001_0	7		Y	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	15.00																			0.00	0.00	0.00																5.00				5.00		0.17			0.00			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H4277	001	0	1	04	01	H4277_001_0	7		Y	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	40.00	80.00	120.00																			40.00	80.00	80.00																40.00				40.00		1.33			1.33			1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4277	001	0	1	04	01	H4277_001_0	7		Y	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	95.00	190.00	285.00																			95.00	190.00	190.00																95.00				95.00		3.17			3.17			3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4277	001	0	1	04	01	H4277_001_0	7		Y	Specialty Tier	4	11	1	1	5	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31				1250.70	33	33	33																		33	33	33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4279	001	0	1	01	01	H4279_001_0	6		N	Preferred Generic	4	11	1	2	1	1		111	01		100	1				30	60	90	1	2						90	30		31								12.00	21.00	30.00					6.00	9.00	12.00													17.00						12.00				12.00				6.00			0.40	0.20				0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4279	001	0	1	01	01	H4279_001_0	6		N	Preferred Generic	4	11	1	2	1	3		111	01		100	1				30	60	90	1	2						90	30		31								20.00	40.00	60.00					15.00	22.50	30.00													35.00						30.00				20.00				15.00			0.67	0.50				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H4279	001	0	1	01	01	H4279_001_0	6		N	Generic	4	11	1	2	2	1		111	01		100	1				30	60	90	1	2						90	30		31								20.00	40.00	60.00					12.00	18.00	24.00													29.00						24.00				20.00				12.00			0.67	0.40				0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4279	001	0	1	01	01	H4279_001_0	6		N	Preferred Brand	4	11	1	2	3	1		111	01		100	1				30	60	90	1	2						90	30		31								40.00	80.00	120.00					30.00	45.00	60.00													65.00						60.00				40.00				30.00			1.33	1.00				0.97	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4279	001	0	1	01	01	H4279_001_0	6		N	Non-Preferred Drug	4	11	1	1	4	1		111	01		100	1				30	60	90	1	2						90	30		31											59.57	49	49	49				63.07	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	6		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											555.25	25						555.88	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		N	Preferred Generic	4	11	1	2	1	1		111	01		100	1				30	60	90	1	2						90	30		31								12.00	16.00	20.00					6.00	9.00	12.00													17.00						12.00				12.00				6.00			0.40	0.20				0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4279	004	0	1	01	01	H4279_004_0	6		N	Preferred Generic	4	11	1	2	1	3		111	01		100	1				30	60	90	1	2						90	30		31								20.00	40.00	60.00					15.00	22.50	30.00													35.00						30.00				20.00				15.00			0.67	0.50				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H4279	004	0	1	01	01	H4279_004_0	6		N	Generic	4	11	1	2	2	1		111	01		100	1				30	60	90	1	2						90	30		31								20.00	40.00	60.00					12.00	18.00	24.00													25.00						20.00				20.00				12.00			0.67	0.40				0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4279	004	0	1	01	01	H4279_004_0	6		N	Preferred Brand	4	11	1	2	3	1		111	01		100	1				30	60	90	1	2						90	30		31								40.00	80.00	120.00					30.00	45.00	60.00													65.00						60.00				40.00				30.00			1.33	1.00				0.97	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4279	004	0	1	01	01	H4279_004_0	6		N	Non-Preferred Drug	4	11	1	1	4	1		111	01		100	1				30	60	90	1	2						90	30		31											66.55	49	49	49				63.33	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		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											578.45	25						591.29	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4286	001	0	1	01	01	H4286_001_0	10		Y	Generic	4	01	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 Brand, Specialty Tier												
H4286	001	0	1	01	01	H4286_001_0	10		Y	Generic	4	01	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			0.16	0.00				0.16	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		3
H4286	001	0	1	01	01	H4286_001_0	10		Y	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 Brand, Specialty Tier												
H4286	001	0	1	01	01	H4286_001_0	10		Y	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	10		Y	Specialty Tier	4	11	1	1	4	1		010	01			1				30											30		31											1388.65	33						887.45	33																							33			33								Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4286	002	0	1	01	01	H4286_002_0	14		N	Generic	4	01	1	1	1	1		111	01			1				30	60	90	2	2							30		31											2.46	24	24	24				2.31	24	24	24																					24			24								Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs												
H4286	002	0	1	01	01	H4286_002_0	14		N	Preferred Brand	4	11	1	1	2	1		111	01			1				30	60	90	2	2							30		31											55.12	24	24	24				55.30	24	24	24																					24			24								Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs												
H4286	002	0	1	01	01	H4286_002_0	14		N	Non-Preferred Brand	4	11	1	1	3	1		010	01			1				30											30		31											36.98	35						33.16	35																							35			35								Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs												
H4286	002	0	1	01	01	H4286_002_0	14		N	Specialty Tier	4	11	1	1	4	1		010	01			1				30											30		31											807.83	25						568.81	25																							25			25								Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs												
H4286	002	0	1	01	01	H4286_002_0	14		N	Supplemental Drugs	4	11	2	2	5	1		010	01			1				30											30		31								20.00							0.00																									20.00				20.00			0.67	0.00				0.65	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs												
H4286	002	0	1	01	01	H4286_002_0	14		N	Supplemental Drugs	4	11	2	2	5	3		010	01			1				30											30		31								20.00							0.00																									20.00				0.00			0.67	0.00				0.00	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs										1		
H4286	003	0	1	01	01	H4286_003_0	9		N	Generic	4	01	3	2	1	1		111	01			1				30	60	90	2	2							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	9		N	Generic	4	01	3	2	1	3		111	01			1				30	60	90	2	2							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	9		N	Preferred Brand	4	10	1	2	2	1		111	01			1				30	60	90	2	2							30		31								47.00	94.00	141.00					47.00	94.00	141.00																							47.00				47.00			1.57	1.57				1.52	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4286	003	0	1	01	01	H4286_003_0	9		N	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	9		N	Specialty Tier	4	11	1	1	4	1		010	01			1				30											30		31											1692.16	33						707.87	33																							33			33								Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4304	001	0	1	04	01	H4304_001_0	6		Y	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	6		Y	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	6		Y	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	6		Y	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	100.00	200.00	300.00																			100.00	200.00	300.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4304	001	0	1	04	01	H4304_001_0	6		Y	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				1483.00	31																				31																	31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4304	002	0	1	04	01	H4304_002_0	6		N	Preferred Generic	3	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																			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												
H4304	002	0	1	04	01	H4304_002_0	6		N	Generic	3	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																			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												
H4304	002	0	1	04	01	H4304_002_0	6		N	Preferred Brand	3	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	002	0	1	04	01	H4304_002_0	6		N	Non-Preferred Drug	3	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	002	0	1	04	01	H4304_002_0	6		N	Specialty Tier	3	11	1	1	5	1	010		01	010		1	30								30						30		31				1483.00	25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4343	001	0	1	01	01	H4343_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												
H4343	001	0	1	01	01	H4343_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					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	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												
H4343	001	0	1	01	01	H4343_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												
H4343	001	0	1	01	01	H4343_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												
H4343	001	0	1	01	01	H4343_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												
H4343	002	0	1	01	01	H4343_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								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00				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	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					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	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												
H4343	002	0	1	01	01	H4343_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												
H4343	002	0	1	01	01	H4343_002_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												
H4343	002	0	1	01	01	H4343_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												
H4343	003	0	1	01	01	H4343_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								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00				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	5			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	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												
H4343	003	0	1	01	01	H4343_003_0	5			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	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												
H4343	003	0	1	01	01	H4343_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												
H4343	003	0	1	01	01	H4343_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												
H4343	003	0	1	01	01	H4343_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												
H4343	003	0	1	01	01	H4343_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	
H4343	004	0	1	01	01	H4343_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												
H4343	004	0	1	01	01	H4343_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								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00				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	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												
H4343	004	0	1	01	01	H4343_004_0	5			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	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												
H4343	004	0	1	01	01	H4343_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												
H4343	004	0	1	01	01	H4343_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												
H4343	004	0	1	01	01	H4343_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												
H4343	004	0	1	01	01	H4343_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	
H4343	005	0	1	01	01	H4343_005_0	5		N	Preferred Generic	3	11	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								19.00	38.00	57.00					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												
H4343	005	0	1	01	01	H4343_005_0	5		N	Generic	3	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					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												
H4343	005	0	1	01	01	H4343_005_0	5		N	Preferred Brand	3	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					47.00	94.00	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, Select Care Drugs												
H4343	005	0	1	01	01	H4343_005_0	5		N	Non-Preferred Drug	3	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											98.91	41	41	41				98.91	41	41	41										41	41	41				41	41	41			41			41								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4343	005	0	1	01	01	H4343_005_0	5		N	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4343	005	0	1	01	01	H4343_005_0	5		N	Select Care Drugs	3	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4343	006	0	1	01	01	H4343_006_0	6		N	Preferred Generic	3	11	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								19.00	38.00	57.00					3.00	6.00	9.00											19.00	38.00	57.00				3.00	6.00	0.00				19.00				19.00			0.63	0.1		0.63	0.1	0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4343	006	0	1	01	01	H4343_006_0	6		N	Generic	3	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					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												
H4343	006	0	1	01	01	H4343_006_0	6		N	Preferred Brand	3	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					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, Select Care Drugs												
H4343	006	0	1	01	01	H4343_006_0	6		N	Non-Preferred Drug	3	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											97.70	41	41	41				97.70	41	41	41										41	41	41				41	41	41			41			41								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4343	006	0	1	01	01	H4343_006_0	6		N	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4343	006	0	1	01	01	H4343_006_0	6		N	Select Care Drugs	3	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4346	001	0	1	01	01	H4346_001_0	5		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								5.00	10.00	15.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.15	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4346	001	0	1	01	01	H4346_001_0	5		N	Preferred Generic	4	01	1	2	1	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								5.00	10.00	15.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.15	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H4346	001	0	1	01	01	H4346_001_0	5		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								12.50	25.00	37.50					7.50	15.00	22.50					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	5		N	Generic	4	01	1	2	2	3		111	01	111		1				30	60	90	2	2	30	60	90				30		34								12.50	25.00	37.50					7.50	15.00	22.50					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	5		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								45.00	90.00	135.00					40.00	80.00	120.00					40.00	80.00	80.00																45.00				45.00			1.50	1.33	1.33			1.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4346	001	0	1	01	01	H4346_001_0	5		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								95.00	190.00	285.00					85.00	170.00	255.00					85.00	170.00	170.00																95.00				95.00			3.17	2.83	2.83			2.79	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4346	001	0	1	01	01	H4346_001_0	5		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4346	001	0	1	01	01	H4346_001_0	5		N	Select Care Drugs	4	11	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4346	001	0	1	01	01	H4346_001_0	5		N	Select Care Drugs	4	11	1	2	6	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	3	
H4346	005	0	1	01	01	H4346_005_0	5		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								5.00	10.00	15.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.15	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4346	005	0	1	01	01	H4346_005_0	5		N	Preferred Generic	4	01	1	2	1	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								5.00	10.00	15.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.15	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H4346	005	0	1	01	01	H4346_005_0	5		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								12.50	25.00	37.50					7.50	15.00	22.50					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	5		N	Generic	4	01	1	2	2	3		111	01	111		1				30	60	90	2	2	30	60	90				30		34								12.50	25.00	37.50					7.50	15.00	22.50					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	5		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								45.00	90.00	135.00					40.00	80.00	120.00					40.00	80.00	80.00																45.00				45.00			1.50	1.33	1.33			1.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4346	005	0	1	01	01	H4346_005_0	5		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								95.00	190.00	285.00					85.00	170.00	255.00					85.00	170.00	170.00																95.00				95.00			3.17	2.83	2.83			2.79	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4346	005	0	1	01	01	H4346_005_0	5		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4346	005	0	1	01	01	H4346_005_0	5		N	Select Care Drugs	4	11	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4346	005	0	1	01	01	H4346_005_0	5		N	Select Care Drugs	4	11	1	2	6	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	3	
H4346	006	0	1	01	01	H4346_006_0	5		Y	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	5		Y	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	5		Y	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	5		Y	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	5		Y	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	5		Y	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	5		Y	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	5		Y	Specialty Tier	4	11	1	1	5	1		010	01	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	5		Y	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	5		Y	Select Care Drugs	4	11	1	2	6	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	3	
H4346	008	0	1	01	01	H4346_008_0	6		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								5.00	10.00	15.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.15	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4346	008	0	1	01	01	H4346_008_0	6		N	Preferred Generic	4	01	1	2	1	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								5.00	10.00	15.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.15	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H4346	008	0	1	01	01	H4346_008_0	6		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								12.50	25.00	37.50					7.50	15.00	22.50					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		N	Generic	4	01	1	2	2	3		111	01	111		1				30	60	90	2	2	30	60	90				30		34								12.50	25.00	37.50					7.50	15.00	22.50					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		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								45.00	90.00	135.00					40.00	80.00	120.00					40.00	80.00	80.00																45.00				45.00			1.50	1.33	1.33			1.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4346	008	0	1	01	01	H4346_008_0	6		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								95.00	190.00	285.00					85.00	170.00	255.00					85.00	170.00	170.00																95.00				95.00			3.17	2.83	2.83			2.79	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4346	008	0	1	01	01	H4346_008_0	6		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4346	008	0	1	01	01	H4346_008_0	6		N	Select Care Drugs	4	11	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4346	008	0	1	01	01	H4346_008_0	6		N	Select Care Drugs	4	11	1	2	6	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	3	
H4346	009	0	1	01	01	H4346_009_0	5		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								10.00	20.00	30.00					5.00	10.00	15.00					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	5		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								15.50	31.00	46.50					10.50	21.00	31.50					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	5		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								45.00	90.00	135.00					40.00	80.00	120.00					40.00	80.00	80.00																45.00				45.00			1.50	1.33	1.33			1.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4346	009	0	1	01	01	H4346_009_0	5		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								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	5		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4346	009	0	1	01	01	H4346_009_0	5		N	Select Care Drugs	4	11	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								10.00	20.00	30.00					10.00	20.00	30.00					10.00	20.00	20.00																10.00				10.00			0.33	0.33	0.33			0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4346	010	0	1	01	01	H4346_010_0	5		N	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		34	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4346	010	0	1	01	01	H4346_010_0	5		N	Preferred Generic	4	01	1	2	1	3	111		01	111		1	30	60	90				1	2	30	60	90				30		34	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H4346	010	0	1	01	01	H4346_010_0	5		N	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				2	2	30	60	90				30		34	7.50	15.00	22.50																			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	5		N	Generic	4	01	1	2	2	3	111		01	111		1	30	60	90				2	2	30	60	90				30		34	7.50	15.00	22.50																			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	5		N	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				2	2	30	60	90				30		34	40.00	80.00	120.00																			40.00	80.00	80.00																40.00				40.00		1.33			1.33			1.18	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4346	010	0	1	01	01	H4346_010_0	5		N	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	90				2	2	30	60	90				30		34	85.00	170.00	255.00																			85.00	170.00	170.00																85.00				85.00		2.83			2.83			2.50	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4346	010	0	1	01	01	H4346_010_0	5		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		34					33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4346	010	0	1	01	01	H4346_010_0	5		N	Select Care Drugs	4	11	1	2	6	1	111		01	111		1	30	60	100				1	2	30	60	100				30		34	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4346	010	0	1	01	01	H4346_010_0	5		N	Select Care Drugs	4	11	1	2	6	3	111		01	111		1	30	60	100				1	2	30	60	100				30		34	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	3	
H4346	012	0	1	01	01	H4346_012_0	5		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								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	5		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								13.00	26.00	39.00					8.00	16.00	24.00					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	5		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00	126.00	126.00																47.00				47.00			1.57	1.40	1.40			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4346	012	0	1	01	01	H4346_012_0	5		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	285.00	285.00																100.00				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	5		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4346	012	0	1	01	01	H4346_012_0	5		N	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4346	012	0	1	01	01	H4346_012_0	5		N	Select Care Drugs	4	01	1	2	6	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H4346	014	0	1	01	01	H4346_014_0	5		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								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												
H4346	014	0	1	01	01	H4346_014_0	5		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								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												
H4346	014	0	1	01	01	H4346_014_0	5		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								47.00	94.00	141.00					47.00	94.00	141.00					47.00	141.00	141.00																47.00				47.00			1.57	1.57	1.57			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4346	014	0	1	01	01	H4346_014_0	5		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	285.00	285.00																100.00				100.00			3.33	3.17	3.17			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4346	014	0	1	01	01	H4346_014_0	5		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												25							25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4346	014	0	1	01	01	H4346_014_0	5		N	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								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												
H4346	017	0	1	01	01	H4346_017_0	5		N	Preferred Generic	4	01	3	2	1	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4346	017	0	1	01	01	H4346_017_0	5		N	Preferred Generic	4	01	3	2	1	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H4346	017	0	1	01	01	H4346_017_0	5		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								10.00	20.00	30.00					5.00	10.00	15.00					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	5		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00	84.00	84.00																47.00				47.00			1.57	1.40	1.40			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4346	017	0	1	01	01	H4346_017_0	5		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	190.00	190.00																100.00				100.00			3.33	3.17	3.17			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4346	017	0	1	01	01	H4346_017_0	5		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4346	019	0	1	01	01	H4346_019_0	5		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4346	019	0	1	01	01	H4346_019_0	5		N	Preferred Generic	4	01	1	2	1	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H4346	019	0	1	01	01	H4346_019_0	5		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								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	5		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00	126.00	126.00																47.00				47.00			1.57	1.40	1.40			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4346	019	0	1	01	01	H4346_019_0	5		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	285.00	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	5		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4346	024	0	1	01	01	H4346_024_0	5		N	Preferred Generic	4	01	3	2	1	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4346	024	0	1	01	01	H4346_024_0	5		N	Preferred Generic	4	01	3	2	1	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H4346	024	0	1	01	01	H4346_024_0	5		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								10.00	20.00	30.00					5.00	10.00	15.00					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	5		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00	84.00	84.00																47.00				47.00			1.57	1.40	1.40			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4346	024	0	1	01	01	H4346_024_0	5		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	190.00	190.00																100.00				100.00			3.33	3.17	3.17			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4346	024	0	1	01	01	H4346_024_0	5		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4346	025	0	1	01	01	H4346_025_0	5		N	Preferred Generic	4	01	3	2	1	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								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												
H4346	025	0	1	01	01	H4346_025_0	5		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								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												
H4346	025	0	1	01	01	H4346_025_0	5		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								47.00	94.00	141.00					47.00	94.00	141.00					47.00	141.00	141.00																47.00				47.00			1.57	1.57	1.57			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4346	025	0	1	01	01	H4346_025_0	5		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	285.00	285.00																100.00				100.00			3.33	3.17	3.17			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4346	025	0	1	01	01	H4346_025_0	5		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												25							25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4346	026	0	1	01	01	H4346_026_0	5		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								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												
H4346	026	0	1	01	01	H4346_026_0	5		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								20.00	40.00	60.00					20.00	40.00	60.00					20.00	60.00	60.00																20.00				20.00			0.67	0.67	0.67			0.59	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4346	026	0	1	01	01	H4346_026_0	5		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								47.00	94.00	141.00					47.00	94.00	141.00					47.00	141.00	141.00																47.00				47.00			1.57	1.57	1.57			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4346	026	0	1	01	01	H4346_026_0	5		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	285.00	285.00																100.00				100.00			3.33	3.17	3.17			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4346	026	0	1	01	01	H4346_026_0	5		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												25							25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4346	026	0	1	01	01	H4346_026_0	5		N	Select Care Drugs	4	11	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								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												
H4346	029	0	1	01	01	H4346_029_0	6		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		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	6		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								13.00	26.00	39.00					8.00	16.00	24.00					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	6		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00	126.00	126.00																47.00				47.00			1.57	1.40	1.40			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4346	029	0	1	01	01	H4346_029_0	6		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	285.00	285.00																100.00				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	6		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4346	029	0	1	01	01	H4346_029_0	6		N	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4346	029	0	1	01	01	H4346_029_0	6		N	Select Care Drugs	4	01	1	2	6	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H4407	026	0	1	01	01	H4407_026_0	4		Y	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								7.00	14.00	21.00					0.00	0.00	0.00											7.00	14.00	21.00				0.00	0.00	0.00				7.00				7.00			0.23	0.00		0.23	0.00	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4407	026	0	1	01	01	H4407_026_0	4		Y	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								15.00	30.00	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		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4407	026	0	1	01	01	H4407_026_0	4		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								100.00	200.00	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		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											935.37	33						675.03	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		Y	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00				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		Y	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		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4407	027	0	1	01	01	H4407_027_0	4		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								100.00	200.00	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		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											924.76	33						753.66	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		Y	Preferred Generic	4	01	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		Y	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					10.00	20.00	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		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4407	028	0	1	01	01	H4407_028_0	4		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00				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		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											897.26	33						789.02	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4461	025	0	1	01	01	H4461_025_0	3		Y	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4461	025	0	1	01	01	H4461_025_0	3		Y	Generic	4	11	3	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	0.00		0.00																									20.00		60.00				0.00		0.00				0.00				0.00		0				0.67	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4461	025	0	1	01	01	H4461_025_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		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		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	97.00		291.00																									100.00		300.00				97.00		281.00				97.00				97.00		3.23				3.33	3.23	3.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4461	025	0	1	01	01	H4461_025_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4461	029	0	1	01	01	H4461_029_0	3		Y	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4461	029	0	1	01	01	H4461_029_0	3		Y	Generic	4	11	3	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	0.00		0.00																									20.00		60.00				0.00		0.00				0.00				0.00		0				0.67	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4461	029	0	1	01	01	H4461_029_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		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		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	97.00		291.00																									100.00		300.00				97.00		281.00				97.00				97.00		3.23				3.33	3.23	3.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4461	029	0	1	01	01	H4461_029_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4461	030	1	1	01	01	H4461_030_1	3		Y	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4461	030	1	1	01	01	H4461_030_1	3		Y	Generic	4	11	3	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	0.00		0.00																									20.00		60.00				0.00		0.00				0.00				0.00		0				0.67	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4461	030	1	1	01	01	H4461_030_1	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		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		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	97.00		291.00																									100.00		300.00				97.00		281.00				97.00				97.00		3.23				3.33	3.23	3.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4461	030	1	1	01	01	H4461_030_1	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4461	030	2	1	01	01	H4461_030_2	3		Y	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4461	030	2	1	01	01	H4461_030_2	3		Y	Generic	4	11	3	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	0.00		0.00																									20.00		60.00				0.00		0.00				0.00				0.00		0				0.67	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4461	030	2	1	01	01	H4461_030_2	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		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		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	97.00		291.00																									100.00		300.00				97.00		281.00				97.00				97.00		3.23				3.33	3.23	3.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4461	030	2	1	01	01	H4461_030_2	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4461	030	3	1	01	01	H4461_030_3	3		Y	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4461	030	3	1	01	01	H4461_030_3	3		Y	Generic	4	11	3	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	0.00		0.00																									20.00		60.00				0.00		0.00				0.00				0.00		0				0.67	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4461	030	3	1	01	01	H4461_030_3	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		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		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	97.00		291.00																									100.00		300.00				97.00		281.00				97.00				97.00		3.23				3.33	3.23	3.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4461	030	3	1	01	01	H4461_030_3	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4461	031	1	1	01	01	H4461_031_1	3		Y	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4461	031	1	1	01	01	H4461_031_1	3		Y	Generic	4	11	3	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	0.00		0.00																									20.00		60.00				0.00		0.00				0.00				0.00		0				0.67	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4461	031	1	1	01	01	H4461_031_1	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		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		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	97.00		291.00																									100.00		300.00				97.00		281.00				97.00				97.00		3.23				3.33	3.23	3.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4461	031	1	1	01	01	H4461_031_1	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4461	031	2	1	01	01	H4461_031_2	3		Y	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4461	031	2	1	01	01	H4461_031_2	3		Y	Generic	4	11	3	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	0.00		0.00																									20.00		60.00				0.00		0.00				0.00				0.00		0				0.67	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4461	031	2	1	01	01	H4461_031_2	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		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		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	97.00		291.00																									100.00		300.00				97.00		281.00				97.00				97.00		3.23				3.33	3.23	3.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4461	031	2	1	01	01	H4461_031_2	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4461	031	3	1	01	01	H4461_031_3	3		Y	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4461	031	3	1	01	01	H4461_031_3	3		Y	Generic	4	11	3	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	0.00		0.00																									20.00		60.00				0.00		0.00				0.00				0.00		0				0.67	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4461	031	3	1	01	01	H4461_031_3	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		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		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	97.00		291.00																									100.00		300.00				97.00		281.00				97.00				97.00		3.23				3.33	3.23	3.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4461	031	3	1	01	01	H4461_031_3	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4461	034	0	1	01	01	H4461_034_0	3		Y	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4461	034	0	1	01	01	H4461_034_0	3		Y	Generic	4	11	3	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	0.00		0.00																									20.00		60.00				0.00		0.00				0.00				0.00		0				0.67	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4461	034	0	1	01	01	H4461_034_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		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		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	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												
H4461	034	0	1	01	01	H4461_034_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4461	035	0	1	01	01	H4461_035_0	3		Y	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4461	035	0	1	01	01	H4461_035_0	3		Y	Generic	4	11	3	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	0.00		0.00																									20.00		60.00				0.00		0.00				0.00				0.00		0				0.67	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4461	035	0	1	01	01	H4461_035_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		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		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	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												
H4461	035	0	1	01	01	H4461_035_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4461	036	0	1	01	01	H4461_036_0	3		Y	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4461	036	0	1	01	01	H4461_036_0	3		Y	Generic	4	11	3	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	0.00		0.00																									20.00		60.00				0.00		0.00				0.00				0.00		0				0.67	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4461	036	0	1	01	01	H4461_036_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		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		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	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												
H4461	036	0	1	01	01	H4461_036_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4461	037	0	1	01	01	H4461_037_0	3		Y	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4461	037	0	1	01	01	H4461_037_0	3		Y	Generic	4	11	3	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	5.00		15.00																									20.00		60.00				5.00		0.00				5.00				5.00		0.17				0.67	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4461	037	0	1	01	01	H4461_037_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		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		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	97.00		291.00																									100.00		300.00				97.00		281.00				97.00				97.00		3.23				3.33	3.23	3.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4461	037	0	1	01	01	H4461_037_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4461	039	0	1	01	01	H4461_039_0	3		Y	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4461	039	0	1	01	01	H4461_039_0	3		Y	Generic	4	11	3	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	5.00		15.00																									20.00		60.00				5.00		0.00				5.00				5.00		0.17				0.67	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4461	039	0	1	01	01	H4461_039_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4461	039	0	1	01	01	H4461_039_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	97.00		291.00																									100.00		300.00				97.00		281.00				97.00				97.00		3.23				3.33	3.23	3.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4461	039	0	1	01	01	H4461_039_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4490	002	0	1	01	01	H4490_002_0	4			Preferred Generic	4	01	1	2	1	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	0.00	0.00	0.00																			0.00	0.00	0.00																	0.00			0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4490	002	0	1	01	01	H4490_002_0	4			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	4			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	4			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	4			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	14			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	14			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	14			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	14			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	14			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	14			Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											71.33	50		50				74.40	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	14			Specialty Tier	4	11	1	1	5	1		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	14			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	14			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	14			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	14			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	14			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	14			Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											71.33	50		50				74.40	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	14			Specialty Tier	4	11	1	1	5	1		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	14			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	14			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	14			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	14			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	14			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	14			Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											71.33	50		50				74.40	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	14			Specialty Tier	4	11	1	1	5	1		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	15			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	15			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	15			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	15			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	15			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	15			Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											59.04	50		50				63.12	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	15			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	14			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	14			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	14			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	14			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	14			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	14			Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											59.04	50		50				63.12	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	14			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	14			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	14			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	14			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	14			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	14			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	14			Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											59.04	50		50				63.12	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	14			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	15			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	15			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	15			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	15			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	15			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	15			Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											67.42	50		50				70.61	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	15			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	15			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	15			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	15			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	15			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	15			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	15			Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											67.42	50		50				70.61	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	15			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	15			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	15			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	15			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	15			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	15			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	15			Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											67.42	50		50				70.61	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	15			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	14			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				0.00		0.00				12.00				12.00			0.40	0.13		0.37	0.00	0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4497	005	1	1	04	01	H4497_005_1	14			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				0.00		0.00				12.00				12.00			0.40	0.13		0.37	0.00	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	14			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				0.00		0.00				16.00				16.00			0.53	0.27		0.50	0.00	0.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4497	005	1	1	04	01	H4497_005_1	14			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				0.00		0.00				16.00				16.00			0.53	0.27		0.50	0.00	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	14			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	14			Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											61.62	50		50				64.75	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	14			Specialty Tier	4	11	1	1	5	1		010	01		010	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	14			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	14			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	14			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				0.00		0.00				12.00				12.00			0.40	0.13		0.37	0.00	0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4497	005	2	1	04	01	H4497_005_2	14			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				0.00		0.00				12.00				12.00			0.40	0.13		0.37	0.00	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	14			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				0.00		0.00				16.00				16.00			0.53	0.27		0.50	0.00	0.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4497	005	2	1	04	01	H4497_005_2	14			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				0.00		0.00				16.00				16.00			0.53	0.27		0.50	0.00	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	14			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	14			Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											61.62	50		50				64.75	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	14			Specialty Tier	4	11	1	1	5	1		010	01		010	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	14			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	14			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		Y	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												
H4506	003	0	1	01	01	H4506_003_0	4		Y	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
H4506	003	0	1	01	01	H4506_003_0	4		Y	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00				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												
H4506	003	0	1	01	01	H4506_003_0	4		Y	Generic	4	11	1	2	2	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00				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										1		
H4506	003	0	1	01	01	H4506_003_0	4		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								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		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	300.00					70.00	140.00	210.00											100.00	200.00	300.00				70.00	140.00	140.00				100.00				100.00			3.33	2.33		3.33	2.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4506	003	0	1	01	01	H4506_003_0	4		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4506	003	0	1	01	01	H4506_003_0	4		Y	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			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		Y	Select Care Drugs	4	11	1	2	6	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			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								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00				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 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
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								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00				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												
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								47.00	94.00	141.00					30.00	60.00	90.00											47.00	94.00	141.00				30.00	60.00	60.00				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												
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												29							29												29						29					29			29								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	4		Y	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												
H4513	026	0	1	01	01	H4513_026_0	4		Y	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										1		3
H4513	026	0	1	01	01	H4513_026_0	4		Y	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								15.00	30.00	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												
H4513	026	0	1	01	01	H4513_026_0	4		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4513	026	0	1	01	01	H4513_026_0	4		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4513	026	0	1	01	01	H4513_026_0	4		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											854.55	33						697.69	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4513	030	0	1	01	01	H4513_030_0	4		Y	Preferred Generic	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		Y	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		Y	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	40.00					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		Y	Generic	4	01	1	2	2	3		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	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		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4513	030	0	1	01	01	H4513_030_0	4		Y	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											91.50	36	36	36				97.86	36	36	36										36	36	36				36	36	36			36			36								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4513	030	0	1	01	01	H4513_030_0	4		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											661.49	29						611.83	29												29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4513	036	0	1	02	01	H4513_036_0	4		Y	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					3.00	6.00	6.00											10.00	20.00	30.00				3.00	6.00	0.00				10.00				10.00			0.33	0.10		0.33	0.10	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4513	036	0	1	02	01	H4513_036_0	4		Y	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					12.00	24.00	24.00											20.00	40.00	60.00				12.00	24.00	0.00				20.00				20.00			0.67	0.40		0.67	0.40	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4513	036	0	1	02	01	H4513_036_0	4		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4513	036	0	1	02	01	H4513_036_0	4		Y	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											98.49	38	38	38				91.17	38	38	38										38	38	38				38	38	38			38			38								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4513	036	0	1	02	01	H4513_036_0	4		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											797.15	29						646.29	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		Y	Preferred Generic	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		Y	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	40.00					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		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4513	037	0	1	01	01	H4513_037_0	4		Y	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											86.27	43	43	43				93.65	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		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											848.84	33						632.17	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		Y	Preferred Generic	4	01	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		Y	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					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	038	0	1	01	01	H4513_038_0	4		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4513	038	0	1	01	01	H4513_038_0	4		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4513	038	0	1	01	01	H4513_038_0	4		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											914.31	33						676.33	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		Y	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		Y	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		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4513	046	1	1	01	01	H4513_046_1	4		Y	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											99.03	38	38	38				97.90	38	38	38										38	38	38				38	38	38			38			38								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4513	046	1	1	01	01	H4513_046_1	4		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											572.34	30						587.26	30												30						30					30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4513	046	2	1	01	01	H4513_046_2	4		Y	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								9.00	18.00	27.00					2.00	4.00	4.00											9.00	18.00	27.00				2.00	4.00	0.00				9.00				9.00			0.30	0.07		0.30	0.07	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4513	046	2	1	01	01	H4513_046_2	4		Y	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	4		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4513	046	2	1	01	01	H4513_046_2	4		Y	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											99.03	38	38	38				97.90	38	38	38										38	38	38				38	38	38			38			38								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4513	046	2	1	01	01	H4513_046_2	4		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											572.34	30						587.26	30												30						30					30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4513	047	0	1	01	01	H4513_047_0	4		Y	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00				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		Y	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		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4513	047	0	1	01	01	H4513_047_0	4		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								100.00	200.00	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		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											750.70	33						720.10	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		Y	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00				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		Y	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		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4513	048	0	1	01	01	H4513_048_0	4		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								100.00	200.00	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		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											701.33	33						603.03	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		Y	Preferred Generic	4	01	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		Y	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					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		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4513	049	1	1	01	01	H4513_049_1	4		Y	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											93.30	50	50	50				88.75	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		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											885.48	33						773.32	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		Y	Preferred Generic	4	01	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		Y	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					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		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4513	049	2	1	01	01	H4513_049_2	4		Y	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											93.30	50	50	50				88.75	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		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											885.48	33						773.32	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4513	049	3	1	01	01	H4513_049_3	4		Y	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00				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	3	1	01	01	H4513_049_3	4		Y	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					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	3	1	01	01	H4513_049_3	4		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4513	049	3	1	01	01	H4513_049_3	4		Y	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											93.30	50	50	50				88.75	50	50	50										50	50	50				50	50	50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4513	049	3	1	01	01	H4513_049_3	4		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											885.48	33						773.32	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4513	049	4	1	01	01	H4513_049_4	4		Y	Preferred Generic	4	01	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	4	1	01	01	H4513_049_4	4		Y	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					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	4	1	01	01	H4513_049_4	4		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4513	049	4	1	01	01	H4513_049_4	4		Y	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											93.30	50	50	50				88.75	50	50	50										50	50	50				50	50	50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4513	049	4	1	01	01	H4513_049_4	4		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											885.48	33						773.32	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4513	049	5	1	01	01	H4513_049_5	4		Y	Preferred Generic	4	01	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	5	1	01	01	H4513_049_5	4		Y	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					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	5	1	01	01	H4513_049_5	4		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4513	049	5	1	01	01	H4513_049_5	4		Y	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											93.30	50	50	50				88.75	50	50	50										50	50	50				50	50	50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4513	049	5	1	01	01	H4513_049_5	4		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											885.48	33						773.32	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		Y	Preferred Generic	4	01	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		Y	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					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	050	0	1	01	01	H4513_050_0	4		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4513	050	0	1	01	01	H4513_050_0	4		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4513	050	0	1	01	01	H4513_050_0	4		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											860.32	33						709.36	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		Y	Preferred Generic	4	01	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		Y	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					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	051	0	1	01	01	H4513_051_0	4		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4513	051	0	1	01	01	H4513_051_0	4		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4513	051	0	1	01	01	H4513_051_0	4		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											1021.91	33						866.56	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		Y	Preferred Generic	4	01	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		Y	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					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	052	0	1	01	01	H4513_052_0	4		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4513	052	0	1	01	01	H4513_052_0	4		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4513	052	0	1	01	01	H4513_052_0	4		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											972.14	33						689.81	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		Y	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								7.00	14.00	21.00					0.00	0.00	0.00											7.00	14.00	21.00				0.00	0.00	0.00				7.00				7.00			0.23	0.00		0.23	0.00	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4513	054	0	1	01	01	H4513_054_0	4		Y	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		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4513	054	0	1	01	01	H4513_054_0	4		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								100.00	200.00	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		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											780.23	33						632.02	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		Y	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								7.00	14.00	21.00					0.00	0.00	0.00											7.00	14.00	21.00				0.00	0.00	0.00				7.00				7.00			0.23	0.00		0.23	0.00	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4513	057	0	1	01	01	H4513_057_0	4		Y	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		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4513	057	0	1	01	01	H4513_057_0	4		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								100.00	200.00	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		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											834.54	33						701.58	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		Y	Preferred Generic	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		Y	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	40.00					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		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4513	059	0	1	01	01	H4513_059_0	4		Y	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											98.65	44	44	44				93.79	44	44	44										44	44	44				44	44	44			44			44								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4513	059	0	1	01	01	H4513_059_0	4		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											973.31	33						862.22	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4513	061	1	1	01	01	H4513_061_1	4		Y	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												
H4513	061	1	1	01	01	H4513_061_1	4		Y	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										1		3
H4513	061	1	1	01	01	H4513_061_1	4		Y	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								15.00	30.00	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												
H4513	061	1	1	01	01	H4513_061_1	4		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4513	061	1	1	01	01	H4513_061_1	4		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4513	061	1	1	01	01	H4513_061_1	4		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											861.38	33						711.66	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4513	061	2	1	01	01	H4513_061_2	4		Y	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												
H4513	061	2	1	01	01	H4513_061_2	4		Y	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										1		3
H4513	061	2	1	01	01	H4513_061_2	4		Y	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								15.00	30.00	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												
H4513	061	2	1	01	01	H4513_061_2	4		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4513	061	2	1	01	01	H4513_061_2	4		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4513	061	2	1	01	01	H4513_061_2	4		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											861.38	33						711.66	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4513	061	3	1	01	01	H4513_061_3	4		Y	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												
H4513	061	3	1	01	01	H4513_061_3	4		Y	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										1		3
H4513	061	3	1	01	01	H4513_061_3	4		Y	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								15.00	30.00	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												
H4513	061	3	1	01	01	H4513_061_3	4		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4513	061	3	1	01	01	H4513_061_3	4		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4513	061	3	1	01	01	H4513_061_3	4		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											861.38	33						711.66	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4513	061	4	1	01	01	H4513_061_4	4		Y	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												
H4513	061	4	1	01	01	H4513_061_4	4		Y	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										1		3
H4513	061	4	1	01	01	H4513_061_4	4		Y	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								15.00	30.00	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												
H4513	061	4	1	01	01	H4513_061_4	4		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4513	061	4	1	01	01	H4513_061_4	4		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4513	061	4	1	01	01	H4513_061_4	4		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											861.38	33						711.66	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4513	061	5	1	01	01	H4513_061_5	4		Y	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												
H4513	061	5	1	01	01	H4513_061_5	4		Y	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										1		3
H4513	061	5	1	01	01	H4513_061_5	4		Y	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								15.00	30.00	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												
H4513	061	5	1	01	01	H4513_061_5	4		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4513	061	5	1	01	01	H4513_061_5	4		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4513	061	5	1	01	01	H4513_061_5	4		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											861.38	33						711.66	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4513	064	0	1	01	01	H4513_064_0	5		Y	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												
H4513	064	0	1	01	01	H4513_064_0	5		Y	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										1		3
H4513	064	0	1	01	01	H4513_064_0	5		Y	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								15.00	30.00	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												
H4513	064	0	1	01	01	H4513_064_0	5		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4513	064	0	1	01	01	H4513_064_0	5		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4513	064	0	1	01	01	H4513_064_0	5		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											894.20	33						734.94	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4513	066	0	1	01	01	H4513_066_0	4		Y	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												
H4513	066	0	1	01	01	H4513_066_0	4		Y	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										1		3
H4513	066	0	1	01	01	H4513_066_0	4		Y	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								15.00	30.00	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												
H4513	066	0	1	01	01	H4513_066_0	4		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4513	066	0	1	01	01	H4513_066_0	4		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4513	066	0	1	01	01	H4513_066_0	4		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											856.99	33						709.47	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4513	068	1	1	01	01	H4513_068_1	4		Y	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00				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	068	1	1	01	01	H4513_068_1	4		Y	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					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	068	1	1	01	01	H4513_068_1	4		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4513	068	1	1	01	01	H4513_068_1	4		Y	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											97.30	42	42	42				92.76	42	42	42										42	42	42				42	42	42			42			42								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4513	068	1	1	01	01	H4513_068_1	4		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											783.09	30						694.69	30												30						30					30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4513	068	2	1	01	01	H4513_068_2	4		Y	Preferred Generic	4	01	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	068	2	1	01	01	H4513_068_2	4		Y	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					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	068	2	1	01	01	H4513_068_2	4		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4513	068	2	1	01	01	H4513_068_2	4		Y	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											97.30	42	42	42				92.76	42	42	42										42	42	42				42	42	42			42			42								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4513	068	2	1	01	01	H4513_068_2	4		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											783.09	30						694.69	30												30						30					30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4513	073	0	1	01	01	H4513_073_0	5		Y	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												
H4513	073	0	1	01	01	H4513_073_0	5		Y	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										1		3
H4513	073	0	1	01	01	H4513_073_0	5		Y	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								15.00	30.00	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												
H4513	073	0	1	01	01	H4513_073_0	5		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4513	073	0	1	01	01	H4513_073_0	5		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4513	073	0	1	01	01	H4513_073_0	5		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											852.03	33						720.55	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4513	074	0	1	01	01	H4513_074_0	5		Y	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												
H4513	074	0	1	01	01	H4513_074_0	5		Y	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										1		3
H4513	074	0	1	01	01	H4513_074_0	5		Y	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								15.00	30.00	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												
H4513	074	0	1	01	01	H4513_074_0	5		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4513	074	0	1	01	01	H4513_074_0	5		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4513	074	0	1	01	01	H4513_074_0	5		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											852.03	33						720.55	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4514	007	0	1	02	01	H4514_007_0	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4514	007	0	1	02	01	H4514_007_0	3		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H4514	007	0	1	02	01	H4514_007_0	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	14.00		42.00																											42.00						0.00				14.00				14.00		0.46						0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4514	007	0	1	02	01	H4514_007_0	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	14.00		42.00																											42.00						0.00				14.00				14.00		0.46						0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H4514	007	0	1	02	01	H4514_007_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4514	007	0	1	02	01	H4514_007_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4514	007	0	1	02	01	H4514_007_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				488.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4514	014	0	1	02	01	H4514_014_0	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4514	014	0	1	02	01	H4514_014_0	3		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H4514	014	0	1	02	01	H4514_014_0	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4514	014	0	1	02	01	H4514_014_0	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H4514	014	0	1	02	01	H4514_014_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4514	014	0	1	02	01	H4514_014_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4514	014	0	1	02	01	H4514_014_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				544.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4514	015	0	1	02	01	H4514_015_0	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4514	015	0	1	02	01	H4514_015_0	3		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H4514	015	0	1	02	01	H4514_015_0	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4514	015	0	1	02	01	H4514_015_0	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H4514	015	0	1	02	01	H4514_015_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						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	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4514	015	0	1	02	01	H4514_015_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				605.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4514	017	0	1	02	01	H4514_017_0	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4514	017	0	1	02	01	H4514_017_0	3		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H4514	017	0	1	02	01	H4514_017_0	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4514	017	0	1	02	01	H4514_017_0	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H4514	017	0	1	02	01	H4514_017_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4514	017	0	1	02	01	H4514_017_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4514	017	0	1	02	01	H4514_017_0	3		Y	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												
H4523	001	0	1	01	01	H4523_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												
H4523	001	0	1	01	01	H4523_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		
H4523	001	0	1	01	01	H4523_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					10.00	20.00	20.00											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												
H4523	001	0	1	01	01	H4523_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					10.00	20.00	20.00											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										1		
H4523	001	0	1	01	01	H4523_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												
H4523	001	0	1	01	01	H4523_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												
H4523	001	0	1	01	01	H4523_001_0	3			Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											780.79	29						623.21	29												29						29						29		29								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					10.00	20.00	20.00											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												
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					10.00	20.00	20.00											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										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											1024.56	29						614.40	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					10.00	20.00	20.00											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												
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					10.00	20.00	20.00											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										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											861.43	29						534.64	29												29						29						29		29								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					10.00	20.00	20.00											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												
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					10.00	20.00	20.00											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										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											980.59	29						623.22	29												29						29						29		29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4523	024	0	1	01	01	H4523_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								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					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	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	024	0	1	01	01	H4523_024_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	024	0	1	01	01	H4523_024_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	024	0	1	01	01	H4523_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												
H4523	024	0	1	01	01	H4523_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												
H4523	024	0	1	01	01	H4523_024_0	2			Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											967.57	30						526.80	30												30						30						30		30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4527	001	0	1	02	01	H4527_001_0	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4527	001	0	1	02	01	H4527_001_0	3		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H4527	001	0	1	02	01	H4527_001_0	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4527	001	0	1	02	01	H4527_001_0	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H4527	001	0	1	02	01	H4527_001_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						75.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4527	001	0	1	02	01	H4527_001_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4527	001	0	1	02	01	H4527_001_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				433.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4527	002	0	1	02	01	H4527_002_0	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4527	002	0	1	02	01	H4527_002_0	3		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H4527	002	0	1	02	01	H4527_002_0	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4527	002	0	1	02	01	H4527_002_0	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H4527	002	0	1	02	01	H4527_002_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											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	02	01	H4527_002_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											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	02	01	H4527_002_0	3		Y	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												
H4527	005	0	1	02	01	H4527_005_0	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4527	005	0	1	02	01	H4527_005_0	3		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H4527	005	0	1	02	01	H4527_005_0	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4527	005	0	1	02	01	H4527_005_0	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H4527	005	0	1	02	01	H4527_005_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4527	005	0	1	02	01	H4527_005_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4527	005	0	1	02	01	H4527_005_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				498.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4527	013	0	1	02	01	H4527_013_0	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4527	013	0	1	02	01	H4527_013_0	3		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H4527	013	0	1	02	01	H4527_013_0	3		Y	Generic	4	01	3	2	2	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												
H4527	013	0	1	02	01	H4527_013_0	3		Y	Generic	4	01	3	2	2	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		3
H4527	013	0	1	02	01	H4527_013_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4527	013	0	1	02	01	H4527_013_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4527	013	0	1	02	01	H4527_013_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				430.00	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		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4527	037	0	1	02	01	H4527_037_0	3		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H4527	037	0	1	02	01	H4527_037_0	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4527	037	0	1	02	01	H4527_037_0	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H4527	037	0	1	02	01	H4527_037_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4527	037	0	1	02	01	H4527_037_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4527	037	0	1	02	01	H4527_037_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				514.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4527	039	0	1	02	01	H4527_039_0	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4527	039	0	1	02	01	H4527_039_0	3		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H4527	039	0	1	02	01	H4527_039_0	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4527	039	0	1	02	01	H4527_039_0	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H4527	039	0	1	02	01	H4527_039_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						75.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4527	039	0	1	02	01	H4527_039_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4527	039	0	1	02	01	H4527_039_0	3		Y	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												
H4527	040	0	1	02	01	H4527_040_0	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4527	040	0	1	02	01	H4527_040_0	3		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H4527	040	0	1	02	01	H4527_040_0	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4527	040	0	1	02	01	H4527_040_0	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H4527	040	0	1	02	01	H4527_040_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						75.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4527	040	0	1	02	01	H4527_040_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4527	040	0	1	02	01	H4527_040_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				648.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4527	041	0	1	02	01	H4527_041_0	4		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4527	041	0	1	02	01	H4527_041_0	4		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H4527	041	0	1	02	01	H4527_041_0	4		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4527	041	0	1	02	01	H4527_041_0	4		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H4527	041	0	1	02	01	H4527_041_0	4		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						75.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4527	041	0	1	02	01	H4527_041_0	4		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4527	041	0	1	02	01	H4527_041_0	4		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				561.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4527	042	0	1	02	01	H4527_042_0	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4527	042	0	1	02	01	H4527_042_0	3		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H4527	042	0	1	02	01	H4527_042_0	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4527	042	0	1	02	01	H4527_042_0	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H4527	042	0	1	02	01	H4527_042_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						75.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4527	042	0	1	02	01	H4527_042_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4527	042	0	1	02	01	H4527_042_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				475.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4527	045	0	1	02	01	H4527_045_0	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4527	045	0	1	02	01	H4527_045_0	3		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H4527	045	0	1	02	01	H4527_045_0	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4527	045	0	1	02	01	H4527_045_0	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H4527	045	0	1	02	01	H4527_045_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4527	045	0	1	02	01	H4527_045_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4527	045	0	1	02	01	H4527_045_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				433.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
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			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
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	001	0	1	04	01	H4537_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	
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												
H4537	003	0	1	04	01	H4537_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												
H4537	003	0	1	04	01	H4537_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								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		3
H4537	003	0	1	04	01	H4537_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					2.00	4.00	6.00											3.00	6.00	9.00				2.00	4.00	0.00				3.00				3.00			0.1	0.07		0.1	0.07	0.1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4537	003	0	1	04	01	H4537_003_0	5			Generic	4	11	1	2	2	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								3.00	6.00	9.00					2.00	4.00	6.00											3.00	6.00	9.00				2.00	4.00	0.00				3.00				3.00			0.10	0.07		0.10	0.07	0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H4537	003	0	1	04	01	H4537_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												
H4537	003	0	1	04	01	H4537_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												
H4537	003	0	1	04	01	H4537_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												
H4537	003	0	1	04	01	H4537_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												
H4537	003	0	1	04	01	H4537_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	
H4544	001	0	1	04	01	H4544_001_0	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4544	001	0	1	04	01	H4544_001_0	3		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H4544	001	0	1	04	01	H4544_001_0	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4544	001	0	1	04	01	H4544_001_0	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H4544	001	0	1	04	01	H4544_001_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	45.00		135.00																											135.00						135.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4544	001	0	1	04	01	H4544_001_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						300.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4544	001	0	1	04	01	H4544_001_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				444.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4590	010	0	1	02	01	H4590_010_0	7		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4590	010	0	1	02	01	H4590_010_0	7		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H4590	010	0	1	02	01	H4590_010_0	7		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4590	010	0	1	02	01	H4590_010_0	7		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H4590	010	0	1	02	01	H4590_010_0	7		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						75.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4590	010	0	1	02	01	H4590_010_0	7		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4590	010	0	1	02	01	H4590_010_0	7		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				505.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4590	012	0	1	02	01	H4590_012_0	5		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4590	012	0	1	02	01	H4590_012_0	5		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H4590	012	0	1	02	01	H4590_012_0	5		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	7.00		21.00																											21.00						0.00				7.00				7.00		0.23						0.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4590	012	0	1	02	01	H4590_012_0	5		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	7.00		21.00																											21.00						0.00				7.00				7.00		0.23						0.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H4590	012	0	1	02	01	H4590_012_0	5		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4590	012	0	1	02	01	H4590_012_0	5		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4590	012	0	1	02	01	H4590_012_0	5		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				461.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4590	025	0	1	02	01	H4590_025_0	5		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4590	025	0	1	02	01	H4590_025_0	5		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H4590	025	0	1	02	01	H4590_025_0	5		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	14.00		42.00																											42.00						0.00				14.00				14.00		0.46						0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4590	025	0	1	02	01	H4590_025_0	5		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	14.00		42.00																											42.00						0.00				14.00				14.00		0.46						0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H4590	025	0	1	02	01	H4590_025_0	5		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4590	025	0	1	02	01	H4590_025_0	5		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4590	025	0	1	02	01	H4590_025_0	5		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				321.00	27																										27						27					27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4590	037	0	1	02	01	H4590_037_0	5		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4590	037	0	1	02	01	H4590_037_0	5		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H4590	037	0	1	02	01	H4590_037_0	5		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4590	037	0	1	02	01	H4590_037_0	5		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H4590	037	0	1	02	01	H4590_037_0	5		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						75.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4590	037	0	1	02	01	H4590_037_0	5		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4590	037	0	1	02	01	H4590_037_0	5		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				515.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4590	041	0	1	02	01	H4590_041_0	5		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4590	041	0	1	02	01	H4590_041_0	5		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H4590	041	0	1	02	01	H4590_041_0	5		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4590	041	0	1	02	01	H4590_041_0	5		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H4590	041	0	1	02	01	H4590_041_0	5		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4590	041	0	1	02	01	H4590_041_0	5		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4590	041	0	1	02	01	H4590_041_0	5		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				440.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4590	042	0	1	02	01	H4590_042_0	5		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4590	042	0	1	02	01	H4590_042_0	5		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H4590	042	0	1	02	01	H4590_042_0	5		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	14.00		42.00																											42.00						0.00				14.00				14.00		0.46						0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4590	042	0	1	02	01	H4590_042_0	5		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	14.00		42.00																											42.00						0.00				14.00				14.00		0.46						0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H4590	042	0	1	02	01	H4590_042_0	5		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4590	042	0	1	02	01	H4590_042_0	5		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4590	042	0	1	02	01	H4590_042_0	5		Y	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												
H4590	043	0	1	02	01	H4590_043_0	5		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4590	043	0	1	02	01	H4590_043_0	5		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H4590	043	0	1	02	01	H4590_043_0	5		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4590	043	0	1	02	01	H4590_043_0	5		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H4590	043	0	1	02	01	H4590_043_0	5		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4590	043	0	1	02	01	H4590_043_0	5		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4590	043	0	1	02	01	H4590_043_0	5		Y	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												
H4590	044	0	1	02	01	H4590_044_0	5		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4590	044	0	1	02	01	H4590_044_0	5		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H4590	044	0	1	02	01	H4590_044_0	5		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4590	044	0	1	02	01	H4590_044_0	5		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H4590	044	0	1	02	01	H4590_044_0	5		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						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	5		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4590	044	0	1	02	01	H4590_044_0	5		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				530.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4590	045	0	1	02	01	H4590_045_0	5		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4590	045	0	1	02	01	H4590_045_0	5		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H4590	045	0	1	02	01	H4590_045_0	5		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4590	045	0	1	02	01	H4590_045_0	5		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H4590	045	0	1	02	01	H4590_045_0	5		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						75.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4590	045	0	1	02	01	H4590_045_0	5		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4590	045	0	1	02	01	H4590_045_0	5		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				627.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4604	003	0	1	02	01	H4604_003_0	2		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4604	003	0	1	02	01	H4604_003_0	2		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H4604	003	0	1	02	01	H4604_003_0	2		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4604	003	0	1	02	01	H4604_003_0	2		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H4604	003	0	1	02	01	H4604_003_0	2		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4604	003	0	1	02	01	H4604_003_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4604	003	0	1	02	01	H4604_003_0	2		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				433.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4604	011	0	1	02	01	H4604_011_0	2		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4604	011	0	1	02	01	H4604_011_0	2		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H4604	011	0	1	02	01	H4604_011_0	2		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4604	011	0	1	02	01	H4604_011_0	2		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H4604	011	0	1	02	01	H4604_011_0	2		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4604	011	0	1	02	01	H4604_011_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4604	011	0	1	02	01	H4604_011_0	2		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				462.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4604	012	0	1	02	01	H4604_012_0	2		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4604	012	0	1	02	01	H4604_012_0	2		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H4604	012	0	1	02	01	H4604_012_0	2		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4604	012	0	1	02	01	H4604_012_0	2		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H4604	012	0	1	02	01	H4604_012_0	2		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4604	012	0	1	02	01	H4604_012_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4604	012	0	1	02	01	H4604_012_0	2		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				398.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4604	013	0	1	02	01	H4604_013_0	2		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4604	013	0	1	02	01	H4604_013_0	2		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H4604	013	0	1	02	01	H4604_013_0	2		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	8.00		24.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4604	013	0	1	02	01	H4604_013_0	2		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	8.00		24.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H4604	013	0	1	02	01	H4604_013_0	2		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4604	013	0	1	02	01	H4604_013_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4604	013	0	1	02	01	H4604_013_0	2		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				267.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4604	014	0	1	02	01	H4604_014_0	2		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4604	014	0	1	02	01	H4604_014_0	2		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H4604	014	0	1	02	01	H4604_014_0	2		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	6.00		18.00																											18.00						0.00				6.00				6.00		0.20						0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4604	014	0	1	02	01	H4604_014_0	2		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	6.00		18.00																											18.00						0.00				6.00				6.00		0.20						0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H4604	014	0	1	02	01	H4604_014_0	2		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4604	014	0	1	02	01	H4604_014_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4604	014	0	1	02	01	H4604_014_0	2		Y	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												
H4604	015	0	1	02	01	H4604_015_0	2		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4604	015	0	1	02	01	H4604_015_0	2		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H4604	015	0	1	02	01	H4604_015_0	2		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	7.00		21.00																											21.00						0.00				7.00				7.00		0.23						0.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4604	015	0	1	02	01	H4604_015_0	2		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	7.00		21.00																											21.00						0.00				7.00				7.00		0.23						0.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H4604	015	0	1	02	01	H4604_015_0	2		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4604	015	0	1	02	01	H4604_015_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4604	015	0	1	02	01	H4604_015_0	2		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				399.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4604	016	0	1	02	01	H4604_016_0	2		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4604	016	0	1	02	01	H4604_016_0	2		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H4604	016	0	1	02	01	H4604_016_0	2		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4604	016	0	1	02	01	H4604_016_0	2		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H4604	016	0	1	02	01	H4604_016_0	2		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4604	016	0	1	02	01	H4604_016_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4604	016	0	1	02	01	H4604_016_0	2		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				326.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4604	017	0	1	02	01	H4604_017_0	2		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4604	017	0	1	02	01	H4604_017_0	2		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H4604	017	0	1	02	01	H4604_017_0	2		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4604	017	0	1	02	01	H4604_017_0	2		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H4604	017	0	1	02	01	H4604_017_0	2		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4604	017	0	1	02	01	H4604_017_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4604	017	0	1	02	01	H4604_017_0	2		Y	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												
H4604	018	0	1	02	01	H4604_018_0	2		Y	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		100	2	2						100	30		31								10.00		30.00					0.00		0.00													30.00						0.00				10.00				10.00			0.33	0.00				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4604	018	0	1	02	01	H4604_018_0	2		Y	Preferred Generic	4	01	1	2	1	3		110	01		100	1				30		100	2	2						100	30		31								10.00		30.00					0.00		0.00													30.00						0.00				10.00				10.00			0.33	0.00				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H4604	018	0	1	02	01	H4604_018_0	2		Y	Generic	4	01	3	2	2	1		110	01		100	1				30		100	2	2						100	30		31								15.00		45.00					0.00		0.00													45.00						0.00				15.00				15.00			0.50	0.00				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4604	018	0	1	02	01	H4604_018_0	2		Y	Generic	4	01	3	2	2	3		110	01		100	1				30		100	2	2						100	30		31								15.00		45.00					0.00		0.00													45.00						0.00				15.00				15.00			0.50	0.00				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H4604	018	0	1	02	01	H4604_018_0	2		Y	Preferred Brand	4	11	1	2	3	1		110	01		100	1				30		100	2	2						100	30		31								47.00		141.00					47.00		131.00													141.00						131.00				47.00				47.00			1.56	1.56				1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4604	018	0	1	02	01	H4604_018_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1		110	01		100	1				30		100	2	2						100	30		31								100.00		300.00					100.00		290.00													300.00						290.00				100.00				100.00			3.33	3.33				3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4604	018	0	1	02	01	H4604_018_0	2		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											244.00	33						320.00	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4604	020	0	1	02	01	H4604_020_0	2		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4604	020	0	1	02	01	H4604_020_0	2		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H4604	020	0	1	02	01	H4604_020_0	2		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4604	020	0	1	02	01	H4604_020_0	2		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H4604	020	0	1	02	01	H4604_020_0	2		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4604	020	0	1	02	01	H4604_020_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4604	020	0	1	02	01	H4604_020_0	2		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				458.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4604	022	0	1	02	01	H4604_022_0	2		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4604	022	0	1	02	01	H4604_022_0	2		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H4604	022	0	1	02	01	H4604_022_0	2		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	8.00		24.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4604	022	0	1	02	01	H4604_022_0	2		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	8.00		24.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H4604	022	0	1	02	01	H4604_022_0	2		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4604	022	0	1	02	01	H4604_022_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4604	022	0	1	02	01	H4604_022_0	2		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				366.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4605	002	0	1	04	01	H4605_002_0	8		Y	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	8		Y	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	8		Y	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	100	1	2	30	60	100				30		31								47.00	94.00	117.50					40.00	80.00	100.00					40.00	80.00	100.00																47.00				47.00			1.57	1.33	1.33			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4605	002	0	1	04	01	H4605_002_0	8		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	100	1	2	30	60	100				30		31								100.00	200.00	250.00					100.00	200.00	250.00					100.00	200.00	250.00																100.00				100.00			3.33	3.33	3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4605	002	0	1	04	01	H4605_002_0	8		Y	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											1035.40	31						1035.40	31						31																	31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4605	004	0	1	04	01	H4605_004_0	9		Y	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	9		Y	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	9		Y	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	100	1	2	30	60	100				30		31								47.00	94.00	117.50					40.00	80.00	100.00					40.00	80.00	100.00																47.00				47.00			1.57	1.33	1.33			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4605	004	0	1	04	01	H4605_004_0	9		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	100	1	2	30	60	100				30		31								100.00	200.00	250.00					100.00	200.00	250.00					100.00	200.00	250.00																100.00				100.00			3.33	3.33	3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4605	004	0	1	04	01	H4605_004_0	9		Y	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											1138.94	33						1138.94	33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4605	007	0	1	04	01	H4605_007_0	9		Y	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	9		Y	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	9		Y	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	100	1	2	30	60	100				30		31								47.00	94.00	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	9		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	100	1	2	30	60	100				30		31								100.00	200.00	300.00					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												
H4605	007	0	1	04	01	H4605_007_0	9		Y	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											1069.92	30						1069.92	30						30																	30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4605	008	0	1	04	01	H4605_008_0	9		Y	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	9		Y	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	9		Y	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	100	1	2	30	60	100				30		31								47.00	94.00	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	9		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	100	1	2	30	60	100				30		31								100.00	200.00	300.00					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												
H4605	008	0	1	04	01	H4605_008_0	9		Y	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											1000.89	29						1000.89	29						29																	29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4605	009	0	1	04	01	H4605_009_0	8		Y	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	8		Y	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	8		Y	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	100	1	2	30	60	100				30		31								47.00	94.00	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	8		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	100	1	2	30	60	100				30		31								100.00	200.00	250.00					100.00	200.00	250.00					100.00	200.00	250.00																100.00				100.00			3.33	3.33	3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4605	009	0	1	04	01	H4605_009_0	8		Y	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											1035.40	30						1035.40	30						30																	30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4620	001	0	1	04	01	H4620_001_0	6		Y	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												
H4620	001	0	1	04	01	H4620_001_0	6		Y	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					5.00	10.00	15.00							12.50																12.00				12.00			0.40	0.17				0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4620	001	0	1	04	01	H4620_001_0	6		Y	Preferred Brand	4	10	1	2	3	1		111	01	100		1				30	60	90	1	2			90				30		31								47.00	94.00	141.00					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												
H4620	001	0	1	04	01	H4620_001_0	6		Y	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												
H4620	001	0	1	04	01	H4620_001_0	6		Y	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4623	001	0	1	02	01	H4623_001_0	3		Y	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4623	001	0	1	02	01	H4623_001_0	3		Y	Preferred Generic	4	11	3	2	1	3	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H4623	001	0	1	02	01	H4623_001_0	3		Y	Generic	4	11	3	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	0.00		0.00																									20.00		60.00				0.00		0.00				0.00				0.00		0				0.67	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4623	001	0	1	02	01	H4623_001_0	3		Y	Generic	4	11	3	2	2	3	110		01		110	1	30		90				2	2				30		90	30		31	0.00		0.00																									20.00		60.00				0.00		0.00				0.00				0.00		0				0.67	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H4623	001	0	1	02	01	H4623_001_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4623	001	0	1	02	01	H4623_001_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	99.00		297.00																									100.00		300.00				99.00		287.00				99.00				99.00		3.30				3.33	3.30	3.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4623	001	0	1	02	01	H4623_001_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4623	002	0	1	02	01	H4623_002_0	3		Y	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4623	002	0	1	02	01	H4623_002_0	3		Y	Preferred Generic	4	11	3	2	1	3	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H4623	002	0	1	02	01	H4623_002_0	3		Y	Generic	4	11	3	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	0.00		0.00																									20.00		60.00				0.00		0.00				0.00				0.00		0				0.67	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4623	002	0	1	02	01	H4623_002_0	3		Y	Generic	4	11	3	2	2	3	110		01		110	1	30		90				2	2				30		90	30		31	0.00		0.00																									20.00		60.00				0.00		0.00				0.00				0.00		0				0.67	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H4623	002	0	1	02	01	H4623_002_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4623	002	0	1	02	01	H4623_002_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	99.00		297.00																									100.00		300.00				99.00		287.00				99.00				99.00		3.30				3.33	3.30	3.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4623	002	0	1	02	01	H4623_002_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4624	001	0	1	01	01	H4624_001_0	10		Y	Preferred Generic	4	11	1	2	1	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4624	001	0	1	01	01	H4624_001_0	10		Y	Preferred Generic	4	11	1	2	1	3	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H4624	001	0	1	01	01	H4624_001_0	10		Y	Generic	4	11	3	2	2	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	5.00	10.00	15.00																			0.00	0.00	0.00																5.00				5.00		0.17			0.00			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4624	001	0	1	01	01	H4624_001_0	10		Y	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	47.00	94.00	141.00																			47.00	94.00	94.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4624	001	0	1	01	01	H4624_001_0	10		Y	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	100.00	200.00	300.00																			100.00	200.00	200.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4624	001	0	1	01	01	H4624_001_0	10		Y	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31					33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4624	002	0	1	02	01	H4624_002_0	9		Y	Preferred Generic	4	11	1	2	1	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4624	002	0	1	02	01	H4624_002_0	9		Y	Preferred Generic	4	11	1	2	1	3	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H4624	002	0	1	02	01	H4624_002_0	9		Y	Generic	4	11	3	2	2	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	5.00	10.00	15.00																			0.00	0.00	0.00																5.00				5.00		0.17			0.00			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4624	002	0	1	02	01	H4624_002_0	9		Y	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	47.00	94.00	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												
H4624	002	0	1	02	01	H4624_002_0	9		Y	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	100.00	200.00	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												
H4624	002	0	1	02	01	H4624_002_0	9		Y	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31					33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4624	003	0	1	01	01	H4624_003_0	9		Y	Preferred Generic	4	11	1	2	1	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4624	003	0	1	01	01	H4624_003_0	9		Y	Preferred Generic	4	11	1	2	1	3	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H4624	003	0	1	01	01	H4624_003_0	9		Y	Generic	4	11	3	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 Drug, Specialty Tier												
H4624	003	0	1	01	01	H4624_003_0	9		Y	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	47.00	94.00	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												
H4624	003	0	1	01	01	H4624_003_0	9		Y	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	100.00	200.00	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												
H4624	003	0	1	01	01	H4624_003_0	9		Y	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31					33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4624	006	0	1	01	01	H4624_006_0	9		Y	Preferred Generic	4	11	1	2	1	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4624	006	0	1	01	01	H4624_006_0	9		Y	Preferred Generic	4	11	1	2	1	3	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H4624	006	0	1	01	01	H4624_006_0	9		Y	Generic	4	11	3	2	2	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	5.00	10.00	15.00																			0.00	0.00	0.00																5.00				5.00		0.17			0.00			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4624	006	0	1	01	01	H4624_006_0	9		Y	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	47.00	94.00	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												
H4624	006	0	1	01	01	H4624_006_0	9		Y	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	100.00	200.00	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												
H4624	006	0	1	01	01	H4624_006_0	9		Y	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31					33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4624	007	0	1	02	01	H4624_007_0	9		Y	Preferred Generic	4	11	1	2	1	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4624	007	0	1	02	01	H4624_007_0	9		Y	Preferred Generic	4	11	1	2	1	3	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H4624	007	0	1	02	01	H4624_007_0	9		Y	Generic	4	11	3	2	2	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	5.00	10.00	15.00																			0.00	0.00	0.00																5.00				5.00		0.17			0.00			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4624	007	0	1	02	01	H4624_007_0	9		Y	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	47.00	94.00	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												
H4624	007	0	1	02	01	H4624_007_0	9		Y	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	100.00	200.00	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												
H4624	007	0	1	02	01	H4624_007_0	9		Y	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31					33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4624	010	0	1	01	01	H4624_010_0	9		Y	Preferred Generic	4	11	1	2	1	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4624	010	0	1	01	01	H4624_010_0	9		Y	Preferred Generic	4	11	1	2	1	3	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H4624	010	0	1	01	01	H4624_010_0	9		Y	Generic	4	11	3	2	2	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	5.00	10.00	15.00																			0.00	0.00	0.00																5.00				5.00		0.17			0.00			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4624	010	0	1	01	01	H4624_010_0	9		Y	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	47.00	94.00	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												
H4624	010	0	1	01	01	H4624_010_0	9		Y	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	100.00	200.00	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												
H4624	010	0	1	01	01	H4624_010_0	9		Y	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31					33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4624	011	0	1	01	01	H4624_011_0	9		Y	Preferred Generic	4	11	1	2	1	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4624	011	0	1	01	01	H4624_011_0	9		Y	Preferred Generic	4	11	1	2	1	3	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H4624	011	0	1	01	01	H4624_011_0	9		Y	Generic	4	11	3	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 Drug, Specialty Tier												
H4624	011	0	1	01	01	H4624_011_0	9		Y	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	47.00	94.00	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												
H4624	011	0	1	01	01	H4624_011_0	9		Y	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	100.00	200.00	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												
H4624	011	0	1	01	01	H4624_011_0	9		Y	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31					33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4624	012	0	1	01	01	H4624_012_0	9		Y	Preferred Generic	4	11	1	2	1	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4624	012	0	1	01	01	H4624_012_0	9		Y	Preferred Generic	4	11	1	2	1	3	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H4624	012	0	1	01	01	H4624_012_0	9		Y	Generic	4	11	3	2	2	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	5.00	10.00	15.00																			0.00	0.00	0.00																5.00				5.00		0.17			0.00			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4624	012	0	1	01	01	H4624_012_0	9		Y	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	47.00	94.00	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												
H4624	012	0	1	01	01	H4624_012_0	9		Y	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	100.00	200.00	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												
H4624	012	0	1	01	01	H4624_012_0	9		Y	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31					33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4624	015	0	1	02	01	H4624_015_0	10		Y	Preferred Generic	4	11	1	2	1	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4624	015	0	1	02	01	H4624_015_0	10		Y	Preferred Generic	4	11	1	2	1	3	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H4624	015	0	1	02	01	H4624_015_0	10		Y	Generic	4	11	3	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 Drug, Specialty Tier												
H4624	015	0	1	02	01	H4624_015_0	10		Y	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	47.00	94.00	141.00																			47.00	94.00	94.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4624	015	0	1	02	01	H4624_015_0	10		Y	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	100.00	200.00	300.00																			100.00	200.00	200.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4624	015	0	1	02	01	H4624_015_0	10		Y	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31					33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4624	016	0	1	02	01	H4624_016_0	8		N	Preferred Generic	4	11	1	2	1	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4624	016	0	1	02	01	H4624_016_0	8		N	Generic	4	11	3	1	2	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31				19.00	25	25	25																		0	0	0															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4624	016	0	1	02	01	H4624_016_0	8		N	Preferred Brand	4	11	1	1	3	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31				121.00	25	25	25																		25	25	25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4624	016	0	1	02	01	H4624_016_0	8		N	Non-Preferred Drug	4	11	1	1	4	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31				91.00	25	25	25																		25	25	25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4624	016	0	1	02	01	H4624_016_0	8		N	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 Drug, Specialty Tier												
H4624	017	0	1	02	01	H4624_017_0	9		Y	Preferred Generic	4	11	1	2	1	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4624	017	0	1	02	01	H4624_017_0	9		Y	Preferred Generic	4	11	1	2	1	3	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H4624	017	0	1	02	01	H4624_017_0	9		Y	Generic	4	11	3	2	2	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	5.00	10.00	15.00																			0.00	0.00	0.00																5.00				5.00		0.17			0.00			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4624	017	0	1	02	01	H4624_017_0	9		Y	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	47.00	94.00	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												
H4624	017	0	1	02	01	H4624_017_0	9		Y	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	100.00	200.00	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												
H4624	017	0	1	02	01	H4624_017_0	9		Y	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31					33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4624	018	0	1	02	01	H4624_018_0	8		N	Preferred Generic	4	11	1	2	1	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4624	018	0	1	02	01	H4624_018_0	8		N	Generic	4	11	3	1	2	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31				21.00	25	25	25																		0	0	0															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4624	018	0	1	02	01	H4624_018_0	8		N	Preferred Brand	4	11	1	1	3	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31				120.00	25	25	25																		25	25	25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4624	018	0	1	02	01	H4624_018_0	8		N	Non-Preferred Drug	4	11	1	1	4	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31				89.00	25	25	25																		25	25	25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4624	018	0	1	02	01	H4624_018_0	8		N	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 Drug, Specialty Tier												
H4624	019	0	1	01	01	H4624_019_0	8		N	Preferred Generic	4	11	1	2	1	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4624	019	0	1	01	01	H4624_019_0	8		N	Generic	4	11	3	1	2	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31				21.00	25	25	25																		0	0	0															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4624	019	0	1	01	01	H4624_019_0	8		N	Preferred Brand	4	11	1	1	3	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31				121.00	25	25	25																		25	25	25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4624	019	0	1	01	01	H4624_019_0	8		N	Non-Preferred Drug	4	11	1	1	4	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31				93.00	25	25	25																		25	25	25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4624	019	0	1	01	01	H4624_019_0	8		N	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 Drug, Specialty Tier												
H4624	020	0	1	01	01	H4624_020_0	11		Y	Preferred Generic	4	11	1	2	1	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4624	020	0	1	01	01	H4624_020_0	11		Y	Preferred Generic	4	11	1	2	1	3	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H4624	020	0	1	01	01	H4624_020_0	11		Y	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																			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												
H4624	020	0	1	01	01	H4624_020_0	11		Y	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	47.00	94.00	141.00																			47.00	94.00	94.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4624	020	0	1	01	01	H4624_020_0	11		Y	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	100.00	200.00	300.00																			100.00	200.00	200.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4624	020	0	1	01	01	H4624_020_0	11		Y	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31					33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4624	021	0	1	01	01	H4624_021_0	11		Y	Preferred Generic	4	11	1	2	1	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4624	021	0	1	01	01	H4624_021_0	11		Y	Preferred Generic	4	11	1	2	1	3	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H4624	021	0	1	01	01	H4624_021_0	11		Y	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																			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												
H4624	021	0	1	01	01	H4624_021_0	11		Y	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	47.00	94.00	141.00																			47.00	94.00	94.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4624	021	0	1	01	01	H4624_021_0	11		Y	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	100.00	200.00	300.00																			100.00	200.00	200.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4624	021	0	1	01	01	H4624_021_0	11		Y	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31					33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4675	001	0	1	01	01	H4675_001_0	8		Y	Preferred Generic	4	11	1	2	1	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				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	8		Y	Generic	4	01	1	2	2	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	8.00	16.00	24.00																									8.00	16.00	24.00				4.00	8.00	12.00				8.00				8.00		0.27				0.27	0.13	0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4675	001	0	1	01	01	H4675_001_0	8		Y	Preferred Brand	4	11	1	2	3	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	47.00	94.00	141.00																									47.00	94.00	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, Select Care Drugs												
H4675	001	0	1	01	01	H4675_001_0	8		Y	Non-Preferred Drug	4	11	1	2	4	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	100.00	200.00	300.00																									100.00	200.00	300.00				100.00	200.00	300.00				100.00				100.00		3.33				3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4675	001	0	1	01	01	H4675_001_0	8		Y	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31				755.00	30																																					30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4675	001	0	1	01	01	H4675_001_0	8		Y	Select Care Drugs	4	01	1	2	6	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4676	001	0	1	01	01	H4676_001_0	11		Y	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, Vaccines												
H4676	001	0	1	01	01	H4676_001_0	11		Y	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, Vaccines										1		
H4676	001	0	1	01	01	H4676_001_0	11		Y	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, Vaccines												
H4676	001	0	1	01	01	H4676_001_0	11		Y	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, Vaccines												
H4676	001	0	1	01	01	H4676_001_0	11		Y	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, Vaccines												
H4676	001	0	1	01	01	H4676_001_0	11		Y	Specialty Tier	4	11	1	1	5	1		111	01			1				30	60	90	2	1							30		31											1042.15	33	33	33				1053.63	33	33	33																					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H4676	001	0	1	01	01	H4676_001_0	11		Y	Vaccines	4	11	1	2	6	1		010	01			1				30											30		31								0.00							0.00																									0.00				0.00			0.00	0.00				0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H4676	001	0	1	01	01	H4676_001_0	11		Y	Vaccines	4	11	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		
H4699	001	0	1	04	01	H4699_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												
H4699	001	0	1	04	01	H4699_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												
H4699	001	0	1	04	01	H4699_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												
H4699	001	0	1	04	01	H4699_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											86.56	45	45	45				82.72	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	4			Specialty Tier	4	11	1	1	5	1		010	01		010	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	4			Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			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	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	
H4699	002	0	1	04	01	H4699_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												
H4699	002	0	1	04	01	H4699_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												
H4699	002	0	1	04	01	H4699_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												
H4699	002	0	1	04	01	H4699_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											94.17	50	50	50				90.40	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	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												
H4699	002	0	1	04	01	H4699_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												
H4699	002	0	1	04	01	H4699_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	
H4699	004	0	1	04	01	H4699_004_0	4			Preferred Generic	4	11	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								19.00	38.00	57.00					0.00	0.00	0.00											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												
H4699	004	0	1	04	01	H4699_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	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												
H4699	004	0	1	04	01	H4699_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	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, Select Care Drugs												
H4699	004	0	1	04	01	H4699_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											98.59	45	45	45				98.59	45	45	45										45	45	45				45	45	45			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4699	004	0	1	04	01	H4699_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												
H4699	004	0	1	04	01	H4699_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												
H4711	001	0	1	02	01	H4711_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					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												
H4711	001	0	1	02	01	H4711_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					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		
H4711	001	0	1	02	01	H4711_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					5.00	10.00	10.00											20.00	40.00	60.00				5.00	10.00	10.00					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	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		
H4711	001	0	1	02	01	H4711_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												
H4711	001	0	1	02	01	H4711_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												
H4711	001	0	1	02	01	H4711_001_0	3			Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1108.12	33						554.98	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4711	002	0	1	02	01	H4711_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												
H4711	002	0	1	02	01	H4711_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		
H4711	002	0	1	02	01	H4711_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	20.00											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												
H4711	002	0	1	02	01	H4711_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	20.00											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										1		
H4711	002	0	1	02	01	H4711_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												
H4711	002	0	1	02	01	H4711_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												
H4711	002	0	1	02	01	H4711_002_0	3			Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1370.09	33						794.97	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	20.00											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												
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	20.00											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										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											1131.32	33						584.26	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					10.00	20.00	20.00											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												
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					10.00	20.00	20.00											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										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											670.04	33						719.25	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					10.00	20.00	20.00											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												
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					10.00	20.00	20.00											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										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											998.98	33						651.62	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	20.00											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												
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	20.00											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										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											706.50	33						544.55	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	20.00											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												
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	20.00											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										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											933.19	33						729.70	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4739	001	0	1	01	01	H4739_001_0	7		N	Generic	2	01	1	2	1	1	111		01	100		1	30	60	100				1	2			100				30		31	7.00	14.00	21.00																					21.00																7.00				7.00		0.23						0.23	Generic, Brand												
H4739	001	0	1	01	01	H4739_001_0	7		N	Brand	2	11	1	1	2	1	111		01	100		1	30	60	100				1	2			100				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											95.90	33	33	33				83.02	31	31	31										33	33	33				31	31	31			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
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												33							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											81.95	32	32	32				79.90	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												30							30												30						30					30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4754	007	0	1	04	01	H4754_007_0	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	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												
H4754	009	0	1	04	01	H4754_009_0	5			Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								17.00	34.00	51.00					12.00	24.00	36.00											17.00	34.00	51.00				12.00	24.00	24.00				17.00				17.00			0.57	0.40		0.57	0.40	0.55	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4754	009	0	1	04	01	H4754_009_0	5			Preferred Brand	4	10	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											47.00	94.00	141.00				37.00	74.00	74.00				47.00				47.00			1.57	1.23		1.57	1.23	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4754	009	0	1	04	01	H4754_009_0	5			Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											88.03	31	31	31				88.63	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	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												
H4754	009	0	1	04	01	H4754_009_0	5			Select Care Drugs	4	01	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4754	009	0	1	04	01	H4754_009_0	5			Select Care Drugs	4	01	1	2	6	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H4754	011	0	1	04	01	H4754_011_0	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					39.00	78.00	117.00											47.00	94.00	141.00				39.00	78.00	78.00				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												
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											91.01	30	30	30				89.11	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												30							30												30						30					30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4754	011	0	1	04	01	H4754_011_0	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	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	017	0	1	04	01	H4754_017_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	017	0	1	04	01	H4754_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					37.00	74.00	111.00											47.00	94.00	141.00				37.00	74.00	74.00				47.00				47.00			1.57	1.23		1.57	1.23	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4754	017	0	1	04	01	H4754_017_0	4			Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											95.24	32	32	32				94.37	31	31	31										32	32	32				31	31	31			32			32								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4754	017	0	1	04	01	H4754_017_0	4			Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												29							29												29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4754	017	0	1	04	01	H4754_017_0	4			Select Care Drugs	4	01	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4754	017	0	1	04	01	H4754_017_0	4			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	6			Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	100	1	2				30	60	100	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												
H4801	001	0	1	04	01	H4801_001_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					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												
H4801	001	0	1	04	01	H4801_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					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												
H4801	001	0	1	04	01	H4801_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					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												
H4801	001	0	1	04	01	H4801_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												
H4801	002	0	1	04	01	H4801_002_0	6			Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	100	1	2				30	60	100	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												
H4801	002	0	1	04	01	H4801_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					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												
H4801	002	0	1	04	01	H4801_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					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												
H4801	002	0	1	04	01	H4801_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					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												
H4801	002	0	1	04	01	H4801_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												
H4801	003	0	1	04	01	H4801_003_0	6			Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	100	1	2				30	60	100	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												
H4801	003	0	1	04	01	H4801_003_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					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												
H4801	003	0	1	04	01	H4801_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					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												
H4801	003	0	1	04	01	H4801_003_0	6			Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	300.00					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												
H4801	003	0	1	04	01	H4801_003_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												
H4801	004	0	1	04	01	H4801_004_0	6			Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	100	1	2				30	60	100	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												
H4801	004	0	1	04	01	H4801_004_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					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												
H4801	004	0	1	04	01	H4801_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					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												
H4801	004	0	1	04	01	H4801_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					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												
H4801	004	0	1	04	01	H4801_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												
H4801	005	0	1	04	01	H4801_005_0	6			Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	100	1	2				30	60	100	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												
H4801	005	0	1	04	01	H4801_005_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					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												
H4801	005	0	1	04	01	H4801_005_0	6			Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					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												
H4801	005	0	1	04	01	H4801_005_0	6			Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	300.00					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												
H4801	005	0	1	04	01	H4801_005_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												
H4801	006	0	1	04	01	H4801_006_0	6			Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	100	1	2				30	60	100	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												
H4801	006	0	1	04	01	H4801_006_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					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												
H4801	006	0	1	04	01	H4801_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					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												
H4801	006	0	1	04	01	H4801_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								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												
H4801	006	0	1	04	01	H4801_006_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												
H4801	007	0	1	04	01	H4801_007_0	6			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											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												
H4801	007	0	1	04	01	H4801_007_0	6			Preferred Generic	4	01	1	2	1	3		111	01		111	1				30	60	100	1	2				30	60	100	30		31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	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		
H4801	007	0	1	04	01	H4801_007_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											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												
H4801	007	0	1	04	01	H4801_007_0	6			Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	94.00				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												
H4801	007	0	1	04	01	H4801_007_0	6			Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00				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	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												
H4801	008	0	1	04	01	H4801_008_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					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												
H4801	008	0	1	04	01	H4801_008_0	7			Preferred Generic	4	01	1	2	1	3		111	01		111	1				30	60	100	1	2				30	60	100	30		31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	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		
H4801	008	0	1	04	01	H4801_008_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											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												
H4801	008	0	1	04	01	H4801_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					47.00	94.00	141.00											47.00	94.00	94.00				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												
H4801	008	0	1	04	01	H4801_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					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00				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	7			Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												29							29												29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4801	009	0	1	04	01	H4801_009_0	6			Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	100	1	2				30	60	100	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												
H4801	009	0	1	04	01	H4801_009_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					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												
H4801	009	0	1	04	01	H4801_009_0	6			Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					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												
H4801	009	0	1	04	01	H4801_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					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												
H4801	009	0	1	04	01	H4801_009_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												
H4801	010	0	1	04	01	H4801_010_0	6			Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00				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	010	0	1	04	01	H4801_010_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					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												
H4801	010	0	1	04	01	H4801_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								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												
H4801	010	0	1	04	01	H4801_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								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												
H4801	010	0	1	04	01	H4801_010_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												
H4801	011	0	1	04	01	H4801_011_0	6			Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	100	1	2				30	60	100	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												
H4801	011	0	1	04	01	H4801_011_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					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												
H4801	011	0	1	04	01	H4801_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					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												
H4801	011	0	1	04	01	H4801_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					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												
H4801	011	0	1	04	01	H4801_011_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												
H4801	012	0	1	04	01	H4801_012_0	6			Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	100	1	2				30	60	100	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												
H4801	012	0	1	04	01	H4801_012_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					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												
H4801	012	0	1	04	01	H4801_012_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					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												
H4801	012	0	1	04	01	H4801_012_0	6			Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		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												
H4801	012	0	1	04	01	H4801_012_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												
H4801	013	0	1	04	01	H4801_013_0	5			Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	100	1	2				30	60	100	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												
H4801	013	0	1	04	01	H4801_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											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												
H4801	013	0	1	04	01	H4801_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					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												
H4801	013	0	1	04	01	H4801_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					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												
H4801	013	0	1	04	01	H4801_013_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												
H4801	014	0	1	04	01	H4801_014_0	5			Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	100	1	2				30	60	100	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												
H4801	014	0	1	04	01	H4801_014_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												
H4801	014	0	1	04	01	H4801_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					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												
H4801	014	0	1	04	01	H4801_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					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												
H4801	014	0	1	04	01	H4801_014_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												
H4801	015	0	1	04	01	H4801_015_0	6			Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	100	1	2				30	60	100	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												
H4801	015	0	1	04	01	H4801_015_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					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												
H4801	015	0	1	04	01	H4801_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								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												
H4801	015	0	1	04	01	H4801_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	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												
H4801	015	0	1	04	01	H4801_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												
H4801	016	0	1	04	01	H4801_016_0	6			Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	100	1	2				30	60	100	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												
H4801	016	0	1	04	01	H4801_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	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												
H4801	016	0	1	04	01	H4801_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					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												
H4801	016	0	1	04	01	H4801_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	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												
H4801	016	0	1	04	01	H4801_016_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												
H4801	017	0	1	04	01	H4801_017_0	6			Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	100	1	2				30	60	100	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												
H4801	017	0	1	04	01	H4801_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					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												
H4801	017	0	1	04	01	H4801_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					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												
H4801	017	0	1	04	01	H4801_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					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												
H4801	017	0	1	04	01	H4801_017_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												
H4801	018	0	1	04	01	H4801_018_0	6			Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	100	1	2				30	60	100	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												
H4801	018	0	1	04	01	H4801_018_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					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												
H4801	018	0	1	04	01	H4801_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					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												
H4801	018	0	1	04	01	H4801_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					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												
H4801	018	0	1	04	01	H4801_018_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												
H4801	021	0	1	04	01	H4801_021_0	8			Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	100	1	2				30	60	100	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												
H4801	021	0	1	04	01	H4801_021_0	8			Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					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												
H4801	021	0	1	04	01	H4801_021_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					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												
H4801	021	0	1	04	01	H4801_021_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					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												
H4801	021	0	1	04	01	H4801_021_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												
H4808	001	0	1	04	01	H4808_001_0	9		Y	Preferred Generic	4	11	1	2	1	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4808	001	0	1	04	01	H4808_001_0	9		Y	Preferred Generic	4	11	1	2	1	3	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H4808	001	0	1	04	01	H4808_001_0	9		Y	Generic	4	11	3	2	2	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	5.00	10.00	15.00																			5.00	10.00	12.50																5.00				5.00		0.17			0.17			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4808	001	0	1	04	01	H4808_001_0	9		Y	Generic	4	11	3	2	2	3	111		01	111		1	30	60	100				1	2	30	60	100				30		31	5.00	10.00	15.00																			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										2	3	3
H4808	001	0	1	04	01	H4808_001_0	9		Y	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	47.00	94.00	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												
H4808	001	0	1	04	01	H4808_001_0	9		Y	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	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												
H4808	001	0	1	04	01	H4808_001_0	9		Y	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												
H4808	002	0	1	04	01	H4808_002_0	9		Y	Preferred Generic	4	11	1	2	1	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4808	002	0	1	04	01	H4808_002_0	9		Y	Preferred Generic	4	11	1	2	1	3	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H4808	002	0	1	04	01	H4808_002_0	9		Y	Generic	4	11	3	2	2	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4808	002	0	1	04	01	H4808_002_0	9		Y	Generic	4	11	3	2	2	3	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	3
H4808	002	0	1	04	01	H4808_002_0	9		Y	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	47.00	94.00	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												
H4808	002	0	1	04	01	H4808_002_0	9		Y	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	100.00	200.00	300.00																			100.00	200.00	300.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4808	002	0	1	04	01	H4808_002_0	9		Y	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												
H4829	003	0	1	04	01	H4829_003_0	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4829	003	0	1	04	01	H4829_003_0	3		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H4829	003	0	1	04	01	H4829_003_0	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4829	003	0	1	04	01	H4829_003_0	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H4829	003	0	1	04	01	H4829_003_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4829	003	0	1	04	01	H4829_003_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		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		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				303.00	30																										30						30					30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4829	004	0	1	04	01	H4829_004_0	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4829	004	0	1	04	01	H4829_004_0	3		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H4829	004	0	1	04	01	H4829_004_0	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4829	004	0	1	04	01	H4829_004_0	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H4829	004	0	1	04	01	H4829_004_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4829	004	0	1	04	01	H4829_004_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4829	004	0	1	04	01	H4829_004_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				683.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4829	005	0	1	04	01	H4829_005_0	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4829	005	0	1	04	01	H4829_005_0	3		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H4829	005	0	1	04	01	H4829_005_0	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4829	005	0	1	04	01	H4829_005_0	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H4829	005	0	1	04	01	H4829_005_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4829	005	0	1	04	01	H4829_005_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4829	005	0	1	04	01	H4829_005_0	3		Y	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												
H4829	008	0	1	04	01	H4829_008_0	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4829	008	0	1	04	01	H4829_008_0	3		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H4829	008	0	1	04	01	H4829_008_0	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4829	008	0	1	04	01	H4829_008_0	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H4829	008	0	1	04	01	H4829_008_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4829	008	0	1	04	01	H4829_008_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4829	008	0	1	04	01	H4829_008_0	3		Y	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												
H4829	010	0	1	04	01	H4829_010_0	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4829	010	0	1	04	01	H4829_010_0	3		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H4829	010	0	1	04	01	H4829_010_0	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	9.00		27.00																											27.00						0.00				9.00				9.00		0.30						0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4829	010	0	1	04	01	H4829_010_0	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	9.00		27.00																											27.00						0.00				9.00				9.00		0.30						0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H4829	010	0	1	04	01	H4829_010_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4829	010	0	1	04	01	H4829_010_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4829	010	0	1	04	01	H4829_010_0	3		Y	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												
H4829	011	0	1	04	01	H4829_011_0	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4829	011	0	1	04	01	H4829_011_0	3		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H4829	011	0	1	04	01	H4829_011_0	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	9.00		27.00																											27.00						0.00				9.00				9.00		0.30						0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4829	011	0	1	04	01	H4829_011_0	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	9.00		27.00																											27.00						0.00				9.00				9.00		0.30						0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H4829	011	0	1	04	01	H4829_011_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4829	011	0	1	04	01	H4829_011_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4829	011	0	1	04	01	H4829_011_0	3		Y	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												
H4829	012	0	1	04	01	H4829_012_0	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4829	012	0	1	04	01	H4829_012_0	3		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H4829	012	0	1	04	01	H4829_012_0	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	9.00		27.00																											27.00						0.00				9.00				9.00		0.30						0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4829	012	0	1	04	01	H4829_012_0	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	9.00		27.00																											27.00						0.00				9.00				9.00		0.30						0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H4829	012	0	1	04	01	H4829_012_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4829	012	0	1	04	01	H4829_012_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4829	012	0	1	04	01	H4829_012_0	3		Y	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												
H4829	013	0	1	04	01	H4829_013_0	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4829	013	0	1	04	01	H4829_013_0	3		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H4829	013	0	1	04	01	H4829_013_0	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4829	013	0	1	04	01	H4829_013_0	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H4829	013	0	1	04	01	H4829_013_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4829	013	0	1	04	01	H4829_013_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4829	013	0	1	04	01	H4829_013_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				573.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4829	014	0	1	04	01	H4829_014_0	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4829	014	0	1	04	01	H4829_014_0	3		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H4829	014	0	1	04	01	H4829_014_0	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4829	014	0	1	04	01	H4829_014_0	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H4829	014	0	1	04	01	H4829_014_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4829	014	0	1	04	01	H4829_014_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4829	014	0	1	04	01	H4829_014_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				573.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4829	015	0	1	04	01	H4829_015_0	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4829	015	0	1	04	01	H4829_015_0	3		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H4829	015	0	1	04	01	H4829_015_0	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4829	015	0	1	04	01	H4829_015_0	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H4829	015	0	1	04	01	H4829_015_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4829	015	0	1	04	01	H4829_015_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4829	015	0	1	04	01	H4829_015_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				573.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4829	016	0	1	04	01	H4829_016_0	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4829	016	0	1	04	01	H4829_016_0	3		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H4829	016	0	1	04	01	H4829_016_0	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4829	016	0	1	04	01	H4829_016_0	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H4829	016	0	1	04	01	H4829_016_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4829	016	0	1	04	01	H4829_016_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4829	016	0	1	04	01	H4829_016_0	3		Y	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												
H4829	017	0	1	04	01	H4829_017_0	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4829	017	0	1	04	01	H4829_017_0	3		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H4829	017	0	1	04	01	H4829_017_0	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4829	017	0	1	04	01	H4829_017_0	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H4829	017	0	1	04	01	H4829_017_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4829	017	0	1	04	01	H4829_017_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4829	017	0	1	04	01	H4829_017_0	3		Y	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												
H4829	018	0	1	04	01	H4829_018_0	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4829	018	0	1	04	01	H4829_018_0	3		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H4829	018	0	1	04	01	H4829_018_0	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	14.00		42.00																											42.00						0.00				14.00				14.00		0.46						0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4829	018	0	1	04	01	H4829_018_0	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	14.00		42.00																											42.00						0.00				14.00				14.00		0.46						0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H4829	018	0	1	04	01	H4829_018_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4829	018	0	1	04	01	H4829_018_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4829	018	0	1	04	01	H4829_018_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				303.00	29																										29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4835	001	0	1	02	01	H4835_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					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												
H4835	001	0	1	02	01	H4835_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					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		
H4835	001	0	1	02	01	H4835_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					5.00	10.00	10.00											20.00	40.00	60.00				5.00	10.00	10.00					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	001	0	1	02	01	H4835_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					5.00	10.00	10.00											20.00	40.00	60.00				5.00	10.00	10.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H4835	001	0	1	02	01	H4835_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												
H4835	001	0	1	02	01	H4835_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												
H4835	001	0	1	02	01	H4835_001_0	4			Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											928.25	33						539.60	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4835	002	0	1	02	01	H4835_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												
H4835	002	0	1	02	01	H4835_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		
H4835	002	0	1	02	01	H4835_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	20.00											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												
H4835	002	0	1	02	01	H4835_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	20.00											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										1		
H4835	002	0	1	02	01	H4835_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												
H4835	002	0	1	02	01	H4835_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												
H4835	002	0	1	02	01	H4835_002_0	3			Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1146.75	33						751.05	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4835	003	0	1	02	01	H4835_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								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					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	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	003	0	1	02	01	H4835_003_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	20.00											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												
H4835	003	0	1	02	01	H4835_003_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	20.00											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										1		
H4835	003	0	1	02	01	H4835_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	94.00	141.00				47.00	94.00	141.00					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	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	003	0	1	02	01	H4835_003_0	3			Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1014.61	33						752.92	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4835	004	0	1	02	01	H4835_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					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												
H4835	004	0	1	02	01	H4835_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					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		
H4835	004	0	1	02	01	H4835_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					5.00	10.00	10.00											20.00	40.00	60.00				5.00	10.00	10.00					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	004	0	1	02	01	H4835_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					5.00	10.00	10.00											20.00	40.00	60.00				5.00	10.00	10.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H4835	004	0	1	02	01	H4835_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												
H4835	004	0	1	02	01	H4835_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												
H4835	004	0	1	02	01	H4835_004_0	3			Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1407.81	33						576.54	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4835	005	0	1	02	01	H4835_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												
H4835	005	0	1	02	01	H4835_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		
H4835	005	0	1	02	01	H4835_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	20.00											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												
H4835	005	0	1	02	01	H4835_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	20.00											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										1		
H4835	005	0	1	02	01	H4835_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												
H4835	005	0	1	02	01	H4835_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												
H4835	005	0	1	02	01	H4835_005_0	3			Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											973.12	33						572.37	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					10.00	20.00	20.00											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												
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					10.00	20.00	20.00											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										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											887.53	29						666.64	29												29						29						29		29								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								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00				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												
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								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												
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	005	0	1	01	01	H4847_005_0	4			Preferred Generic	4	11	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								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												
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	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												
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	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, 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											99.04	47	47	47				99.04	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	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			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	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4863	001	0	1	01	01	H4863_001_0	6		Y	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4863	001	0	1	01	01	H4863_001_0	6		Y	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																			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												
H4863	001	0	1	01	01	H4863_001_0	6		Y	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	141.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4863	001	0	1	01	01	H4863_001_0	6		Y	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	100.00	200.00	300.00																			100.00	200.00	300.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4863	001	0	1	01	01	H4863_001_0	6		Y	Specialty Tier	4	11	1	1	5	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31				940.86	33	33	33																		33	33	33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4863	003	0	1	01	01	H4863_003_0	6		Y	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4863	003	0	1	01	01	H4863_003_0	6		Y	Generic	4	11	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	5.00	10.00	15.00																			0.00	0.00	0.00																5.00				5.00		0.17			0.00			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4863	003	0	1	01	01	H4863_003_0	6		Y	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	141.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4863	003	0	1	01	01	H4863_003_0	6		Y	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	100.00	200.00	300.00																			100.00	200.00	300.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4863	003	0	1	01	01	H4863_003_0	6		Y	Specialty Tier	4	11	1	1	5	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31				919.63	33	33	33																		33	33	33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4863	005	0	1	01	01	H4863_005_0	6		Y	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4863	005	0	1	01	01	H4863_005_0	6		Y	Generic	4	11	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	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												
H4863	005	0	1	01	01	H4863_005_0	6		Y	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	141.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4863	005	0	1	01	01	H4863_005_0	6		Y	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	100.00	200.00	300.00																			100.00	200.00	300.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4863	005	0	1	01	01	H4863_005_0	6		Y	Specialty Tier	4	11	1	1	5	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31				951.66	33	33	33																		33	33	33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4868	016	0	1	01	01	H4868_016_0	4			Preferred Generic	4	11	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								19.00	38.00	57.00					0.00	0.00	0.00											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												
H4868	016	0	1	01	01	H4868_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	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												
H4868	016	0	1	01	01	H4868_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	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, Select Care Drugs												
H4868	016	0	1	01	01	H4868_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											99.60	45	45	45				99.60	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	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												
H4868	016	0	1	01	01	H4868_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												
H4868	019	0	1	01	01	H4868_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								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00				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												
H4868	019	0	1	01	01	H4868_019_0	4			Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								12.00	24.00	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	4			Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											47.00	94.00	141.00				37.00	74.00	74.00				47.00				47.00			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	4			Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											80.06	50	50	50				76.86	48	48	48										50	50	50				48	48	48			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4868	019	0	1	01	01	H4868_019_0	4			Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4868	019	0	1	01	01	H4868_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												
H4869	001	0	1	01	01	H4869_001_0	7		Y	Preferred Generic	4	01	1	2	1	1	110		01	110		1	30		90				1	2	30		90				30		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4869	001	0	1	01	01	H4869_001_0	7		Y	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, Select Care Drugs										1		
H4869	001	0	1	01	01	H4869_001_0	7		Y	Generic	4	01	1	2	2	1	110		01	110		1	30		90				1	2	30		90				30		31	5.00		12.00																			5.00		12.00																5.00				5.00		0.17			0.17			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4869	001	0	1	01	01	H4869_001_0	7		Y	Generic	4	01	1	2	2	3	110		01	110		1	30		90				1	2	30		90				30		31	5.00		12.00																			5.00		12.00																5.00				5.00		0.17			0.17			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H4869	001	0	1	01	01	H4869_001_0	7		Y	Preferred Brand	4	10	1	2	3	1	110		01	110		1	30		90				1	2	30		90				30		31	45.00		112.00																			45.00		112.00																45.00				45.00		1.50			1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4869	001	0	1	01	01	H4869_001_0	7		Y	Non-Preferred Drug	4	10	1	2	4	1	110		01	110		1	30		90				1	2	30		90				30		31	100.00		250.00																			100.00		250.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4869	001	0	1	01	01	H4869_001_0	7		Y	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				970.79	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4869	001	0	1	01	01	H4869_001_0	7		Y	Select Care Drugs	4	11	3	2	6	1	110		01	110		1	30		90				1	2	30		90				30		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4869	002	0	1	01	01	H4869_002_0	8		N	Preferred Generic	4	01	1	1	1	1	110		01	110		1	30		90				1	2	30		90				30		31				2.04	25		25																		25		25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4869	002	0	1	01	01	H4869_002_0	8		N	Generic	4	01	1	1	2	1	110		01	110		1	30		90				1	2	30		90				30		31				16.02	25		25																		25		25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4869	002	0	1	01	01	H4869_002_0	8		N	Preferred Brand	4	10	1	1	3	1	110		01	110		1	30		90				1	2	30		90				30		31				168.54	25		25																		25		25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4869	002	0	1	01	01	H4869_002_0	8		N	Non-Preferred Drug	4	10	1	1	4	1	110		01	110		1	30		90				1	2	30		90				30		31				72.59	25		25																		25		25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4869	002	0	1	01	01	H4869_002_0	8		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				1027.91	25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4869	002	0	1	01	01	H4869_002_0	8		N	Select Care Drugs	4	11	3	1	6	1	110		01	110		1	30		90				1	2	30		90				30		31				3.21	15		15																		15		15															15			15								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4869	003	0	1	02	01	H4869_003_0	8		Y	Preferred Generic	4	01	1	2	1	1	110		01	110		1	30		90				1	2	30		90				30		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4869	003	0	1	02	01	H4869_003_0	8		Y	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, Select Care Drugs										1		
H4869	003	0	1	02	01	H4869_003_0	8		Y	Generic	4	01	1	2	2	1	110		01	110		1	30		90				1	2	30		90				30		31	5.00		12.00																			5.00		12.00																5.00				5.00		0.17			0.17			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4869	003	0	1	02	01	H4869_003_0	8		Y	Generic	4	01	1	2	2	3	110		01	110		1	30		90				1	2	30		90				30		31	5.00		12.00																			5.00		12.00																5.00				5.00		0.17			0.17			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H4869	003	0	1	02	01	H4869_003_0	8		Y	Preferred Brand	4	10	1	2	3	1	110		01	110		1	30		90				1	2	30		90				30		31	45.00		112.00																			45.00		112.00																45.00				45.00		1.50			1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4869	003	0	1	02	01	H4869_003_0	8		Y	Non-Preferred Drug	4	10	1	2	4	1	110		01	110		1	30		90				2	2	30		90				30		31	100.00		250.00																			100.00		250.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4869	003	0	1	02	01	H4869_003_0	8		Y	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				595.43	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4869	003	0	1	02	01	H4869_003_0	8		Y	Select Care Drugs	4	11	1	2	6	1	110		01	110		1	30		90				1	2	30		90				30		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4869	005	0	1	01	01	H4869_005_0	7		Y	Preferred Generic	4	01	1	2	1	1	110		01	110		1	30		90				1	2	30		90				30		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4869	005	0	1	01	01	H4869_005_0	7		Y	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, Select Care Drugs										1		
H4869	005	0	1	01	01	H4869_005_0	7		Y	Generic	4	01	1	2	2	1	110		01	110		1	30		90				1	2	30		90				30		31	5.00		12.00																			5.00		12.00																5.00				5.00		0.17			0.17			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4869	005	0	1	01	01	H4869_005_0	7		Y	Generic	4	01	1	2	2	3	110		01	110		1	30		90				1	2	30		90				30		31	5.00		12.00																			5.00		12.00																5.00				5.00		0.17			0.17			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H4869	005	0	1	01	01	H4869_005_0	7		Y	Preferred Brand	4	10	1	2	3	1	110		01	110		1	30		90				1	2	30		90				30		31	45.00		112.00																			45.00		112.00																45.00				45.00		1.50			1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4869	005	0	1	01	01	H4869_005_0	7		Y	Non-Preferred Drug	4	10	1	2	4	1	110		01	110		1	30		90				1	2	30		90				30		31	100.00		250.00																			100.00		250.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4869	005	0	1	01	01	H4869_005_0	7		Y	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				925.63	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4869	005	0	1	01	01	H4869_005_0	7		Y	Select Care Drugs	4	11	3	2	6	1	110		01	110		1	30		90				1	2	30		90				30		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4875	016	1	1	04	01	H4875_016_1	12			Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								7.00	14.00	21.00					2.00	4.00	0.00											7.00	14.00	21.00				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	12			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	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					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	12			Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											26.70	50	50	50				30.39	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	12			Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											99.00	33						99.00	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4875	016	2	1	04	01	H4875_016_2	12			Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								7.00	14.00	21.00					2.00	4.00	0.00											7.00	14.00	21.00				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	12			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	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					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	12			Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											26.70	50	50	50				30.39	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	12			Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											99.00	33						99.00	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4875	016	3	1	04	01	H4875_016_3	12			Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								7.00	14.00	21.00					2.00	4.00	0.00											7.00	14.00	21.00				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	12			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	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					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	12			Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											26.70	50	50	50				30.39	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	12			Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											99.00	33						99.00	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4875	016	4	1	04	01	H4875_016_4	12			Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								7.00	14.00	21.00					2.00	4.00	0.00											7.00	14.00	21.00				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	12			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	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					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	12			Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											26.70	50	50	50				30.39	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	12			Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											99.00	33						99.00	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4875	016	5	1	04	01	H4875_016_5	12			Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								7.00	14.00	21.00					2.00	4.00	0.00											7.00	14.00	21.00				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	12			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	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					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	12			Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											26.70	50	50	50				30.39	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	12			Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											99.00	33						99.00	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4875	017	1	1	04	01	H4875_017_1	12			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	0.00											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	12			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	12			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	12			Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											26.55	50	50	50				30.12	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	12			Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											99.00	33						99.00	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4875	017	2	1	04	01	H4875_017_2	12			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	0.00											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	12			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	12			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	12			Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											26.55	50	50	50				30.12	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	12			Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											99.00	33						99.00	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4875	017	3	1	04	01	H4875_017_3	12			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	0.00											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	12			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	12			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	12			Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											26.55	50	50	50				30.12	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	12			Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											99.00	33						99.00	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4875	017	4	1	04	01	H4875_017_4	14			Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								6.00	12.00	18.00					1.00	2.00	0.00											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	14			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	14			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	14			Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											26.55	50	50	50				30.12	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	14			Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											99.00	33						99.00	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4875	017	5	1	04	01	H4875_017_5	14			Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								6.00	12.00	18.00					1.00	2.00	0.00											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	14			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	14			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	14			Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											26.55	50	50	50				30.12	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	14			Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											99.00	33						99.00	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4875	018	1	1	04	01	H4875_018_1	12			Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								9.00	18.00	27.00					4.00	8.00	0.00											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	12			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	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					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	12			Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											47.47	50	50	50				52.05	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	12			Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											99.00	30						99.00	30												30						30					30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4875	018	2	1	04	01	H4875_018_2	12			Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								9.00	18.00	27.00					4.00	8.00	0.00											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	12			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	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					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	12			Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											47.47	50	50	50				52.05	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	12			Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											99.00	30						99.00	30												30						30					30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4875	018	3	1	04	01	H4875_018_3	12			Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								9.00	18.00	27.00					4.00	8.00	0.00											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	12			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	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					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	12			Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											47.47	50	50	50				52.05	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	12			Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											99.00	30						99.00	30												30						30					30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4875	018	4	1	04	01	H4875_018_4	12			Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								9.00	18.00	27.00					4.00	8.00	0.00											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	12			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	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					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	12			Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											47.47	50	50	50				52.05	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	12			Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											99.00	30						99.00	30												30						30					30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4875	018	5	1	04	01	H4875_018_5	12			Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								9.00	18.00	27.00					4.00	8.00	0.00											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	12			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	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					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	12			Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											47.47	50	50	50				52.05	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	12			Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											99.00	30						99.00	30												30						30					30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4875	020	1	1	04	01	H4875_020_1	12			Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								7.00	14.00	21.00					2.00	4.00	0.00											7.00	14.00	21.00				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	12			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			0.50	0.27		0.50	0.27	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4875	020	1	1	04	01	H4875_020_1	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					38.00	76.00	114.00											47.00	94.00	141.00				38.00	76.00	95.00				47.00				47.00			1.57	1.27		1.57	1.27	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4875	020	1	1	04	01	H4875_020_1	12			Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											25.70	45	45	45				22.87	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	12			Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											99.00	33						99.00	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4875	020	2	1	04	01	H4875_020_2	12			Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								7.00	14.00	21.00					2.00	4.00	0.00											7.00	14.00	21.00				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	12			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			0.50	0.27		0.50	0.27	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4875	020	2	1	04	01	H4875_020_2	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					38.00	76.00	114.00											47.00	94.00	141.00				38.00	76.00	95.00				47.00				47.00			1.57	1.27		1.57	1.27	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4875	020	2	1	04	01	H4875_020_2	12			Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											25.70	45	45	45				22.87	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	12			Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											99.00	33						99.00	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4875	020	3	1	04	01	H4875_020_3	12			Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								7.00	14.00	21.00					2.00	4.00	0.00											7.00	14.00	21.00				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	12			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			0.50	0.27		0.50	0.27	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4875	020	3	1	04	01	H4875_020_3	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					38.00	76.00	114.00											47.00	94.00	141.00				38.00	76.00	95.00				47.00				47.00			1.57	1.27		1.57	1.27	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4875	020	3	1	04	01	H4875_020_3	12			Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											25.70	45	45	45				22.87	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	12			Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											99.00	33						99.00	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4875	021	1	1	04	01	H4875_021_1	12			Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								11.00	22.00	33.00					4.00	8.00	0.00											11.00	22.00	33.00				4.00	8.00	0.00				11.00				11.00			0.37	0.13		0.37	0.13	0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4875	021	1	1	04	01	H4875_021_1	12			Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					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	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					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	12			Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											30.04	50	50	50				26.88	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	12			Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											99.00	33						99.00	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4875	021	2	1	04	01	H4875_021_2	12			Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								11.00	22.00	33.00					4.00	8.00	0.00											11.00	22.00	33.00				4.00	8.00	0.00				11.00				11.00			0.37	0.13		0.37	0.13	0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4875	021	2	1	04	01	H4875_021_2	12			Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					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	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					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	12			Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											30.04	50	50	50				26.88	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	12			Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											99.00	33						99.00	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4875	022	1	1	04	01	H4875_022_1	14			Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								6.00	12.00	18.00					1.00	2.00	0.00											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	14			Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					10.00	20.00	30.00											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	14			Preferred Brand	4	10	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											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	14			Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											56.78	50	50	50				41.61	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	14			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	14			Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								6.00	12.00	18.00					1.00	2.00	0.00											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	14			Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					10.00	20.00	30.00											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	14			Preferred Brand	4	10	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											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	14			Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											56.78	50	50	50				41.61	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	14			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	13			Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								6.00	12.00	18.00					1.00	2.00	0.00											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	13			Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					10.00	20.00	30.00											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	13			Preferred Brand	4	10	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											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	13			Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											56.78	50	50	50				41.61	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	13			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	023	0	1	04	01	H4875_023_0	13		N	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								11.00	22.00	33.00					3.00	6.00	0.00											11.00	22.00	33.00				3.00	6.00	0.00				11.00				11.00			0.37	0.10		0.37	0.10	0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4875	023	0	1	04	01	H4875_023_0	13		N	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								18.00	36.00	54.00					10.00	20.00	30.00											18.00	36.00	54.00				10.00	20.00	0.00				18.00				18.00			0.60	0.33		0.60	0.33	0.58	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4875	023	0	1	04	01	H4875_023_0	13		N	Preferred Brand	4	10	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											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	023	0	1	04	01	H4875_023_0	13		N	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											29.20	50	50	50				25.59	45	45	45										50	50	50				45	45	45			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4875	023	0	1	04	01	H4875_023_0	13		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											99.00	33						99.00	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4882	001	0	1	04	01	H4882_001_0	2		Y	Preferred Generic	4	11	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4882	001	0	1	04	01	H4882_001_0	2		Y	Generic	4	11	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	12.00		36.00																									12.00		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	2		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4882	001	0	1	04	01	H4882_001_0	2		Y	Non-Preferred Drug	4	11	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				80.81	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	2		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				722.24	27																										27						27					27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4882	003	0	1	04	01	H4882_003_0	4		Y	Preferred Generic	4	11	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	4.00		12.00																									4.00		12.00				4.00		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	4		Y	Generic	4	11	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	10.00		30.00																									10.00		30.00				10.00		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	4		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4882	003	0	1	04	01	H4882_003_0	4		Y	Non-Preferred Drug	4	11	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				75.30	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	4		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				820.94	27																										27						27					27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4882	004	0	1	04	01	H4882_004_0	9		Y	Preferred Generic	4	11	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4882	004	0	1	04	01	H4882_004_0	9		Y	Generic	4	11	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4882	004	0	1	04	01	H4882_004_0	9		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4882	004	0	1	04	01	H4882_004_0	9		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				1	2				30		90	30		31	100.00		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	9		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				767.78	29																										29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4882	005	0	1	04	01	H4882_005_0	8		Y	Preferred Generic	4	11	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4882	005	0	1	04	01	H4882_005_0	8		Y	Preferred Generic	4	11	1	2	1	3	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H4882	005	0	1	04	01	H4882_005_0	8		Y	Generic	4	11	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	9.00		27.00																									9.00		27.00				9.00		18.00				9.00				9.00		0.30				0.30	0.30	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4882	005	0	1	04	01	H4882_005_0	8		Y	Generic	4	11	1	2	2	3	110		01		110	1	30		90				1	2				30		90	30		31	9.00		27.00																									9.00		27.00				9.00		18.00				9.00				9.00		0.30				0.30	0.30	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H4882	005	0	1	04	01	H4882_005_0	8		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4882	005	0	1	04	01	H4882_005_0	8		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				1	2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		290.00				100.00				100.00		3.33				3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4882	005	0	1	04	01	H4882_005_0	8		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				1039.19	29																										29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4882	009	1	1	04	01	H4882_009_1	4		Y	Preferred Generic	4	11	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4882	009	1	1	04	01	H4882_009_1	4		Y	Generic	4	11	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	14.00		42.00																									14.00		42.00				14.00		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	009	1	1	04	01	H4882_009_1	4		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4882	009	1	1	04	01	H4882_009_1	4		Y	Non-Preferred Drug	4	11	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				71.53	35		35																								35		35				35		35			35			35								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4882	009	1	1	04	01	H4882_009_1	4		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				753.79	27																										27						27					27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4882	009	2	1	04	01	H4882_009_2	4		Y	Preferred Generic	4	11	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4882	009	2	1	04	01	H4882_009_2	4		Y	Generic	4	11	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	14.00		42.00																									14.00		42.00				14.00		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	009	2	1	04	01	H4882_009_2	4		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4882	009	2	1	04	01	H4882_009_2	4		Y	Non-Preferred Drug	4	11	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				71.53	35		35																								35		35				35		35			35			35								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4882	009	2	1	04	01	H4882_009_2	4		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				753.79	27																										27						27					27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4882	010	1	1	04	01	H4882_010_1	2		Y	Preferred Generic	4	11	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4882	010	1	1	04	01	H4882_010_1	2		Y	Generic	4	11	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	10.00		30.00																									10.00		30.00				10.00		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	010	1	1	04	01	H4882_010_1	2		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4882	010	1	1	04	01	H4882_010_1	2		Y	Non-Preferred Drug	4	11	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				68.97	40		40																								40		40				40		40			40			40								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4882	010	1	1	04	01	H4882_010_1	2		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				777.88	27																										27						27					27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4882	010	2	1	04	01	H4882_010_2	2		Y	Preferred Generic	4	11	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4882	010	2	1	04	01	H4882_010_2	2		Y	Generic	4	11	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	10.00		30.00																									10.00		30.00				10.00		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	010	2	1	04	01	H4882_010_2	2		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4882	010	2	1	04	01	H4882_010_2	2		Y	Non-Preferred Drug	4	11	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				68.97	40		40																								40		40				40		40			40			40								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4882	010	2	1	04	01	H4882_010_2	2		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				777.88	27																										27						27					27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4909	014	0	1	04	01	H4909_014_0	6		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								9.00	18.00	27.00					4.00	8.00	12.00					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		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								18.00	36.00	54.00					13.00	26.00	39.00					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		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00	84.00	84.00																47.00				47.00			1.57	1.40	1.40			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4909	014	0	1	04	01	H4909_014_0	6		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	190.00	190.00																100.00				100.00			3.33	3.17	3.17			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4909	014	0	1	04	01	H4909_014_0	6		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												31							31						31																	31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4909	014	0	1	04	01	H4909_014_0	6		N	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4909	014	0	1	04	01	H4909_014_0	6		N	Select Care Drugs	4	01	1	2	6	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H4909	015	0	1	04	01	H4909_015_0	5		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								9.00	18.00	27.00					4.00	8.00	12.00					0.00	0.00	0.00																9.00				9.00			0.30	0.13	0.00			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4909	015	0	1	04	01	H4909_015_0	5		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								18.00	36.00	54.00					13.00	26.00	39.00					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	5		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00	84.00	84.00																47.00				47.00			1.57	1.40	1.40			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4909	015	0	1	04	01	H4909_015_0	5		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	190.00	190.00																100.00				100.00			3.33	3.17	3.17			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4909	015	0	1	04	01	H4909_015_0	5		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4909	015	0	1	04	01	H4909_015_0	5		N	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4909	015	0	1	04	01	H4909_015_0	5		N	Select Care Drugs	4	01	1	2	6	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H4909	016	0	1	04	01	H4909_016_0	5		Y	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								9.00	18.00	27.00					4.00	8.00	12.00					0.00	0.00	0.00																9.00				9.00			0.30	0.13	0.00			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4909	016	0	1	04	01	H4909_016_0	5		Y	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												
H4909	016	0	1	04	01	H4909_016_0	5		Y	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00	84.00	84.00																47.00				47.00			1.57	1.40	1.40			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4909	016	0	1	04	01	H4909_016_0	5		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	190.00	190.00																100.00				100.00			3.33	3.17	3.17			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4909	016	0	1	04	01	H4909_016_0	5		Y	Specialty Tier	4	11	1	1	5	1		010	01	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	5		Y	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4909	016	0	1	04	01	H4909_016_0	5		Y	Select Care Drugs	4	01	1	2	6	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H4909	018	0	1	04	01	H4909_018_0	8		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								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												
H4909	018	0	1	04	01	H4909_018_0	8		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								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												
H4909	018	0	1	04	01	H4909_018_0	8		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								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												
H4909	018	0	1	04	01	H4909_018_0	8		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	285.00	285.00																100.00				100.00			3.33	3.17	3.17			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4909	018	0	1	04	01	H4909_018_0	8		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												25							25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4909	018	0	1	04	01	H4909_018_0	8		N	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								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												
H4909	022	0	1	04	01	H4909_022_0	5		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								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	5		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								17.00	34.00	51.00					12.00	24.00	36.00					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	5		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								47.00	94.00	141.00					37.00	74.00	111.00					37.00	111.00	111.00																47.00				47.00			1.57	1.23	1.23			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4909	022	0	1	04	01	H4909_022_0	5		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								100.00	200.00	300.00					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	5		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4909	022	0	1	04	01	H4909_022_0	5		N	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4909	022	0	1	04	01	H4909_022_0	5		N	Select Care Drugs	4	01	1	2	6	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H4909	024	0	1	04	01	H4909_024_0	5		Y	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	5		Y	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	5		Y	Preferred Brand	4	11	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	5		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				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	5		Y	Specialty Tier	4	11	1	1	5	1		010	01	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	024	0	1	04	01	H4909_024_0	5		Y	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				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	5		Y	Select Care Drugs	4	01	1	2	6	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				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	6		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								8.00	16.00	24.00					3.00	6.00	9.00					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	6		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								17.00	34.00	51.00					12.00	24.00	36.00					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	6		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00	84.00	84.00																47.00				47.00			1.57	1.40	1.40			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4909	025	0	1	04	01	H4909_025_0	6		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	190.00	190.00																100.00				100.00			3.33	3.17	3.17			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4909	025	0	1	04	01	H4909_025_0	6		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												31							31						31																	31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4909	025	0	1	04	01	H4909_025_0	6		N	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4909	025	0	1	04	01	H4909_025_0	6		N	Select Care Drugs	4	01	1	2	6	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H4909	026	0	1	04	01	H4909_026_0	6		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								5.00	10.00	15.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.15	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4909	026	0	1	04	01	H4909_026_0	6		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								18.00	36.00	54.00					13.00	26.00	39.00					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		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00	84.00	84.00																47.00				47.00			1.57	1.40	1.40			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4909	026	0	1	04	01	H4909_026_0	6		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		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		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												31							31						31																	31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4909	026	0	1	04	01	H4909_026_0	6		N	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4909	026	0	1	04	01	H4909_026_0	6		N	Select Care Drugs	4	01	1	2	6	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H4909	028	0	1	04	01	H4909_028_0	8		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								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												
H4909	028	0	1	04	01	H4909_028_0	8		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								20.00	40.00	60.00					20.00	40.00	60.00					20.00	60.00	60.00																20.00				20.00			0.67	0.67	0.67			0.59	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4909	028	0	1	04	01	H4909_028_0	8		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								47.00	94.00	141.00					47.00	94.00	141.00					47.00	141.00	141.00																47.00				47.00			1.57	1.57	1.57			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4909	028	0	1	04	01	H4909_028_0	8		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	285.00	285.00																100.00				100.00			3.33	3.17	3.17			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4909	028	0	1	04	01	H4909_028_0	8		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												28							28						28																	28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4909	028	0	1	04	01	H4909_028_0	8		N	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								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												
H4922	011	0	1	01	01	H4922_011_0	7			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	7			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	7			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	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	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	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	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	7			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												
H4937	001	0	1	04	01	H4937_001_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												
H4937	001	0	1	04	01	H4937_001_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		
H4937	001	0	1	04	01	H4937_001_0	5			Generic	4	01	3	2	2	1		111	01	100		1				30	60	90	2	2			90				30		31								20.00	40.00	60.00					5.00	10.00	7.50							7.50																20.00				20.00			0.67	0.17				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4937	001	0	1	04	01	H4937_001_0	5			Generic	4	01	3	2	2	3		111	01	100		1				30	60	90	2	2			90				30		31								20.00	40.00	60.00					5.00	10.00	7.50							7.50																20.00				20.00			0.67	0.17				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H4937	001	0	1	04	01	H4937_001_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												
H4937	001	0	1	04	01	H4937_001_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												
H4937	001	0	1	04	01	H4937_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												
H4937	002	0	1	04	01	H4937_002_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												
H4937	002	0	1	04	01	H4937_002_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		
H4937	002	0	1	04	01	H4937_002_0	6			Generic	4	01	3	2	2	1		111	01	100		1				30	60	90	2	2			90				30		31								20.00	40.00	60.00					10.00	20.00	15.00							15.00																20.00				20.00			0.67	0.33				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4937	002	0	1	04	01	H4937_002_0	6			Generic	4	01	3	2	2	3		111	01	100		1				30	60	90	2	2			90				30		31								20.00	40.00	60.00					10.00	20.00	15.00							15.00																20.00				20.00			0.67	0.33				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H4937	002	0	1	04	01	H4937_002_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												
H4937	002	0	1	04	01	H4937_002_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												
H4937	002	0	1	04	01	H4937_002_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												
H4943	001	0	1	01	01	H4943_001_0	7		Y	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31	5.00	10.00	10.00																			0.00	0.00	0.00																5.00				5.00		0.17			0.00			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4943	001	0	1	01	01	H4943_001_0	7		Y	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31	20.00	40.00	40.00																			0.00	0.00	0.00																20.00				20.00		0.67			0.00			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4943	001	0	1	01	01	H4943_001_0	7		Y	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31	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												
H4943	001	0	1	01	01	H4943_001_0	7		Y	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31	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												
H4943	001	0	1	01	01	H4943_001_0	7		Y	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31					30																				30																	30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4961	001	0	1	04	01	H4961_001_0	6			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, Select Care Drugs												
H4961	001	0	1	04	01	H4961_001_0	6			Generic	4	01	1	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	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	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	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	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	300.00																			100.00	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	6			Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				796.20	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	6			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	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	6			Select Care Drugs	4	01	1	2	6	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, Select Care Drugs										1		
H4961	003	0	1	04	01	H4961_003_0	6			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, Select Care Drugs												
H4961	003	0	1	04	01	H4961_003_0	6			Generic	4	01	1	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	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	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	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	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	300.00																			100.00	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	6			Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				1107.51	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	6			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	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	6			Select Care Drugs	4	01	1	2	6	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, Select Care Drugs										1		
H4961	006	0	1	04	01	H4961_006_0	6			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, Select Care Drugs												
H4961	006	0	1	04	01	H4961_006_0	6			Generic	4	01	1	2	2	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	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	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	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	6			Non-Preferred Drug	4	11	3	2	4	1	111		01	111		1	30	60	100				1	2	30	60	100				30		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	6			Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				837.63	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4961	006	0	1	04	01	H4961_006_0	6			Select Care Drugs	4	01	1	2	6	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, Select Care Drugs												
H4961	006	0	1	04	01	H4961_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	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	6			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, Select Care Drugs												
H4961	007	0	1	04	01	H4961_007_0	6			Generic	4	01	1	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	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	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	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	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	300.00																			100.00	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	6			Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				983.08	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	6			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	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	6			Select Care Drugs	4	01	1	2	6	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, Select Care Drugs										1		
H4961	008	0	1	04	01	H4961_008_0	6			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, Select Care Drugs												
H4961	008	0	1	04	01	H4961_008_0	6			Generic	4	01	1	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	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	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	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	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	300.00																			100.00	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	6			Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				981.02	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	6			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	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	6			Select Care Drugs	4	01	1	2	6	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, Select Care Drugs										1		
H4982	001	0	1	01	01	H4982_001_0	5			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	5			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	5			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	5			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	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					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	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					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	5			Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											802.16	33						499.50	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4982	002	0	1	01	01	H4982_002_0	5			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	5			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	5			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	5			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	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					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	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					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	5			Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1099.18	33						702.12	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4982	003	0	1	01	01	H4982_003_0	5			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	5			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	5			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	5			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	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					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	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					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	5			Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1127.93	33						425.05	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4982	004	0	1	01	01	H4982_004_0	5			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	5			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	5			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	5			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	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					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	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					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	5			Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											895.77	33						771.05	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4982	005	0	1	01	01	H4982_005_0	6			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	6			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	6			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	6			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	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					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00					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	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					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	6			Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1008.22	33						567.72	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4982	006	0	1	01	01	H4982_006_0	5			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	5			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	5			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	5			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	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					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00					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	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					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	5			Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											891.56	33						571.91	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4982	007	0	1	01	01	H4982_007_0	5			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	5			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	5			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	5			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	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					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00					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	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					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	5			Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											665.44	33						473.16	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4982	010	0	1	01	01	H4982_010_0	5			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	5			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	5			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	5			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	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					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00					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	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					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	5			Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											751.57	33						539.17	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4982	011	0	1	01	01	H4982_011_0	5			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	5			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	5			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	5			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	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					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00					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	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					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	5			Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1256.97	33						606.52	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4982	012	0	1	01	01	H4982_012_0	5			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	5			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	5			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	5			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	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					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00					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	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					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	5			Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											979.08	33						528.80	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5009	002	0	1	04	01	H5009_002_0	9		Y	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	9		Y	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	9		Y	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	100	1	2	30	60	100				30		31								47.00	94.00	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	9		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	100	1	2	30	60	100				30		31								100.00	200.00	250.00					100.00	200.00	250.00					100.00	200.00	250.00																100.00				100.00			3.33	3.33	3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5009	002	0	1	04	01	H5009_002_0	9		Y	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											966.38	28						966.38	28						28																	28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5009	008	0	1	04	01	H5009_008_0	8		Y	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		Y	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		Y	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	100	1	2	30	60	100				30		31								47.00	94.00	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		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	100	1	2	30	60	100				30		31								100.00	200.00	250.00					100.00	200.00	250.00					100.00	200.00	250.00																100.00				100.00			3.33	3.33	3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5009	008	0	1	04	01	H5009_008_0	8		Y	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											966.38	28						966.38	28						28																	28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5009	009	0	1	04	01	H5009_009_0	9		Y	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	9		Y	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	9		Y	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	100	1	2	30	60	100				30		31								47.00	94.00	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	9		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	100	1	2	30	60	100				30		31								100.00	200.00	300.00					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												
H5009	009	0	1	04	01	H5009_009_0	9		Y	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											931.86	27						931.86	27						27																	27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5009	010	0	1	04	01	H5009_010_0	8		Y	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		Y	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		Y	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	100	1	2	30	60	100				30		31								47.00	94.00	141.00					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		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	100	1	2	30	60	100				30		31								100.00	200.00	300.00					100.00	200.00	300.00					100.00	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												
H5009	010	0	1	04	01	H5009_010_0	8		Y	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											931.86	27						931.86	27						27																	27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5010	008	1	1	04	01	H5010_008_1	9		Y	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	008	1	1	04	01	H5010_008_1	9		Y	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	008	1	1	04	01	H5010_008_1	9		Y	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	100	1	2	30	60	100				30		31								47.00	94.00	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	008	1	1	04	01	H5010_008_1	9		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	100	1	2	30	60	100				30		31								100.00	200.00	300.00					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												
H5010	008	1	1	04	01	H5010_008_1	9		Y	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											931.86	27						931.86	27						27																	27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5010	008	2	1	04	01	H5010_008_2	9		Y	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	008	2	1	04	01	H5010_008_2	9		Y	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	008	2	1	04	01	H5010_008_2	9		Y	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	100	1	2	30	60	100				30		31								47.00	94.00	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	008	2	1	04	01	H5010_008_2	9		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	100	1	2	30	60	100				30		31								100.00	200.00	300.00					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												
H5010	008	2	1	04	01	H5010_008_2	9		Y	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											931.86	27						931.86	27						27																	27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5010	009	1	1	04	01	H5010_009_1	8		Y	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	009	1	1	04	01	H5010_009_1	8		Y	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	009	1	1	04	01	H5010_009_1	8		Y	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	100	1	2	30	60	100				30		31								47.00	94.00	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	009	1	1	04	01	H5010_009_1	8		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	100	1	2	30	60	100				30		31								100.00	200.00	250.00					100.00	200.00	250.00					100.00	200.00	250.00																100.00				100.00			3.33	3.33	3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5010	009	1	1	04	01	H5010_009_1	8		Y	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											1000.89	29						1000.89	29						29																	29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5010	009	2	1	04	01	H5010_009_2	8		Y	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	009	2	1	04	01	H5010_009_2	8		Y	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	009	2	1	04	01	H5010_009_2	8		Y	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	100	1	2	30	60	100				30		31								47.00	94.00	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	009	2	1	04	01	H5010_009_2	8		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	100	1	2	30	60	100				30		31								100.00	200.00	250.00					100.00	200.00	250.00					100.00	200.00	250.00																100.00				100.00			3.33	3.33	3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5010	009	2	1	04	01	H5010_009_2	8		Y	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											1000.89	29						1000.89	29						29																	29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5042	009	0	1	04	01	H5042_009_0	14		Y	Preferred Generic	4	01	1	2	1	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	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	14		Y	Generic	4	01	1	2	2	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	17.00	34.00	51.00																									17.00	34.00	51.00				0.00	0.00	0.00				17.00				17.00		0.57				0.57	0.00	0.55	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5042	009	0	1	04	01	H5042_009_0	14		Y	Preferred Brand	4	11	1	2	3	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	47.00	94.00	141.00																									47.00	94.00	141.00				47.00	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	14		Y	Non-Preferred Drug	4	11	1	2	4	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	100.00	200.00	300.00																									100.00	200.00	300.00				100.00	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	14		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				1399.46	26																										26						26					26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5042	011	0	1	04	01	H5042_011_0	13		Y	Preferred Generic	4	01	1	2	1	1	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	13		Y	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				0.00	0.00	0.00				14.00				14.00		0.47				0.47	0.00	0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5042	011	0	1	04	01	H5042_011_0	13		Y	Preferred Brand	4	11	1	2	3	1	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	13		Y	Non-Preferred Drug	4	11	1	2	4	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	95.00	190.00	285.00																									95.00	190.00	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	13		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				1399.46	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5050	004	0	1	01	01	H5050_004_0	12			Preferred Generic	4	11	1	2	1	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					3.00	0.00	0.00																15.00				15.00			0.50	0.10	0.10			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H5050	004	0	1	01	01	H5050_004_0	12			Preferred Generic	4	11	1	2	1	3		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					3.00	0.00	0.00																15.00				15.00			0.50	0.10	0.10			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H5050	004	0	1	01	01	H5050_004_0	12			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					7.00	14.00	21.00					7.00	0.00	0.00																20.00				20.00			0.66	0.23	0.23			0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H5050	004	0	1	01	01	H5050_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								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 Brand, Specialty Tier, Vaccines												
H5050	004	0	1	01	01	H5050_004_0	12			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	297.00					99.00	198.00	247.50																99.00				99.00			3.30	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	12			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								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H5050	004	0	1	01	01	H5050_004_0	12			Vaccines	4	10	1	2	6	1		010	01			1				30											30		31								0.00							0.00																									0.00				0.00			0.00	0.00				0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H5050	004	0	1	01	01	H5050_004_0	12			Vaccines	4	10	1	2	6	3		010	01			1				30											30		31								0.00							0.00																									0.00				0.00			0.00	0.00				0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H5050	009	0	1	01	01	H5050_009_0	12			Preferred Generic	4	11	1	2	1	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					3.00	0.00	0.00																15.00				15.00			0.50	0.10	0.10			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H5050	009	0	1	01	01	H5050_009_0	12			Preferred Generic	4	11	1	2	1	3		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					3.00	0.00	0.00																15.00				15.00			0.50	0.10	0.10			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H5050	009	0	1	01	01	H5050_009_0	12			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					7.00	14.00	21.00					7.00	0.00	0.00																20.00				20.00			0.66	0.23	0.23			0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H5050	009	0	1	01	01	H5050_009_0	12			Preferred Brand	4	10	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		31								45.00	90.00	135.00					45.00	90.00	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 Brand, Specialty Tier, Vaccines												
H5050	009	0	1	01	01	H5050_009_0	12			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	297.00					99.00	198.00	247.50																99.00				99.00			3.30	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	12			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								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H5050	009	0	1	01	01	H5050_009_0	12			Vaccines	4	10	1	2	6	1		010	01			1				30											30		31								0.00							0.00																									0.00				0.00			0.00	0.00				0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H5050	009	0	1	01	01	H5050_009_0	12			Vaccines	4	10	1	2	6	3		010	01			1				30											30		31								0.00							0.00																									0.00				0.00			0.00	0.00				0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H5050	013	0	1	01	01	H5050_013_0	12			Preferred Generic	4	11	1	2	1	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					3.00	0.00	0.00																15.00				15.00			0.50	0.10	0.10			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H5050	013	0	1	01	01	H5050_013_0	12			Preferred Generic	4	11	1	2	1	3		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					3.00	0.00	0.00																15.00				15.00			0.50	0.10	0.10			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H5050	013	0	1	01	01	H5050_013_0	12			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					7.00	14.00	21.00					7.00	0.00	0.00																20.00				20.00			0.66	0.23	0.23			0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H5050	013	0	1	01	01	H5050_013_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	141.00					47.00	94.00	141.00					47.00	94.00	117.50																47.00				47.00			1.56	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	12			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	297.00					99.00	198.00	247.50																99.00				99.00			3.30	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	12			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								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H5050	013	0	1	01	01	H5050_013_0	12			Vaccines	4	10	1	2	6	1		010	01			1				30											30		31								0.00							0.00																									0.00				0.00			0.00	0.00				0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H5050	013	0	1	01	01	H5050_013_0	12			Vaccines	4	10	1	2	6	3		010	01			1				30											30		31								0.00							0.00																									0.00				0.00			0.00	0.00				0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H5050	017	0	1	01	01	H5050_017_0	12			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					0.00	0.00	0.00																3.00				3.00			0.10	0.00	0.00			0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H5050	017	0	1	01	01	H5050_017_0	12			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					0.00	0.00	0.00																3.00				3.00			0.10	0.00	0.00			0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H5050	017	0	1	01	01	H5050_017_0	12			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					5.00	10.00	15.00					5.00	0.00	0.00																9.00				9.00			0.30	0.16	0.16			0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H5050	017	0	1	01	01	H5050_017_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	141.00					47.00	94.00	141.00					47.00	94.00	117.50																47.00				47.00			1.56	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	12			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	297.00					99.00	198.00	247.50																99.00				99.00			3.30	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	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	30															30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H5050	017	0	1	01	01	H5050_017_0	12			Vaccines	4	10	1	2	6	1		010	01			1				30											30		31								0.00							0.00																									0.00				0.00			0.00	0.00				0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H5050	017	0	1	01	01	H5050_017_0	12			Vaccines	4	10	1	2	6	3		010	01			1				30											30		31								0.00							0.00																									0.00				0.00			0.00	0.00				0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H5050	019	0	1	01	01	H5050_019_0	12			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					2.00	4.00	6.00					2.00	0.00	0.00																10.00				10.00			0.33	0.06	0.06			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H5050	019	0	1	01	01	H5050_019_0	12			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					2.00	4.00	6.00					2.00	0.00	0.00																10.00				10.00			0.33	0.06	0.06			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H5050	019	0	1	01	01	H5050_019_0	12			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					7.00	14.00	21.00					7.00	0.00	0.00																20.00				20.00			0.66	0.23	0.23			0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H5050	019	0	1	01	01	H5050_019_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	141.00					40.00	80.00	120.00					40.00	80.00	100.00																47.00				47.00			1.56	1.33	1.33			1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H5050	019	0	1	01	01	H5050_019_0	12			Non-Preferred Brand	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		31								100.00	200.00	300.00					90.00	180.00	270.00					90.00	180.00	225.00																100.00				100.00			3.33	3.00	3.00			3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H5050	019	0	1	01	01	H5050_019_0	12			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								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H5050	019	0	1	01	01	H5050_019_0	12			Vaccines	4	10	1	2	6	1		010	01			1				30											30		31								0.00							0.00																									0.00				0.00			0.00	0.00				0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H5050	019	0	1	01	01	H5050_019_0	12			Vaccines	4	10	1	2	6	3		010	01			1				30											30		31								0.00							0.00																									0.00				0.00			0.00	0.00				0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H5050	021	0	1	01	01	H5050_021_0	12			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					2.00	4.00	6.00					2.00	0.00	0.00																10.00				10.00			0.33	0.06	0.06			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H5050	021	0	1	01	01	H5050_021_0	12			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					2.00	4.00	6.00					2.00	0.00	0.00																10.00				10.00			0.33	0.06	0.06			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H5050	021	0	1	01	01	H5050_021_0	12			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					7.00	14.00	21.00					7.00	0.00	0.00																20.00				20.00			0.66	0.23	0.23			0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H5050	021	0	1	01	01	H5050_021_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	141.00					45.00	90.00	135.00					45.00	90.00	112.50																47.00				47.00			1.56	1.50	1.50			1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H5050	021	0	1	01	01	H5050_021_0	12			Non-Preferred Brand	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		31								100.00	200.00	300.00					95.00	190.00	285.00					95.00	190.00	237.50																100.00				100.00			3.33	3.16	3.16			3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H5050	021	0	1	01	01	H5050_021_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	30															30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H5050	021	0	1	01	01	H5050_021_0	12			Vaccines	4	10	1	2	6	1		010	01			1				30											30		31								0.00							0.00																									0.00				0.00			0.00	0.00				0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H5050	021	0	1	01	01	H5050_021_0	12			Vaccines	4	10	1	2	6	3		010	01			1				30											30		31								0.00							0.00																									0.00				0.00			0.00	0.00				0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H5050	022	0	1	01	01	H5050_022_0	12			Preferred Generic	4	11	1	2	1	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					3.00	0.00	0.00																15.00				15.00			0.50	0.10	0.10			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H5050	022	0	1	01	01	H5050_022_0	12			Preferred Generic	4	11	1	2	1	3		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					3.00	0.00	0.00																15.00				15.00			0.50	0.10	0.10			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H5050	022	0	1	01	01	H5050_022_0	12			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					10.00	0.00	0.00																20.00				20.00			0.66	0.33	0.33			0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H5050	022	0	1	01	01	H5050_022_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	141.00					47.00	94.00	141.00					47.00	94.00	117.50																47.00				47.00			1.56	1.56	1.56			1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H5050	022	0	1	01	01	H5050_022_0	12			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	297.00					99.00	198.00	247.50																99.00				99.00			3.30	3.30	3.30			3.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H5050	022	0	1	01	01	H5050_022_0	12			Specialty Tier	4	11	1	1	5	1		111	01	111		1				30	60	90	2	2	30	60	90				30		31												31	31	31					31	31	31				31	31	31															31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H5050	022	0	1	01	01	H5050_022_0	12			Vaccines	4	10	1	2	6	1		010	01			1				30											30		31								0.00							0.00																									0.00				0.00			0.00	0.00				0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H5050	022	0	1	01	01	H5050_022_0	12			Vaccines	4	10	1	2	6	3		010	01			1				30											30		31								0.00							0.00																									0.00				0.00			0.00	0.00				0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H5050	023	0	1	01	01	H5050_023_0	12			Preferred Generic	4	11	1	2	1	1		111	01	111		1				30	60	90	2	2	30	60	90				30		31								4.00	8.00	12.00					0.00	0.00	0.00					0.00	0.00	0.00																4.00				4.00			0.13	0.00	0.00			0.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H5050	023	0	1	01	01	H5050_023_0	12			Preferred Generic	4	11	1	2	1	3		111	01	111		1				30	60	90	2	2	30	60	90				30		31								4.00	8.00	12.00					0.00	0.00	0.00					0.00	0.00	0.00																4.00				4.00			0.13	0.00	0.00			0.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H5050	023	0	1	01	01	H5050_023_0	12			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					9.00	18.00	27.00					9.00	0.00	0.00																14.00				14.00			0.46	0.30	0.30			0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H5050	023	0	1	01	01	H5050_023_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	141.00					47.00	94.00	141.00					47.00	94.00	117.50																47.00				47.00			1.56	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	12			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	297.00					99.00	198.00	247.50																99.00				99.00			3.30	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	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	29															29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H5050	023	0	1	01	01	H5050_023_0	12			Vaccines	4	10	1	2	6	1		010	01			1				30											30		31								0.00							0.00																									0.00				0.00			0.00	0.00				0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H5050	023	0	1	01	01	H5050_023_0	12			Vaccines	4	10	1	2	6	3		010	01			1				30											30		31								0.00							0.00																									0.00				0.00			0.00	0.00				0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
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								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00				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												
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								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												
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								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												
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								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
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								10.00	20.00	30.00					3.00	6.00	9.00											10.00	20.00	30.00				3.00	6.00	0.00				10.00				10.00			0.33	0.1		0.33	0.1	0.32	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								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00				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												
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								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00				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
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								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												
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	026	0	1	01	01	H5087_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								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00				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												
H5087	026	0	1	01	01	H5087_026_0	5			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
H5087	026	0	1	01	01	H5087_026_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												
H5087	026	0	1	01	01	H5087_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					30.00	60.00	90.00											47.00	94.00	141.00				30.00	60.00	60.00				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												
H5087	026	0	1	01	01	H5087_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												
H5087	026	0	1	01	01	H5087_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												
H5087	026	0	1	01	01	H5087_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												
H5087	026	0	1	01	01	H5087_026_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	
H5087	028	0	1	01	01	H5087_028_0	4		Y	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												
H5087	028	0	1	01	01	H5087_028_0	4		Y	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
H5087	028	0	1	01	01	H5087_028_0	4		Y	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					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	4		Y	Generic	4	11	1	2	2	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					5.00	10.00	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	4		Y	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	4		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								99.00	198.00	297.00					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	4		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs												
H5087	028	0	1	01	01	H5087_028_0	4		Y	Select Diabetic Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				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	4		Y	Select Diabetic 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 Diabetic Drugs										2	2	
H5087	029	1	1	01	01	H5087_029_1	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												
H5087	029	1	1	01	01	H5087_029_1	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												
H5087	029	1	1	01	01	H5087_029_1	4			Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											47.00	94.00	141.00				37.00	74.00	74.00				47.00				47.00			1.57	1.23		1.57	1.23	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5087	029	1	1	01	01	H5087_029_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								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	029	1	1	01	01	H5087_029_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												
H5087	029	1	1	01	01	H5087_029_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												
H5087	029	1	1	01	01	H5087_029_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	
H5087	029	2	1	01	01	H5087_029_2	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												
H5087	029	2	1	01	01	H5087_029_2	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												
H5087	029	2	1	01	01	H5087_029_2	4			Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											47.00	94.00	141.00				37.00	74.00	74.00				47.00				47.00			1.57	1.23		1.57	1.23	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5087	029	2	1	01	01	H5087_029_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								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	029	2	1	01	01	H5087_029_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												
H5087	029	2	1	01	01	H5087_029_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												
H5087	029	2	1	01	01	H5087_029_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	
H5106	013	0	1	04	01	H5106_013_0	10		Y	Preferred Generic	4	01	1	2	1	1		110	01		100	1				31		90	1	2						90	31		31								5.00		15.00					0.00		0.00													15.00						0.00				5.00				5.00			0.16	0.00				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5106	013	0	1	04	01	H5106_013_0	10		Y	Generic	4	01	1	2	2	1		110	01		100	1				31		90	1	2						90	31		31								19.00		57.00					11.00		33.00													57.00						27.00				19.00				19.00			0.61	0.35				0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5106	013	0	1	04	01	H5106_013_0	10		Y	Preferred Brand	4	11	1	2	3	1		110	01		100	1				31		90	1	2						90	31		31								47.00		141.00					45.00		135.00													141.00						115.00				47.00				47.00			1.52	1.45				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5106	013	0	1	04	01	H5106_013_0	10		Y	Non-Preferred Drug	4	11	1	2	4	1		110	01		100	1				31		90	1	2						90	31		31								100.00		300.00					100.00		300.00													300.00						275.00				100.00				100.00			3.23	3.23				3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5106	013	0	1	04	01	H5106_013_0	10		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				31								31			31		31											1026.68	33						1026.68	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5106	029	1	1	04	01	H5106_029_1	9		Y	Preferred Generic	4	01	1	2	1	1		110	01		100	1				31		90	1	2						90	31		31								7.00		21.00					0.00		0.00													21.00						0.00				7.00				7.00			0.23	0.00				0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5106	029	1	1	04	01	H5106_029_1	9		Y	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													45.00						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	9		Y	Preferred Brand	4	11	1	2	3	1		110	01		100	1				31		90	1	2						90	31		31								47.00		141.00					42.00		126.00													141.00						120.00				47.00				47.00			1.52	1.35				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5106	029	1	1	04	01	H5106_029_1	9		Y	Non-Preferred Drug	4	11	1	2	4	1		110	01		100	1				31		90	1	2						90	31		31								100.00		300.00					100.00		300.00													300.00						275.00				100.00				100.00			3.23	3.23				3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5106	029	1	1	04	01	H5106_029_1	9		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				31								31			31		31											854.86	33						854.86	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5106	029	2	1	04	01	H5106_029_2	9		Y	Preferred Generic	4	01	1	2	1	1		110	01		100	1				31		90	1	2						90	31		31								7.00		21.00					0.00		0.00													21.00						0.00				7.00				7.00			0.23	0.00				0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5106	029	2	1	04	01	H5106_029_2	9		Y	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													45.00						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	9		Y	Preferred Brand	4	11	1	2	3	1		110	01		100	1				31		90	1	2						90	31		31								47.00		141.00					42.00		126.00													141.00						120.00				47.00				47.00			1.52	1.35				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5106	029	2	1	04	01	H5106_029_2	9		Y	Non-Preferred Drug	4	11	1	2	4	1		110	01		100	1				31		90	1	2						90	31		31								100.00		300.00					100.00		300.00													300.00						275.00				100.00				100.00			3.23	3.23				3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5106	029	2	1	04	01	H5106_029_2	9		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				31								31			31		31											854.86	33						854.86	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5106	030	1	1	04	01	H5106_030_1	9		N	Preferred Generic	4	01	1	2	1	1		110	01		100	1				31		90	1	2						90	31		31								7.00		21.00					0.00		0.00													21.00						0.00				7.00				7.00			0.23	0.00				0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5106	030	1	1	04	01	H5106_030_1	9		N	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													60.00						0.00				20.00				20.00			0.65	0.16				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5106	030	1	1	04	01	H5106_030_1	9		N	Preferred Brand	4	11	1	2	3	1		110	01		100	1				31		90	1	2						90	31		31								47.00		141.00					47.00		141.00													141.00						120.00				47.00				47.00			1.52	1.52				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5106	030	1	1	04	01	H5106_030_1	9		N	Non-Preferred Drug	4	11	1	2	4	1		110	01		100	1				31		90	1	2						90	31		31								100.00		300.00					100.00		300.00													300.00						275.00				100.00				100.00			3.23	3.23				3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5106	030	1	1	04	01	H5106_030_1	9		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				31								31			31		31											903.66	33						903.66	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5106	030	2	1	04	01	H5106_030_2	9		N	Preferred Generic	4	01	1	2	1	1		110	01		100	1				31		90	1	2						90	31		31								7.00		21.00					0.00		0.00													21.00						0.00				7.00				7.00			0.23	0.00				0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5106	030	2	1	04	01	H5106_030_2	9		N	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													60.00						0.00				20.00				20.00			0.65	0.16				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5106	030	2	1	04	01	H5106_030_2	9		N	Preferred Brand	4	11	1	2	3	1		110	01		100	1				31		90	1	2						90	31		31								47.00		141.00					47.00		141.00													141.00						120.00				47.00				47.00			1.52	1.52				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5106	030	2	1	04	01	H5106_030_2	9		N	Non-Preferred Drug	4	11	1	2	4	1		110	01		100	1				31		90	1	2						90	31		31								100.00		300.00					100.00		300.00													300.00						275.00				100.00				100.00			3.23	3.23				3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5106	030	2	1	04	01	H5106_030_2	9		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				31								31			31		31											903.66	33						903.66	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5106	031	1	1	04	01	H5106_031_1	9		N	Preferred Generic	4	01	1	2	1	1		110	01		100	1				31		90	1	2						90	31		31								7.00		21.00					0.00		0.00													21.00						0.00				7.00				7.00			0.23	0.00				0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5106	031	1	1	04	01	H5106_031_1	9		N	Generic	4	01	1	2	2	1		110	01		100	1				31		90	1	2						90	31		31								20.00		60.00					10.00		30.00													60.00						0.00				20.00				20.00			0.65	0.32				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5106	031	1	1	04	01	H5106_031_1	9		N	Preferred Brand	4	11	1	2	3	1		110	01		100	1				31		90	1	2						90	31		31								47.00		141.00					47.00		141.00													141.00						120.00				47.00				47.00			1.52	1.52				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5106	031	1	1	04	01	H5106_031_1	9		N	Non-Preferred Drug	4	11	1	2	4	1		110	01		100	1				31		90	1	2						90	31		31								100.00		300.00					100.00		300.00													300.00						275.00				100.00				100.00			3.23	3.23				3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5106	031	1	1	04	01	H5106_031_1	9		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				31								31			31		31											964.56	33						964.56	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5106	031	2	1	04	01	H5106_031_2	9		N	Preferred Generic	4	01	1	2	1	1		110	01		100	1				31		90	1	2						90	31		31								7.00		21.00					0.00		0.00													21.00						0.00				7.00				7.00			0.23	0.00				0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5106	031	2	1	04	01	H5106_031_2	9		N	Generic	4	01	1	2	2	1		110	01		100	1				31		90	1	2						90	31		31								20.00		60.00					10.00		30.00													60.00						0.00				20.00				20.00			0.65	0.32				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5106	031	2	1	04	01	H5106_031_2	9		N	Preferred Brand	4	11	1	2	3	1		110	01		100	1				31		90	1	2						90	31		31								47.00		141.00					47.00		141.00													141.00						120.00				47.00				47.00			1.52	1.52				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5106	031	2	1	04	01	H5106_031_2	9		N	Non-Preferred Drug	4	11	1	2	4	1		110	01		100	1				31		90	1	2						90	31		31								100.00		300.00					100.00		300.00													300.00						275.00				100.00				100.00			3.23	3.23				3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5106	031	2	1	04	01	H5106_031_2	9		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				31								31			31		31											964.56	33						964.56	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5106	032	1	1	04	01	H5106_032_1	9		Y	Preferred Generic	4	01	1	2	1	1		110	01		100	1				31		90	1	2						90	31		31								7.00		21.00					0.00		0.00													21.00						0.00				7.00				7.00			0.23	0.00				0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5106	032	1	1	04	01	H5106_032_1	9		Y	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													45.00						0.00				15.00				15.00			0.48	0.00				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5106	032	1	1	04	01	H5106_032_1	9		Y	Preferred Brand	4	11	1	2	3	1		110	01		100	1				31		90	1	2						90	31		31								47.00		141.00					42.00		126.00													141.00						105.00				47.00				47.00			1.52	1.35				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5106	032	1	1	04	01	H5106_032_1	9		Y	Non-Preferred Drug	4	11	1	2	4	1		110	01		100	1				31		90	1	2						90	31		31								100.00		300.00					100.00		300.00													300.00						275.00				100.00				100.00			3.23	3.23				3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5106	032	1	1	04	01	H5106_032_1	9		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				31								31			31		31											1003.22	33						1003.22	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5106	032	2	1	04	01	H5106_032_2	9		Y	Preferred Generic	4	01	1	2	1	1		110	01		100	1				31		90	1	2						90	31		31								7.00		21.00					0.00		0.00													21.00						0.00				7.00				7.00			0.23	0.00				0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5106	032	2	1	04	01	H5106_032_2	9		Y	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													45.00						0.00				15.00				15.00			0.48	0.00				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5106	032	2	1	04	01	H5106_032_2	9		Y	Preferred Brand	4	11	1	2	3	1		110	01		100	1				31		90	1	2						90	31		31								47.00		141.00					42.00		126.00													141.00						105.00				47.00				47.00			1.52	1.35				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5106	032	2	1	04	01	H5106_032_2	9		Y	Non-Preferred Drug	4	11	1	2	4	1		110	01		100	1				31		90	1	2						90	31		31								100.00		300.00					100.00		300.00													300.00						275.00				100.00				100.00			3.23	3.23				3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5106	032	2	1	04	01	H5106_032_2	9		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				31								31			31		31											1003.22	33						1003.22	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5117	003	0	1	01	01	H5117_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								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												
H5117	003	0	1	01	01	H5117_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								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
H5117	003	0	1	01	01	H5117_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					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												
H5117	003	0	1	01	01	H5117_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					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	84.00				47.00				47.00			1.57	1.4		1.57	1.4	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5117	003	0	1	01	01	H5117_003_0	4			Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	300.00					95.00	190.00	285.00											100.00	200.00	300.00				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 Drug, Specialty Tier, Select Care Drugs												
H5117	003	0	1	01	01	H5117_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												
H5117	003	0	1	01	01	H5117_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												
H5117	003	0	1	01	01	H5117_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	
H5140	001	0	1	04	01	H5140_001_0	16			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												
H5140	001	0	1	04	01	H5140_001_0	16			Generic	4	01	1	2	2	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	9.00	9.00	9.00																			9.00	9.00	9.00																9.00				9.00		0.30			0.30			0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H5140	001	0	1	04	01	H5140_001_0	16			Preferred Brand	4	10	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	141.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H5140	001	0	1	04	01	H5140_001_0	16			Non-Preferred Brand	4	10	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	100.00	200.00	300.00																			100.00	200.00	300.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H5140	001	0	1	04	01	H5140_001_0	16			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												
H5140	001	0	1	04	01	H5140_001_0	16			Vaccines	4	11	1	2	6	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H5140	002	0	1	04	01	H5140_002_0	13			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												
H5140	002	0	1	04	01	H5140_002_0	13			Generic	4	01	1	2	2	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	9.00	9.00	9.00																			9.00	9.00	9.00																9.00				9.00		0.30			0.30			0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H5140	002	0	1	04	01	H5140_002_0	13			Preferred Brand	4	10	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	141.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H5140	002	0	1	04	01	H5140_002_0	13			Non-Preferred Brand	4	10	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	100.00	200.00	300.00																			100.00	200.00	300.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H5140	002	0	1	04	01	H5140_002_0	13			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												
H5140	002	0	1	04	01	H5140_002_0	13			Vaccines	4	11	1	2	6	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H5141	001	0	1	04	01	H5141_001_0	7		Y	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	7		Y	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	7		Y	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	7		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01	100		1				30	60	100	1	2			100				30		31								100.00	200.00	300.00					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	7		Y	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	7		Y	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	7		Y	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	7		Y	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	7		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01	100		1				30	60	100	1	2			100				30		31								100.00	200.00	300.00					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	7		Y	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	6		N	Preferred Generic	4	11	1	2	1	1		111	01	100		1				30	60	100	1	2			100				30		31								12.00	24.00	5.00					2.00	4.00	0.00							0.00																12.00				12.00			0.40	0.07				0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5141	007	0	1	04	01	H5141_007_0	6		N	Generic	4	11	1	1	2	1		111	01	100		1				30	60	100	1	2			100				30		31											10.20	25	25	25				10.20	22	22	22						0															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5141	007	0	1	04	01	H5141_007_0	6		N	Preferred Brand	4	11	1	1	3	1		111	01	100		1				30	60	100	1	2			100				30		31											174.05	25	25	25				174.05	22	22	22						22															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5141	007	0	1	04	01	H5141_007_0	6		N	Non-Preferred Drug	4	11	1	1	4	1		111	01	100		1				30	60	100	1	2			100				30		31											222.18	25	25	25				222.18	25	25	25						25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5141	007	0	1	04	01	H5141_007_0	6		N	Specialty Tier	4	11	1	1	5	1		111	01	100		1				30	60	100	1	2			100				30		31											2124.94	25	25	25				2124.94	25	25	25						25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5141	025	0	1	04	01	H5141_025_0	7		Y	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	7		Y	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	7		Y	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	7		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01	100		1				30	60	100	1	2			100				30		31								100.00	200.00	300.00					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	7		Y	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	7		Y	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	7		Y	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	7		Y	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	7		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01	100		1				30	60	100	1	2			100				30		31								100.00	200.00	300.00					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	7		Y	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	7		Y	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	7		Y	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	7		Y	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	7		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01	100		1				30	60	100	1	2			100				30		31								100.00	200.00	300.00					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	7		Y	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	7		Y	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	7		Y	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	7		Y	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	7		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01	100		1				30	60	100	1	2			100				30		31								100.00	200.00	300.00					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	7		Y	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	036	0	1	04	01	H5141_036_0	7		Y	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	7		Y	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	7		Y	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	7		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01	100		1				30	60	100	1	2			100				30		31								100.00	200.00	300.00					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	7		Y	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	8		Y	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	8		Y	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					5.00	10.00	15.00							0.00																15.00				15.00			0.50	0.17				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5141	037	0	1	04	01	H5141_037_0	8		Y	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	8		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01	100		1				30	60	100	1	2			100				30		31								100.00	200.00	300.00					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	8		Y	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	7		Y	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	7		Y	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	7		Y	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	7		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01	100		1				30	60	100	1	2			100				30		31								100.00	200.00	300.00					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	7		Y	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	042	0	1	04	01	H5141_042_0	6			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	6			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	6			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	6			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	6			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	5		N	Preferred Generic	4	11	1	2	1	1		111	01	100		1				30	60	100	1	2			100				30		31								12.00	24.00	5.00					0.00	0.00	0.00							0.00																12.00				12.00			0.40	0.00				0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5141	045	0	1	04	01	H5141_045_0	5		N	Generic	4	11	1	1	2	1		111	01	100		1				30	60	100	1	2			100				30		31											10.20	25	25	25				10.20	22	22	22						0															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5141	045	0	1	04	01	H5141_045_0	5		N	Preferred Brand	4	11	1	1	3	1		111	01	100		1				30	60	100	1	2			100				30		31											174.05	25	25	25				174.05	22	22	22						22															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5141	045	0	1	04	01	H5141_045_0	5		N	Non-Preferred Drug	4	11	1	1	4	1		111	01	100		1				30	60	100	1	2			100				30		31											222.18	25	25	25				222.18	25	25	25						25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5141	045	0	1	04	01	H5141_045_0	5		N	Specialty Tier	4	11	1	1	5	1		111	01	100		1				30	60	100	1	2			100				30		31											2124.94	25	25	25				2124.94	25	25	25						25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5141	050	0	1	04	01	H5141_050_0	7		Y	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	7		Y	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	7		Y	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	7		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01	100		1				30	60	100	1	2			100				30		31								100.00	200.00	300.00					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	7		Y	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	7			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	7			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	7			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	7			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	7			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	7		Y	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	7		Y	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	7		Y	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	7		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01	100		1				30	60	100	1	2			100				30		31								100.00	200.00	300.00					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	7		Y	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	8			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	8			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	8			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	8			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	8			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	8		Y	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	8		Y	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	8		Y	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	8		Y	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	8		Y	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	7			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	7			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	7			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	7			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	7			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	058	0	1	04	01	H5141_058_0	9		N	Preferred Generic	4	11	1	2	1	1		111	01	100		1				30	60	100	1	2			100				30		31								12.00	24.00	5.00					2.00	4.00	0.00							0.00																12.00				12.00			0.40	0.07				0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5141	058	0	1	04	01	H5141_058_0	9		N	Generic	4	11	1	2	2	1		111	01	100		1				30	60	100	1	2			100				30		31								20.00	40.00	60.00					12.00	24.00	36.00							8.00																20.00				20.00			0.67	0.40				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5141	058	0	1	04	01	H5141_058_0	9		N	Preferred Brand	4	11	1	2	3	1		111	01	100		1				30	60	100	1	2			100				30		31								47.00	94.00	141.00					47.00	94.00	141.00							130.00																47.00				47.00			1.57	1.57				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5141	058	0	1	04	01	H5141_058_0	9		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	100		1				30	60	100	1	2			100				30		31								100.00	200.00	300.00					100.00	200.00	300.00							290.00																100.00				100.00			3.33	3.33				3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5141	058	0	1	04	01	H5141_058_0	9		N	Specialty Tier	4	11	1	1	5	1		111	01	100		1				30	60	100	1	2			100				30		31											2284.07	30	30	30				2284.07	30	30	30						30															30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5141	059	0	1	04	01	H5141_059_0	7		N	Preferred Generic	4	11	1	2	1	1		111	01	100		1				30	60	100	1	2			100				30		31								12.00	24.00	5.00					2.00	4.00	0.00							0.00																12.00				12.00			0.40	0.07				0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5141	059	0	1	04	01	H5141_059_0	7		N	Generic	4	11	1	1	2	1		111	01	100		1				30	60	100	1	2			100				30		31											10.20	25	25	25				10.20	22	22	22						0															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5141	059	0	1	04	01	H5141_059_0	7		N	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	059	0	1	04	01	H5141_059_0	7		N	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	059	0	1	04	01	H5141_059_0	7		N	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												
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	8.00		24.00																									15.00		45.00				8.00		0.00				8.00				8.00		0.27				0.50	0.27	0.26	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	12.00		36.00																									20.00		60.00				12.00		0.00				12.00				12.00		0.40				0.67	0.40	0.39	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				63.00	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				51.00	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								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
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	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	
H5211	002	0	1	02	01	H5211_002_0	4		Y	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	4		Y	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	4		Y	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	4		Y	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	4		Y	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	4		Y	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	4		Y	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	4		Y	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	4		Y	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	4		Y	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	4		Y	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	4		Y	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	4		Y	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	4		Y	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	4		Y	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	4		Y	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	4		Y	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	4		Y	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	4		Y	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	4		Y	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	4		Y	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	4		Y	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	4		Y	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	4		Y	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	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	002	0	1	04	01	H5215_002_0	8			Generic	4	01	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								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	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	002	0	1	04	01	H5215_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												
H5215	002	0	1	04	01	H5215_002_0	8			Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												29							29												29						29					29			29								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												29							29												29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5215	007	0	1	04	01	H5215_007_0	7		N	Preferred Generic	3	01	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		25.00					7.00		17.00											10.00		25.00				7.00		0.00				7.00				7.00			0.33	0.23		0.33	0.23	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5215	007	0	1	04	01	H5215_007_0	7		N	Generic	3	01	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								19.00		47.00					12.00		30.00											19.00		47.00				12.00		0.00				12.00				12.00			0.63	0.40		0.63	0.40	0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5215	007	0	1	04	01	H5215_007_0	7		N	Preferred Brand	3	11	1	2	3	1		110	01		110	1				30		90	1	2				30		90	30		31								47.00		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	7		N	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	7		N	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5215	008	0	1	04	01	H5215_008_0	7			Preferred Generic	4	01	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								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	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	008	0	1	04	01	H5215_008_0	7			Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	1	2				30		90	30		31								47.00		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	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	008	0	1	04	01	H5215_008_0	7			Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												26							26												26						26					26			26								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												30							30												30						30					30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5215	010	0	1	04	01	H5215_010_0	9			Preferred Generic	4	01	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								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	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	010	0	1	04	01	H5215_010_0	9			Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	1	2				30		90	30		31								47.00		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	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	010	0	1	04	01	H5215_010_0	9			Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												29							29												29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5215	011	0	1	04	01	H5215_011_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	011	0	1	04	01	H5215_011_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	011	0	1	04	01	H5215_011_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	011	0	1	04	01	H5215_011_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	011	0	1	04	01	H5215_011_0	8			Specialty Tier	4	11	1	1	5	1		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	012	0	1	04	01	H5215_012_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	012	0	1	04	01	H5215_012_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	012	0	1	04	01	H5215_012_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	012	0	1	04	01	H5215_012_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	012	0	1	04	01	H5215_012_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	001	0	1	04	01	H5216_001_0	3		Y	Preferred Generic	4	11	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	6.00		18.00																									10.00		30.00				6.00		0.00				6.00				6.00		0.20				0.33	0.20	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	001	0	1	04	01	H5216_001_0	3		Y	Generic	4	11	1	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	15.00		45.00																									20.00		60.00				15.00		0.00				15.00				15.00		0.50				0.67	0.50	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	001	0	1	04	01	H5216_001_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		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	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		290.00				100.00				100.00		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	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					29																										29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	006	0	1	04	01	H5216_006_0	3		Y	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	006	0	1	04	01	H5216_006_0	3		Y	Preferred Generic	4	11	3	2	1	3	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H5216	006	0	1	04	01	H5216_006_0	3		Y	Generic	4	11	3	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	5.00		15.00																									20.00		60.00				5.00		0.00				5.00				5.00		0.17				0.67	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	006	0	1	04	01	H5216_006_0	3		Y	Generic	4	11	3	2	2	3	110		01		110	1	30		90				2	2				30		90	30		31	5.00		15.00																									20.00		60.00				5.00		0.00				5.00				5.00		0.17				0.67	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H5216	006	0	1	04	01	H5216_006_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	006	0	1	04	01	H5216_006_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	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												
H5216	006	0	1	04	01	H5216_006_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					29																										29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	009	0	1	04	01	H5216_009_0	5		Y	Preferred Generic	4	11	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	6.00		18.00																									10.00		30.00				6.00		0.00				6.00				6.00		0.20				0.33	0.20	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	009	0	1	04	01	H5216_009_0	5		Y	Generic	4	11	1	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	15.00		45.00																									20.00		60.00				15.00		0.00				15.00				15.00		0.50				0.67	0.50	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	009	0	1	04	01	H5216_009_0	5		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		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	5		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		290.00				100.00				100.00		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	5		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	011	0	1	04	01	H5216_011_0	4		Y	Preferred Generic	4	11	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	6.00		18.00																									10.00		30.00				6.00		0.00				6.00				6.00		0.20				0.33	0.20	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	011	0	1	04	01	H5216_011_0	4		Y	Generic	4	11	1	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	15.00		45.00																									20.00		60.00				15.00		0.00				15.00				15.00		0.50				0.67	0.50	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	011	0	1	04	01	H5216_011_0	4		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	011	0	1	04	01	H5216_011_0	4		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	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												
H5216	011	0	1	04	01	H5216_011_0	4		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	013	0	1	04	01	H5216_013_0	3		Y	Preferred Generic	4	11	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	6.00		18.00																									10.00		30.00				6.00		0.00				6.00				6.00		0.20				0.33	0.20	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	013	0	1	04	01	H5216_013_0	3		Y	Generic	4	11	1	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	15.00		45.00																									20.00		60.00				15.00		0.00				15.00				15.00		0.50				0.67	0.50	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	013	0	1	04	01	H5216_013_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		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	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		290.00				100.00				100.00		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	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	014	0	1	04	01	H5216_014_0	3		Y	Preferred Generic	4	11	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	6.00		18.00																									10.00		30.00				6.00		0.00				6.00				6.00		0.20				0.33	0.20	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	014	0	1	04	01	H5216_014_0	3		Y	Generic	4	11	1	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	16.00		48.00																									20.00		60.00				16.00		0.00				16.00				16.00		0.53				0.67	0.53	0.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	014	0	1	04	01	H5216_014_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		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	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		290.00				100.00				100.00		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	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					27																										27						27					27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	017	0	1	04	01	H5216_017_0	3		Y	Preferred Generic	4	11	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	017	0	1	04	01	H5216_017_0	3		Y	Generic	4	11	1	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	5.00		15.00																									20.00		60.00				5.00		0.00				5.00				5.00		0.17				0.67	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	017	0	1	04	01	H5216_017_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		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	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	99.00		297.00																									100.00		300.00				99.00		287.00				99.00				99.00		3.30				3.33	3.30	3.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	017	0	1	04	01	H5216_017_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					28																										28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	019	0	1	04	01	H5216_019_0	3		Y	Preferred Generic	4	11	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	5.00		15.00																									10.00		30.00				5.00		0.00				5.00				5.00		0.17				0.33	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	019	0	1	04	01	H5216_019_0	3		Y	Generic	4	11	1	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	15.00		45.00																									20.00		60.00				15.00		0.00				15.00				15.00		0.50				0.67	0.50	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	019	0	1	04	01	H5216_019_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	019	0	1	04	01	H5216_019_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	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												
H5216	019	0	1	04	01	H5216_019_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	021	0	1	04	01	H5216_021_0	4		Y	Preferred Generic	4	11	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	5.00		15.00																									10.00		30.00				5.00		0.00				5.00				5.00		0.17				0.33	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	021	0	1	04	01	H5216_021_0	4		Y	Generic	4	11	1	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	15.00		45.00																									20.00		60.00				15.00		0.00				15.00				15.00		0.50				0.67	0.50	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	021	0	1	04	01	H5216_021_0	4		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	021	0	1	04	01	H5216_021_0	4		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	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												
H5216	021	0	1	04	01	H5216_021_0	4		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	023	0	1	04	01	H5216_023_0	4		Y	Preferred Generic	4	11	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	7.00		21.00																									10.00		30.00				7.00		0.00				7.00				7.00		0.23				0.33	0.23	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	023	0	1	04	01	H5216_023_0	4		Y	Generic	4	11	1	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	17.00		51.00																									20.00		60.00				17.00		0.00				17.00				17.00		0.57				0.67	0.57	0.55	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	023	0	1	04	01	H5216_023_0	4		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		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	4		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		290.00				100.00				100.00		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	4		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					31																										31						31					31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	024	0	1	04	01	H5216_024_0	4		Y	Preferred Generic	4	11	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	024	0	1	04	01	H5216_024_0	4		Y	Preferred Generic	4	11	1	2	1	3	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5216	024	0	1	04	01	H5216_024_0	4		Y	Generic	4	11	1	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	5.00		15.00																									20.00		60.00				5.00		0.00				5.00				5.00		0.17				0.67	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	024	0	1	04	01	H5216_024_0	4		Y	Generic	4	11	1	2	2	3	110		01		110	1	30		90				2	2				30		90	30		31	5.00		15.00																									20.00		60.00				5.00		0.00				5.00				5.00		0.17				0.67	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5216	024	0	1	04	01	H5216_024_0	4		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		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		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	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												
H5216	024	0	1	04	01	H5216_024_0	4		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					31																										31						31					31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	027	0	1	04	01	H5216_027_0	4		Y	Preferred Generic	4	11	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	4.00		12.00																									10.00		30.00				4.00		0.00				4.00				4.00		0.13				0.33	0.13	0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	027	0	1	04	01	H5216_027_0	4		Y	Generic	4	11	1	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	12.00		36.00																									20.00		60.00				12.00		0.00				12.00				12.00		0.40				0.67	0.40	0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	027	0	1	04	01	H5216_027_0	4		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		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		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	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												
H5216	027	0	1	04	01	H5216_027_0	4		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					28																										28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	029	0	1	04	01	H5216_029_0	4		Y	Preferred Generic	4	11	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	029	0	1	04	01	H5216_029_0	4		Y	Generic	4	11	1	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	0.00		0.00																									20.00		60.00				0.00		0.00				0.00				0.00		0				0.67	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	029	0	1	04	01	H5216_029_0	4		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	029	0	1	04	01	H5216_029_0	4		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	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												
H5216	029	0	1	04	01	H5216_029_0	4		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					28																										28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	032	0	1	04	01	H5216_032_0	3		Y	Preferred Generic	4	11	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	8.00		24.00																									10.00		30.00				8.00		0.00				8.00				8.00		0.27				0.33	0.27	0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	032	0	1	04	01	H5216_032_0	3		Y	Generic	4	11	1	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	15.00		45.00																									20.00		60.00				15.00		0.00				15.00				15.00		0.50				0.67	0.50	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	032	0	1	04	01	H5216_032_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	032	0	1	04	01	H5216_032_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	99.00		297.00																									100.00		300.00				99.00		287.00				99.00				99.00		3.30				3.33	3.30	3.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	032	0	1	04	01	H5216_032_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					30																										30						30					30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	034	0	1	04	01	H5216_034_0	3		Y	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	5.00		15.00																									10.00		30.00				5.00		0.00				5.00				5.00		0.17				0.33	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	034	0	1	04	01	H5216_034_0	3		Y	Generic	4	11	3	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	15.00		45.00																									20.00		60.00				15.00		0.00				15.00				15.00		0.50				0.67	0.50	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	034	0	1	04	01	H5216_034_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	45.00		135.00																									47.00		141.00				45.00		90.00				45.00				45.00		1.50				1.57	1.50	1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	034	0	1	04	01	H5216_034_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		200.00				100.00				100.00		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	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					29																										29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	037	0	1	04	01	H5216_037_0	3		Y	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		100				1	2				30		100	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	037	0	1	04	01	H5216_037_0	3		Y	Generic	4	11	3	2	2	1	110		01		110	1	30		100				2	2				30		100	30		31	5.00		15.00																									20.00		60.00				5.00		0.00				5.00				5.00		0.17				0.67	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	037	0	1	04	01	H5216_037_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		100				2	2				30		100	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												
H5216	037	0	1	04	01	H5216_037_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		100				2	2				30		100	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												
H5216	037	0	1	04	01	H5216_037_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					29																										29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	039	0	1	04	01	H5216_039_0	3		Y	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		100				1	2				30		100	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	039	0	1	04	01	H5216_039_0	3		Y	Generic	4	11	3	2	2	1	110		01		110	1	30		100				2	2				30		100	30		31	5.00		15.00																									20.00		60.00				5.00		0.00				5.00				5.00		0.17				0.67	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	039	0	1	04	01	H5216_039_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		100				2	2				30		100	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												
H5216	039	0	1	04	01	H5216_039_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		100				2	2				30		100	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												
H5216	039	0	1	04	01	H5216_039_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	042	0	1	04	01	H5216_042_0	3		Y	Preferred Generic	4	11	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	7.00		21.00																									10.00		30.00				7.00		0.00				7.00				7.00		0.23				0.33	0.23	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	042	0	1	04	01	H5216_042_0	3		Y	Generic	4	11	1	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	12.00		36.00																									20.00		60.00				12.00		0.00				12.00				12.00		0.40				0.67	0.40	0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	042	0	1	04	01	H5216_042_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		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	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	99.00		297.00																									100.00		300.00				99.00		287.00				99.00				99.00		3.30				3.33	3.30	3.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	042	0	1	04	01	H5216_042_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					29																										29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	043	1	1	04	01	H5216_043_1	3		Y	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	043	1	1	04	01	H5216_043_1	3		Y	Preferred Generic	4	11	3	2	1	3	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H5216	043	1	1	04	01	H5216_043_1	3		Y	Generic	4	11	3	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	5.00		15.00																									20.00		60.00				5.00		0.00				5.00				5.00		0.17				0.67	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	043	1	1	04	01	H5216_043_1	3		Y	Generic	4	11	3	2	2	3	110		01		110	1	30		90				2	2				30		90	30		31	5.00		15.00																									20.00		60.00				5.00		0.00				5.00				5.00		0.17				0.67	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H5216	043	1	1	04	01	H5216_043_1	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		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	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	99.00		297.00																									100.00		300.00				99.00		287.00				99.00				99.00		3.30				3.33	3.30	3.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	043	1	1	04	01	H5216_043_1	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	043	5	1	04	01	H5216_043_5	3		Y	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	043	5	1	04	01	H5216_043_5	3		Y	Preferred Generic	4	11	3	2	1	3	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H5216	043	5	1	04	01	H5216_043_5	3		Y	Generic	4	11	3	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	5.00		15.00																									20.00		60.00				5.00		0.00				5.00				5.00		0.17				0.67	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	043	5	1	04	01	H5216_043_5	3		Y	Generic	4	11	3	2	2	3	110		01		110	1	30		90				2	2				30		90	30		31	5.00		15.00																									20.00		60.00				5.00		0.00				5.00				5.00		0.17				0.67	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H5216	043	5	1	04	01	H5216_043_5	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	043	5	1	04	01	H5216_043_5	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	99.00		297.00																									100.00		300.00				99.00		287.00				99.00				99.00		3.30				3.33	3.30	3.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	043	5	1	04	01	H5216_043_5	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	043	6	1	04	01	H5216_043_6	3		Y	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	043	6	1	04	01	H5216_043_6	3		Y	Preferred Generic	4	11	3	2	1	3	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H5216	043	6	1	04	01	H5216_043_6	3		Y	Generic	4	11	3	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	5.00		15.00																									20.00		60.00				5.00		0.00				5.00				5.00		0.17				0.67	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	043	6	1	04	01	H5216_043_6	3		Y	Generic	4	11	3	2	2	3	110		01		110	1	30		90				2	2				30		90	30		31	5.00		15.00																									20.00		60.00				5.00		0.00				5.00				5.00		0.17				0.67	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H5216	043	6	1	04	01	H5216_043_6	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	043	6	1	04	01	H5216_043_6	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	99.00		297.00																									100.00		300.00				99.00		287.00				99.00				99.00		3.30				3.33	3.30	3.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	043	6	1	04	01	H5216_043_6	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	044	0	1	04	01	H5216_044_0	2		Y	Preferred Generic	4	11	1	2	1	1	110		01		110	1	30		100				1	2				30		100	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	044	0	1	04	01	H5216_044_0	2		Y	Preferred Generic	4	11	1	2	1	3	110		01		110	1	30		100				1	2				30		100	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5216	044	0	1	04	01	H5216_044_0	2		Y	Generic	4	11	1	2	2	1	110		01		110	1	30		100				2	2				30		100	30		31	5.00		15.00																									20.00		60.00				5.00		0.00				5.00				5.00		0.17				0.67	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	044	0	1	04	01	H5216_044_0	2		Y	Generic	4	11	1	2	2	3	110		01		110	1	30		100				2	2				30		100	30		31	5.00		15.00																									20.00		60.00				5.00		0.00				5.00				5.00		0.17				0.67	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5216	044	0	1	04	01	H5216_044_0	2		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		100				2	2				30		100	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												
H5216	044	0	1	04	01	H5216_044_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		100				2	2				30		100	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												
H5216	044	0	1	04	01	H5216_044_0	2		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					29																										29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	047	0	1	04	01	H5216_047_0	2		Y	Preferred Generic	4	11	1	2	1	1	110		01		110	1	30		100				1	2				30		100	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	047	0	1	04	01	H5216_047_0	2		Y	Preferred Generic	4	11	1	2	1	3	110		01		110	1	30		100				1	2				30		100	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5216	047	0	1	04	01	H5216_047_0	2		Y	Generic	4	11	1	2	2	1	110		01		110	1	30		100				2	2				30		100	30		31	5.00		15.00																									20.00		60.00				5.00		0.00				5.00				5.00		0.17				0.67	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	047	0	1	04	01	H5216_047_0	2		Y	Generic	4	11	1	2	2	3	110		01		110	1	30		100				2	2				30		100	30		31	5.00		15.00																									20.00		60.00				5.00		0.00				5.00				5.00		0.17				0.67	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5216	047	0	1	04	01	H5216_047_0	2		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		100				2	2				30		100	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												
H5216	047	0	1	04	01	H5216_047_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		100				2	2				30		100	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												
H5216	047	0	1	04	01	H5216_047_0	2		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					28																										28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	048	0	1	04	01	H5216_048_0	2		N	Preferred Generic	3	11	1	2	1	1	110		01		110	1	30		100				1	2				30		100	30		31	16.00		48.00																									18.00		54.00				16.00		0.00				16.00				16.00		0.53				0.60	0.53	0.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	048	0	1	04	01	H5216_048_0	2		N	Generic	3	11	1	2	2	1	110		01		110	1	30		100				2	2				30		100	30		31	18.00		54.00																									20.00		60.00				18.00		0.00				18.00				18.00		0.60				0.67	0.60	0.58	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	048	0	1	04	01	H5216_048_0	2		N	Preferred Brand	3	11	1	1	3	1	110		01		110	1	30		100				2	2				30		100	30		31				61.00	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	2		N	Non-Preferred Drug	3	11	1	1	4	1	110		01		110	1	30		100				2	2				30		100	30		31				56.00	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	2		N	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												
H5216	050	0	1	04	01	H5216_050_0	4		Y	Preferred Generic	4	11	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	050	0	1	04	01	H5216_050_0	4		Y	Generic	4	11	1	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	5.00		15.00																									20.00		60.00				5.00		0.00				5.00				5.00		0.17				0.67	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	050	0	1	04	01	H5216_050_0	4		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		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	4		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		290.00				100.00				100.00		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	4		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	051	0	1	04	01	H5216_051_0	4		Y	Preferred Generic	4	11	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	7.00		21.00																									10.00		30.00				7.00		0.00				7.00				7.00		0.23				0.33	0.23	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	051	0	1	04	01	H5216_051_0	4		Y	Generic	4	11	1	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	17.00		51.00																									20.00		60.00				17.00		0.00				17.00				17.00		0.57				0.67	0.57	0.55	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	051	0	1	04	01	H5216_051_0	4		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		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	4		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		290.00				100.00				100.00		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	4		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	052	1	1	04	01	H5216_052_1	4		Y	Preferred Generic	4	11	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	7.00		21.00																									10.00		30.00				7.00		0.00				7.00				7.00		0.23				0.33	0.23	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	052	1	1	04	01	H5216_052_1	4		Y	Generic	4	11	1	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	17.00		51.00																									20.00		60.00				17.00		0.00				17.00				17.00		0.57				0.67	0.57	0.55	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	052	1	1	04	01	H5216_052_1	4		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	47.00		141.00																									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												
H5216	052	1	1	04	01	H5216_052_1	4		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	100.00		300.00																									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												
H5216	052	1	1	04	01	H5216_052_1	4		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					31																										31						31					31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	052	2	1	04	01	H5216_052_2	4		Y	Preferred Generic	4	11	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	7.00		21.00																									10.00		30.00				7.00		0.00				7.00				7.00		0.23				0.33	0.23	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	052	2	1	04	01	H5216_052_2	4		Y	Generic	4	11	1	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	17.00		51.00																									20.00		60.00				17.00		0.00				17.00				17.00		0.57				0.67	0.57	0.55	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	052	2	1	04	01	H5216_052_2	4		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		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	4		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		290.00				100.00				100.00		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	4		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					31																										31						31					31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	053	0	1	04	01	H5216_053_0	4		Y	Preferred Generic	4	11	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	7.00		21.00																									10.00		30.00				7.00		0.00				7.00				7.00		0.23				0.33	0.23	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	053	0	1	04	01	H5216_053_0	4		Y	Generic	4	11	1	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	17.00		51.00																									20.00		60.00				17.00		0.00				17.00				17.00		0.57				0.67	0.57	0.55	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	053	0	1	04	01	H5216_053_0	4		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		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	4		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		290.00				100.00				100.00		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	4		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	055	0	1	04	01	H5216_055_0	4		Y	Preferred Generic	4	11	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	7.00		21.00																									10.00		30.00				7.00		0.00				7.00				7.00		0.23				0.33	0.23	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	055	0	1	04	01	H5216_055_0	4		Y	Generic	4	11	1	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	17.00		51.00																									20.00		60.00				17.00		0.00				17.00				17.00		0.57				0.67	0.57	0.55	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	055	0	1	04	01	H5216_055_0	4		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		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	4		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		290.00				100.00				100.00		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	4		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	057	0	1	04	01	H5216_057_0	3		Y	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	057	0	1	04	01	H5216_057_0	3		Y	Preferred Generic	4	11	3	2	1	3	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H5216	057	0	1	04	01	H5216_057_0	3		Y	Generic	4	11	3	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	0.00		0.00																									20.00		60.00				0.00		0.00				0.00				0.00		0				0.67	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	057	0	1	04	01	H5216_057_0	3		Y	Generic	4	11	3	2	2	3	110		01		110	1	30		90				2	2				30		90	30		31	0.00		0.00																									20.00		60.00				0.00		0.00				0.00				0.00		0				0.67	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H5216	057	0	1	04	01	H5216_057_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	057	0	1	04	01	H5216_057_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	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												
H5216	057	0	1	04	01	H5216_057_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	058	0	1	04	01	H5216_058_0	3		Y	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	2.00		6.00																									10.00		30.00				2.00		0.00				2.00				2.00		0.07				0.33	0.07	0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	058	0	1	04	01	H5216_058_0	3		Y	Preferred Generic	4	11	3	2	1	3	110		01		110	1	30		90				1	2				30		90	30		31	2.00		6.00																									10.00		30.00				2.00		0.00				2.00				2.00		0.07				0.33	0.07	0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H5216	058	0	1	04	01	H5216_058_0	3		Y	Generic	4	11	3	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	9.00		27.00																									20.00		60.00				9.00		0.00				9.00				9.00		0.30				0.67	0.30	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	058	0	1	04	01	H5216_058_0	3		Y	Generic	4	11	3	2	2	3	110		01		110	1	30		90				2	2				30		90	30		31	9.00		27.00																									20.00		60.00				9.00		0.00				9.00				9.00		0.30				0.67	0.30	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H5216	058	0	1	04	01	H5216_058_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	058	0	1	04	01	H5216_058_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	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												
H5216	058	0	1	04	01	H5216_058_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					28																										28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	062	0	1	04	01	H5216_062_0	3		Y	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	062	0	1	04	01	H5216_062_0	3		Y	Generic	4	11	3	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	5.00		15.00																									20.00		60.00				5.00		0.00				5.00				5.00		0.17				0.67	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	062	0	1	04	01	H5216_062_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	30.00		90.00																									47.00		141.00				30.00		80.00				30.00				30.00		1				1.57	1	0.97	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	062	0	1	04	01	H5216_062_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		290.00				100.00				100.00		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	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					30																										30						30					30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	063	0	1	04	01	H5216_063_0	3		Y	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	063	0	1	04	01	H5216_063_0	3		Y	Preferred Generic	4	11	3	2	1	3	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H5216	063	0	1	04	01	H5216_063_0	3		Y	Generic	4	11	3	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	5.00		15.00																									20.00		60.00				5.00		0.00				5.00				5.00		0.17				0.67	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	063	0	1	04	01	H5216_063_0	3		Y	Generic	4	11	3	2	2	3	110		01		110	1	30		90				2	2				30		90	30		31	5.00		15.00																									20.00		60.00				5.00		0.00				5.00				5.00		0.17				0.67	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H5216	063	0	1	04	01	H5216_063_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		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	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		290.00				100.00				100.00		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	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	064	0	1	04	01	H5216_064_0	4		Y	Preferred Generic	4	11	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	5.00		15.00																									10.00		30.00				5.00		0.00				5.00				5.00		0.17				0.33	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	064	0	1	04	01	H5216_064_0	4		Y	Generic	4	11	1	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	15.00		45.00																									20.00		60.00				15.00		0.00				15.00				15.00		0.50				0.67	0.50	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	064	0	1	04	01	H5216_064_0	4		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		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		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	99.00		297.00																									100.00		300.00				99.00		287.00				99.00				99.00		3.30				3.33	3.30	3.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	064	0	1	04	01	H5216_064_0	4		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	068	0	1	04	01	H5216_068_0	3		Y	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	068	0	1	04	01	H5216_068_0	3		Y	Generic	4	11	3	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	0.00		0.00																									20.00		60.00				0.00		0.00				0.00				0.00		0				0.67	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	068	0	1	04	01	H5216_068_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		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	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		290.00				100.00				100.00		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	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					30																										30						30					30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	070	0	1	04	01	H5216_070_0	3		Y	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	2.00		6.00																									10.00		30.00				2.00		0.00				2.00				2.00		0.07				0.33	0.07	0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	070	0	1	04	01	H5216_070_0	3		Y	Preferred Generic	4	11	3	2	1	3	110		01		110	1	30		90				1	2				30		90	30		31	2.00		6.00																									10.00		30.00				2.00		0.00				2.00				2.00		0.07				0.33	0.07	0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H5216	070	0	1	04	01	H5216_070_0	3		Y	Generic	4	11	3	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	10.00		30.00																									20.00		60.00				10.00		0.00				10.00				10.00		0.33				0.67	0.33	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	070	0	1	04	01	H5216_070_0	3		Y	Generic	4	11	3	2	2	3	110		01		110	1	30		90				2	2				30		90	30		31	10.00		30.00																									20.00		60.00				10.00		0.00				10.00				10.00		0.33				0.67	0.33	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H5216	070	0	1	04	01	H5216_070_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		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	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		290.00				100.00				100.00		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	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					30																										30						30					30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	072	0	1	04	01	H5216_072_0	4		Y	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	2.00		6.00																									10.00		30.00				2.00		0.00				2.00				2.00		0.07				0.33	0.07	0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	072	0	1	04	01	H5216_072_0	4		Y	Preferred Generic	4	11	3	2	1	3	110		01		110	1	30		90				1	2				30		90	30		31	2.00		6.00																									10.00		30.00				2.00		0.00				2.00				2.00		0.07				0.33	0.07	0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H5216	072	0	1	04	01	H5216_072_0	4		Y	Generic	4	11	3	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	10.00		30.00																									20.00		60.00				10.00		0.00				10.00				10.00		0.33				0.67	0.33	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	072	0	1	04	01	H5216_072_0	4		Y	Generic	4	11	3	2	2	3	110		01		110	1	30		90				2	2				30		90	30		31	10.00		30.00																									20.00		60.00				10.00		0.00				10.00				10.00		0.33				0.67	0.33	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H5216	072	0	1	04	01	H5216_072_0	4		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	072	0	1	04	01	H5216_072_0	4		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	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												
H5216	072	0	1	04	01	H5216_072_0	4		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					30																										30						30					30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	073	0	1	04	01	H5216_073_0	3		Y	Preferred Generic	4	11	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	7.00		21.00																									10.00		30.00				7.00		0.00				7.00				7.00		0.23				0.33	0.23	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	073	0	1	04	01	H5216_073_0	3		Y	Generic	4	11	1	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	17.00		51.00																									20.00		60.00				17.00		0.00				17.00				17.00		0.57				0.67	0.57	0.55	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	073	0	1	04	01	H5216_073_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	073	0	1	04	01	H5216_073_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	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												
H5216	073	0	1	04	01	H5216_073_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					27																										27						27					27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	074	0	1	04	01	H5216_074_0	3		Y	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	2.00		6.00																									10.00		30.00				2.00		0.00				2.00				2.00		0.07				0.33	0.07	0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	074	0	1	04	01	H5216_074_0	3		Y	Preferred Generic	4	11	3	2	1	3	110		01		110	1	30		90				1	2				30		90	30		31	2.00		6.00																									10.00		30.00				2.00		0.00				2.00				2.00		0.07				0.33	0.07	0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H5216	074	0	1	04	01	H5216_074_0	3		Y	Generic	4	11	3	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	10.00		30.00																									20.00		60.00				10.00		0.00				10.00				10.00		0.33				0.67	0.33	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	074	0	1	04	01	H5216_074_0	3		Y	Generic	4	11	3	2	2	3	110		01		110	1	30		90				2	2				30		90	30		31	10.00		30.00																									20.00		60.00				10.00		0.00				10.00				10.00		0.33				0.67	0.33	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H5216	074	0	1	04	01	H5216_074_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	47.00		141.00																									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												
H5216	074	0	1	04	01	H5216_074_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	100.00		300.00																									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												
H5216	074	0	1	04	01	H5216_074_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	078	1	1	04	01	H5216_078_1	3		Y	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	078	1	1	04	01	H5216_078_1	3		Y	Preferred Generic	4	11	3	2	1	3	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H5216	078	1	1	04	01	H5216_078_1	3		Y	Generic	4	11	3	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	5.00		15.00																									20.00		60.00				5.00		0.00				5.00				5.00		0.17				0.67	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	078	1	1	04	01	H5216_078_1	3		Y	Generic	4	11	3	2	2	3	110		01		110	1	30		90				2	2				30		90	30		31	5.00		15.00																									20.00		60.00				5.00		0.00				5.00				5.00		0.17				0.67	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H5216	078	1	1	04	01	H5216_078_1	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	45.00		135.00																									47.00		141.00				45.00		90.00				45.00				45.00		1.50				1.57	1.50	1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	078	1	1	04	01	H5216_078_1	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		200.00				100.00				100.00		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	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	078	2	1	04	01	H5216_078_2	3		Y	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	078	2	1	04	01	H5216_078_2	3		Y	Preferred Generic	4	11	3	2	1	3	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H5216	078	2	1	04	01	H5216_078_2	3		Y	Generic	4	11	3	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	5.00		15.00																									20.00		60.00				5.00		0.00				5.00				5.00		0.17				0.67	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	078	2	1	04	01	H5216_078_2	3		Y	Generic	4	11	3	2	2	3	110		01		110	1	30		90				2	2				30		90	30		31	5.00		15.00																									20.00		60.00				5.00		0.00				5.00				5.00		0.17				0.67	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H5216	078	2	1	04	01	H5216_078_2	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	45.00		135.00																									47.00		141.00				45.00		90.00				45.00				45.00		1.50				1.57	1.50	1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	078	2	1	04	01	H5216_078_2	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		200.00				100.00				100.00		3.33				3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	078	2	1	04	01	H5216_078_2	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	081	0	1	04	01	H5216_081_0	3		Y	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	7.00		21.00																									10.00		30.00				7.00		0.00				7.00				7.00		0.23				0.33	0.23	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	081	0	1	04	01	H5216_081_0	3		Y	Generic	4	11	3	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	12.00		36.00																									20.00		60.00				12.00		0.00				12.00				12.00		0.40				0.67	0.40	0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	081	0	1	04	01	H5216_081_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		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	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	99.00		297.00																									100.00		300.00				99.00		287.00				99.00				99.00		3.30				3.33	3.30	3.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	081	0	1	04	01	H5216_081_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					30																										30						30					30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	083	0	1	04	01	H5216_083_0	3		Y	Preferred Generic	4	11	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	8.00		24.00																									10.00		30.00				8.00		0.00				8.00				8.00		0.27				0.33	0.27	0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	083	0	1	04	01	H5216_083_0	3		Y	Generic	4	11	1	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	15.00		45.00																									20.00		60.00				15.00		0.00				15.00				15.00		0.50				0.67	0.50	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	083	0	1	04	01	H5216_083_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	083	0	1	04	01	H5216_083_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	99.00		297.00																									100.00		300.00				99.00		287.00				99.00				99.00		3.30				3.33	3.30	3.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	083	0	1	04	01	H5216_083_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					30																										30						30					30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	088	0	1	04	01	H5216_088_0	3		Y	Preferred Generic	4	11	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	5.00		15.00																									10.00		30.00				5.00		0.00				5.00				5.00		0.17				0.33	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	088	0	1	04	01	H5216_088_0	3		Y	Generic	4	11	1	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	15.00		45.00																									20.00		60.00				15.00		0.00				15.00				15.00		0.50				0.67	0.50	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	088	0	1	04	01	H5216_088_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	088	0	1	04	01	H5216_088_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	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												
H5216	088	0	1	04	01	H5216_088_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					27																										27						27					27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	089	0	1	04	01	H5216_089_0	2		Y	Preferred Generic	4	11	1	2	1	1	110		01		110	1	30		100				1	2				30		100	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	089	0	1	04	01	H5216_089_0	2		Y	Preferred Generic	4	11	1	2	1	3	110		01		110	1	30		100				1	2				30		100	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5216	089	0	1	04	01	H5216_089_0	2		Y	Generic	4	11	1	2	2	1	110		01		110	1	30		100				2	2				30		100	30		31	5.00		15.00																									20.00		60.00				5.00		0.00				5.00				5.00		0.17				0.67	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	089	0	1	04	01	H5216_089_0	2		Y	Generic	4	11	1	2	2	3	110		01		110	1	30		100				2	2				30		100	30		31	5.00		15.00																									20.00		60.00				5.00		0.00				5.00				5.00		0.17				0.67	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5216	089	0	1	04	01	H5216_089_0	2		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		100				2	2				30		100	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												
H5216	089	0	1	04	01	H5216_089_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		100				2	2				30		100	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												
H5216	089	0	1	04	01	H5216_089_0	2		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					27																										27						27					27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	092	0	1	04	01	H5216_092_0	3		Y	Preferred Generic	4	11	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	4.00		12.00																									10.00		30.00				4.00		0.00				4.00				4.00		0.13				0.33	0.13	0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	092	0	1	04	01	H5216_092_0	3		Y	Generic	4	11	1	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	15.00		45.00																									20.00		60.00				15.00		0.00				15.00				15.00		0.50				0.67	0.50	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	092	0	1	04	01	H5216_092_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	47.00		141.00																									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												
H5216	092	0	1	04	01	H5216_092_0	3		Y	Non-Preferred Drug	4	11	1	1	4	1	110		01		110	1	30		90				2	2				30		90	30		31				99.00	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	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					27																										27						27					27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	093	0	1	04	01	H5216_093_0	3		Y	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	093	0	1	04	01	H5216_093_0	3		Y	Generic	4	11	3	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	5.00		15.00																									20.00		60.00				5.00		0.00				5.00				5.00		0.17				0.67	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	093	0	1	04	01	H5216_093_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		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	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	97.00		291.00																									100.00		300.00				97.00		281.00				97.00				97.00		3.23				3.33	3.23	3.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	093	0	1	04	01	H5216_093_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					30																										30						30					30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	096	0	1	04	01	H5216_096_0	4		Y	Preferred Generic	4	11	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	5.00		15.00																									10.00		30.00				5.00		0.00				5.00				5.00		0.17				0.33	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	096	0	1	04	01	H5216_096_0	4		Y	Generic	4	11	1	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	15.00		45.00																									20.00		60.00				15.00		0.00				15.00				15.00		0.50				0.67	0.50	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	096	0	1	04	01	H5216_096_0	4		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		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		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	97.00		291.00																									100.00		300.00				97.00		281.00				97.00				97.00		3.23				3.33	3.23	3.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	096	0	1	04	01	H5216_096_0	4		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					30																										30						30					30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	097	0	1	04	01	H5216_097_0	3		Y	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	097	0	1	04	01	H5216_097_0	3		Y	Generic	4	11	3	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	5.00		15.00																									20.00		60.00				5.00		0.00				5.00				5.00		0.17				0.67	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	097	0	1	04	01	H5216_097_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	097	0	1	04	01	H5216_097_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	97.00		291.00																									100.00		300.00				97.00		281.00				97.00				97.00		3.23				3.33	3.23	3.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	097	0	1	04	01	H5216_097_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					30																										30						30					30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	098	0	1	04	01	H5216_098_0	3		Y	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	098	0	1	04	01	H5216_098_0	3		Y	Generic	4	11	3	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	5.00		15.00																									20.00		60.00				5.00		0.00				5.00				5.00		0.17				0.67	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	098	0	1	04	01	H5216_098_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	47.00		141.00																									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												
H5216	098	0	1	04	01	H5216_098_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	97.00		291.00																									100.00		300.00				97.00		281.00				97.00				97.00		3.23				3.33	3.23	3.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	098	0	1	04	01	H5216_098_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					30																										30						30					30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	099	0	1	04	01	H5216_099_0	3		Y	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	099	0	1	04	01	H5216_099_0	3		Y	Generic	4	11	3	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	5.00		15.00																									20.00		60.00				5.00		0.00				5.00				5.00		0.17				0.67	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	099	0	1	04	01	H5216_099_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		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	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	97.00		291.00																									100.00		300.00				97.00		281.00				97.00				97.00		3.23				3.33	3.23	3.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	099	0	1	04	01	H5216_099_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					30																										30						30					30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	100	0	1	04	01	H5216_100_0	5		Y	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	100	0	1	04	01	H5216_100_0	5		Y	Generic	4	11	3	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	5.00		15.00																									20.00		60.00				5.00		0.00				5.00				5.00		0.17				0.67	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	100	0	1	04	01	H5216_100_0	5		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		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	5		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	97.00		291.00																									100.00		300.00				97.00		281.00				97.00				97.00		3.23				3.33	3.23	3.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	100	0	1	04	01	H5216_100_0	5		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	103	0	1	04	01	H5216_103_0	3		Y	Preferred Generic	4	11	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	4.00		12.00																									10.00		30.00				4.00		0.00				4.00				4.00		0.13				0.33	0.13	0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	103	0	1	04	01	H5216_103_0	3		Y	Generic	4	11	1	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	15.00		45.00																									20.00		60.00				15.00		0.00				15.00				15.00		0.50				0.67	0.50	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	103	0	1	04	01	H5216_103_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		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	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		290.00				100.00				100.00		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	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					29																										29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	106	0	1	04	01	H5216_106_0	4		Y	Preferred Generic	4	11	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	106	0	1	04	01	H5216_106_0	4		Y	Preferred Generic	4	11	1	2	1	3	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5216	106	0	1	04	01	H5216_106_0	4		Y	Generic	4	11	1	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	5.00		15.00																									20.00		60.00				5.00		0.00				5.00				5.00		0.17				0.67	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	106	0	1	04	01	H5216_106_0	4		Y	Generic	4	11	1	2	2	3	110		01		110	1	30		90				2	2				30		90	30		31	5.00		15.00																									20.00		60.00				5.00		0.00				5.00				5.00		0.17				0.67	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5216	106	0	1	04	01	H5216_106_0	4		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		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	4		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		290.00				100.00				100.00		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	4		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	107	0	1	04	01	H5216_107_0	3		Y	Preferred Generic	4	11	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	5.00		15.00																									10.00		30.00				5.00		0.00				5.00				5.00		0.17				0.33	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	107	0	1	04	01	H5216_107_0	3		Y	Generic	4	11	1	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	15.00		45.00																									20.00		60.00				15.00		0.00				15.00				15.00		0.50				0.67	0.50	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	107	0	1	04	01	H5216_107_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		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	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	97.00		291.00																									100.00		300.00				97.00		281.00				97.00				97.00		3.23				3.33	3.23	3.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	107	0	1	04	01	H5216_107_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					29																										29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	112	0	1	04	01	H5216_112_0	4		Y	Preferred Generic	4	11	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	112	0	1	04	01	H5216_112_0	4		Y	Preferred Generic	4	11	1	2	1	3	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5216	112	0	1	04	01	H5216_112_0	4		Y	Generic	4	11	1	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	5.00		15.00																									20.00		60.00				5.00		0.00				5.00				5.00		0.17				0.67	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	112	0	1	04	01	H5216_112_0	4		Y	Generic	4	11	1	2	2	3	110		01		110	1	30		90				2	2				30		90	30		31	5.00		15.00																									20.00		60.00				5.00		0.00				5.00				5.00		0.17				0.67	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5216	112	0	1	04	01	H5216_112_0	4		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		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		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	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												
H5216	112	0	1	04	01	H5216_112_0	4		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	114	0	1	04	01	H5216_114_0	4		Y	Preferred Generic	4	11	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	114	0	1	04	01	H5216_114_0	4		Y	Preferred Generic	4	11	1	2	1	3	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5216	114	0	1	04	01	H5216_114_0	4		Y	Generic	4	11	1	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	5.00		15.00																									20.00		60.00				5.00		0.00				5.00				5.00		0.17				0.67	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	114	0	1	04	01	H5216_114_0	4		Y	Generic	4	11	1	2	2	3	110		01		110	1	30		90				2	2				30		90	30		31	5.00		15.00																									20.00		60.00				5.00		0.00				5.00				5.00		0.17				0.67	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5216	114	0	1	04	01	H5216_114_0	4		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		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	4		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		290.00				100.00				100.00		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	4		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	117	0	1	04	01	H5216_117_0	4		Y	Preferred Generic	4	11	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	117	0	1	04	01	H5216_117_0	4		Y	Generic	4	11	1	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	20.00		60.00																									20.00		60.00				20.00		0.00				20.00				20.00		0.67				0.67	0.67	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	117	0	1	04	01	H5216_117_0	4		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		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		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	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												
H5216	117	0	1	04	01	H5216_117_0	4		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	120	0	1	04	01	H5216_120_0	5		Y	Preferred Generic	4	11	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	5.00		15.00																									10.00		30.00				5.00		0.00				5.00				5.00		0.17				0.33	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	120	0	1	04	01	H5216_120_0	5		Y	Generic	4	11	1	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	15.00		45.00																									20.00		60.00				15.00		0.00				15.00				15.00		0.50				0.67	0.50	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	120	0	1	04	01	H5216_120_0	5		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	120	0	1	04	01	H5216_120_0	5		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	97.00		291.00																									100.00		300.00				97.00		281.00				97.00				97.00		3.23				3.33	3.23	3.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	120	0	1	04	01	H5216_120_0	5		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	124	0	1	04	01	H5216_124_0	4		Y	Preferred Generic	4	11	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	5.00		15.00																									10.00		30.00				5.00		0.00				5.00				5.00		0.17				0.33	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	124	0	1	04	01	H5216_124_0	4		Y	Generic	4	11	1	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	15.00		45.00																									20.00		60.00				15.00		0.00				15.00				15.00		0.50				0.67	0.50	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	124	0	1	04	01	H5216_124_0	4		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	124	0	1	04	01	H5216_124_0	4		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	97.00		291.00																									100.00		300.00				97.00		281.00				97.00				97.00		3.23				3.33	3.23	3.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	124	0	1	04	01	H5216_124_0	4		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	131	0	1	04	01	H5216_131_0	2		Y	Preferred Generic	4	11	1	2	1	1	110		01		110	1	30		100				1	2				30		100	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	131	0	1	04	01	H5216_131_0	2		Y	Preferred Generic	4	11	1	2	1	3	110		01		110	1	30		100				1	2				30		100	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5216	131	0	1	04	01	H5216_131_0	2		Y	Generic	4	11	1	2	2	1	110		01		110	1	30		100				2	2				30		100	30		31	0.00		0.00																									20.00		60.00				0.00		0.00				0.00				0.00		0				0.67	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	131	0	1	04	01	H5216_131_0	2		Y	Generic	4	11	1	2	2	3	110		01		110	1	30		100				2	2				30		100	30		31	0.00		0.00																									20.00		60.00				0.00		0.00				0.00				0.00		0				0.67	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5216	131	0	1	04	01	H5216_131_0	2		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		100				2	2				30		100	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												
H5216	131	0	1	04	01	H5216_131_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		100				2	2				30		100	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												
H5216	131	0	1	04	01	H5216_131_0	2		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					31																										31						31					31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	132	0	1	04	01	H5216_132_0	2		Y	Preferred Generic	4	11	1	2	1	1	110		01		110	1	30		100				1	2				30		100	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	132	0	1	04	01	H5216_132_0	2		Y	Preferred Generic	4	11	1	2	1	3	110		01		110	1	30		100				1	2				30		100	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5216	132	0	1	04	01	H5216_132_0	2		Y	Generic	4	11	1	2	2	1	110		01		110	1	30		100				2	2				30		100	30		31	0.00		0.00																									20.00		60.00				0.00		0.00				0.00				0.00		0				0.67	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	132	0	1	04	01	H5216_132_0	2		Y	Generic	4	11	1	2	2	3	110		01		110	1	30		100				2	2				30		100	30		31	0.00		0.00																									20.00		60.00				0.00		0.00				0.00				0.00		0				0.67	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5216	132	0	1	04	01	H5216_132_0	2		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		100				2	2				30		100	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												
H5216	132	0	1	04	01	H5216_132_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		100				2	2				30		100	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												
H5216	132	0	1	04	01	H5216_132_0	2		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					31																										31						31					31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	133	0	1	04	01	H5216_133_0	4		Y	Preferred Generic	4	11	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	133	0	1	04	01	H5216_133_0	4		Y	Generic	4	11	1	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	10.00		30.00																									20.00		60.00				10.00		0.00				10.00				10.00		0.33				0.67	0.33	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	133	0	1	04	01	H5216_133_0	4		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	133	0	1	04	01	H5216_133_0	4		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	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												
H5216	133	0	1	04	01	H5216_133_0	4		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	136	0	1	04	01	H5216_136_0	3		Y	Preferred Generic	4	11	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	136	0	1	04	01	H5216_136_0	3		Y	Generic	4	11	1	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	5.00		15.00																									20.00		60.00				5.00		0.00				5.00				5.00		0.17				0.67	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	136	0	1	04	01	H5216_136_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	136	0	1	04	01	H5216_136_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	99.00		297.00																									100.00		300.00				99.00		287.00				99.00				99.00		3.30				3.33	3.30	3.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	136	0	1	04	01	H5216_136_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	137	0	1	04	01	H5216_137_0	3		Y	Preferred Generic	4	11	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	7.00		21.00																									10.00		30.00				7.00		0.00				7.00				7.00		0.23				0.33	0.23	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	137	0	1	04	01	H5216_137_0	3		Y	Generic	4	11	1	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	17.00		51.00																									20.00		60.00				17.00		0.00				17.00				17.00		0.57				0.67	0.57	0.55	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	137	0	1	04	01	H5216_137_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	45.00		135.00																									47.00		141.00				45.00		90.00				45.00				45.00		1.50				1.57	1.50	1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	137	0	1	04	01	H5216_137_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	99.00		297.00																									100.00		300.00				99.00		198.00				99.00				99.00		3.30				3.33	3.30	3.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	137	0	1	04	01	H5216_137_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	138	0	1	04	01	H5216_138_0	6		N	Preferred Generic	4	11	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	138	0	1	04	01	H5216_138_0	6		N	Preferred Generic	4	11	1	2	1	3	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5216	138	0	1	04	01	H5216_138_0	6		N	Generic	4	11	1	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	5.00		15.00																									20.00		60.00				5.00		0.00				5.00				5.00		0.17				0.67	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	138	0	1	04	01	H5216_138_0	6		N	Generic	4	11	1	2	2	3	110		01		110	1	30		90				2	2				30		90	30		31	5.00		15.00																									20.00		60.00				5.00		0.00				5.00				5.00		0.17				0.67	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5216	138	0	1	04	01	H5216_138_0	6		N	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		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		N	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		290.00				100.00				100.00		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		N	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					28																										28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	141	0	1	04	01	H5216_141_0	3		N	Preferred Generic	4	11	1	2	1	1	110		01		110	1	30		100				1	2				30		100	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	141	0	1	04	01	H5216_141_0	3		N	Generic	4	11	1	2	2	1	110		01		110	1	30		100				2	2				30		100	30		31	5.00		15.00																									20.00		60.00				5.00		0.00				5.00				5.00		0.17				0.67	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	141	0	1	04	01	H5216_141_0	3		N	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		100				2	2				30		100	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												
H5216	141	0	1	04	01	H5216_141_0	3		N	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		100				2	2				30		100	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												
H5216	141	0	1	04	01	H5216_141_0	3		N	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					30																										30						30					30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	142	1	1	04	01	H5216_142_1	3		Y	Preferred Generic	4	11	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	4.00		12.00																									10.00		30.00				4.00		0.00				4.00				4.00		0.13				0.33	0.13	0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	142	1	1	04	01	H5216_142_1	3		Y	Generic	4	11	1	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	12.00		36.00																									20.00		60.00				12.00		0.00				12.00				12.00		0.40				0.67	0.40	0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	142	1	1	04	01	H5216_142_1	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	142	1	1	04	01	H5216_142_1	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	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												
H5216	142	1	1	04	01	H5216_142_1	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					29																										29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	142	2	1	04	01	H5216_142_2	3		Y	Preferred Generic	4	11	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	4.00		12.00																									10.00		30.00				4.00		0.00				4.00				4.00		0.13				0.33	0.13	0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	142	2	1	04	01	H5216_142_2	3		Y	Generic	4	11	1	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	12.00		36.00																									20.00		60.00				12.00		0.00				12.00				12.00		0.40				0.67	0.40	0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	142	2	1	04	01	H5216_142_2	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	142	2	1	04	01	H5216_142_2	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	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												
H5216	142	2	1	04	01	H5216_142_2	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					29																										29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	144	0	1	04	01	H5216_144_0	4		Y	Preferred Generic	4	11	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	4.00		12.00																									10.00		30.00				4.00		0.00				4.00				4.00		0.13				0.33	0.13	0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	144	0	1	04	01	H5216_144_0	4		Y	Generic	4	11	1	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	12.00		36.00																									20.00		60.00				12.00		0.00				12.00				12.00		0.40				0.67	0.40	0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	144	0	1	04	01	H5216_144_0	4		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		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		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	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												
H5216	144	0	1	04	01	H5216_144_0	4		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					28																										28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	149	0	1	04	01	H5216_149_0	4		Y	Preferred Generic	4	11	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	2.00		6.00																									10.00		30.00				2.00		0.00				2.00				2.00		0.07				0.33	0.07	0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	149	0	1	04	01	H5216_149_0	4		Y	Generic	4	11	1	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	8.00		24.00																									20.00		60.00				8.00		0.00				8.00				8.00		0.27				0.67	0.27	0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	149	0	1	04	01	H5216_149_0	4		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	149	0	1	04	01	H5216_149_0	4		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	95.00		285.00																									100.00		300.00				95.00		275.00				95.00				95.00		3.17				3.33	3.17	3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	149	0	1	04	01	H5216_149_0	4		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					29																										29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	154	0	1	04	01	H5216_154_0	3		Y	Preferred Generic	4	11	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	5.00		15.00																									10.00		30.00				5.00		0.00				5.00				5.00		0.17				0.33	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	154	0	1	04	01	H5216_154_0	3		Y	Generic	4	11	1	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	15.00		45.00																									20.00		60.00				15.00		0.00				15.00				15.00		0.50				0.67	0.50	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	154	0	1	04	01	H5216_154_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	154	0	1	04	01	H5216_154_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	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												
H5216	154	0	1	04	01	H5216_154_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					26																										26						26					26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	160	0	1	04	01	H5216_160_0	3		N	Preferred Generic	3	11	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	18.00		54.00																									19.00		57.00				18.00		0.00				18.00				18.00		0.60				0.63	0.60	0.58	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	160	0	1	04	01	H5216_160_0	3		N	Generic	3	11	1	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	20.00		60.00																									20.00		60.00				20.00		0.00				20.00				20.00		0.67				0.67	0.67	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	160	0	1	04	01	H5216_160_0	3		N	Preferred Brand	3	11	1	1	3	1	110		01		110	1	30		90				2	2				30		90	30		31				45.00	20		20																								20		20				20		20			20			20								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	160	0	1	04	01	H5216_160_0	3		N	Non-Preferred Drug	3	11	1	1	4	1	110		01		110	1	30		90				2	2				30		90	30		31				59.00	25		25																								25		25				25		25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	160	0	1	04	01	H5216_160_0	3		N	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												
H5216	161	0	1	04	01	H5216_161_0	3		N	Preferred Generic	3	11	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	6.00		18.00																									18.00		54.00				6.00		0.00				6.00				6.00		0.20				0.60	0.20	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	161	0	1	04	01	H5216_161_0	3		N	Generic	3	11	1	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	15.00		45.00																									20.00		60.00				15.00		0.00				15.00				15.00		0.50				0.67	0.50	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	161	0	1	04	01	H5216_161_0	3		N	Preferred Brand	3	11	1	1	3	1	110		01		110	1	30		90				2	2				30		90	30		31				44.00	22		22																								22		22				22		22			22			22								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	161	0	1	04	01	H5216_161_0	3		N	Non-Preferred Drug	3	11	1	1	4	1	110		01		110	1	30		90				2	2				30		90	30		31				66.00	25		25																								25		25				25		25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	161	0	1	04	01	H5216_161_0	3		N	Specialty Tier	3	11	1	1	5	1	010		01		010	1	30											30			30		31					25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	167	0	1	04	01	H5216_167_0	4		Y	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	167	0	1	04	01	H5216_167_0	4		Y	Preferred Generic	4	11	3	2	1	3	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H5216	167	0	1	04	01	H5216_167_0	4		Y	Generic	4	11	3	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	5.00		15.00																									20.00		60.00				5.00		0.00				5.00				5.00		0.17				0.67	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	167	0	1	04	01	H5216_167_0	4		Y	Generic	4	11	3	2	2	3	110		01		110	1	30		90				2	2				30		90	30		31	5.00		15.00																									20.00		60.00				5.00		0.00				5.00				5.00		0.17				0.67	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H5216	167	0	1	04	01	H5216_167_0	4		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		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		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	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												
H5216	167	0	1	04	01	H5216_167_0	4		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	168	0	1	04	01	H5216_168_0	3		Y	Preferred Generic	4	11	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	4.00		12.00																									10.00		30.00				4.00		0.00				4.00				4.00		0.13				0.33	0.13	0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	168	0	1	04	01	H5216_168_0	3		Y	Generic	4	11	1	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	15.00		45.00																									20.00		60.00				15.00		0.00				15.00				15.00		0.50				0.67	0.50	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	168	0	1	04	01	H5216_168_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	168	0	1	04	01	H5216_168_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	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												
H5216	168	0	1	04	01	H5216_168_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					29																										29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	169	0	1	04	01	H5216_169_0	2		Y	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	169	0	1	04	01	H5216_169_0	2		Y	Generic	4	11	3	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	5.00		15.00																									20.00		60.00				5.00		0.00				5.00				5.00		0.17				0.67	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	169	0	1	04	01	H5216_169_0	2		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	47.00		141.00																									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												
H5216	169	0	1	04	01	H5216_169_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		290.00				100.00				100.00		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	2		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					28																										28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	170	0	1	04	01	H5216_170_0	2		Y	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	170	0	1	04	01	H5216_170_0	2		Y	Generic	4	11	3	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	5.00		15.00																									20.00		60.00				5.00		0.00				5.00				5.00		0.17				0.67	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	170	0	1	04	01	H5216_170_0	2		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	47.00		141.00																									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												
H5216	170	0	1	04	01	H5216_170_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		290.00				100.00				100.00		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	2		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					29																										29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	171	0	1	04	01	H5216_171_0	3		N	Preferred Generic	3	11	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	10.00		30.00																									10.00		30.00				10.00		0.00				10.00				10.00		0.33				0.33	0.33	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	171	0	1	04	01	H5216_171_0	3		N	Generic	3	11	1	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	16.00		48.00																									20.00		60.00				16.00		0.00				16.00				16.00		0.53				0.67	0.53	0.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	171	0	1	04	01	H5216_171_0	3		N	Preferred Brand	3	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		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	3		N	Non-Preferred Drug	3	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		290.00				100.00				100.00		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	3		N	Specialty Tier	3	11	1	1	5	1	010		01		010	1	30											30			30		31					25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	172	0	1	04	01	H5216_172_0	3		N	Preferred Generic	4	11	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	172	0	1	04	01	H5216_172_0	3		N	Preferred Generic	4	11	1	2	1	3	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5216	172	0	1	04	01	H5216_172_0	3		N	Generic	4	11	1	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	5.00		15.00																									20.00		60.00				5.00		0.00				5.00				5.00		0.17				0.67	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	172	0	1	04	01	H5216_172_0	3		N	Generic	4	11	1	2	2	3	110		01		110	1	30		90				2	2				30		90	30		31	5.00		15.00																									20.00		60.00				5.00		0.00				5.00				5.00		0.17				0.67	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5216	172	0	1	04	01	H5216_172_0	3		N	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		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	3		N	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		290.00				100.00				100.00		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	3		N	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					28																										28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	173	0	1	04	01	H5216_173_0	3		N	Preferred Generic	3	11	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	8.00		24.00																									10.00		30.00				8.00		0.00				8.00				8.00		0.27				0.33	0.27	0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	173	0	1	04	01	H5216_173_0	3		N	Generic	3	11	1	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	18.00		54.00																									20.00		60.00				18.00		0.00				18.00				18.00		0.60				0.67	0.60	0.58	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	173	0	1	04	01	H5216_173_0	3		N	Preferred Brand	3	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		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	3		N	Non-Preferred Drug	3	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		290.00				100.00				100.00		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	3		N	Specialty Tier	3	11	1	1	5	1	010		01		010	1	30											30			30		31					25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	175	0	1	04	01	H5216_175_0	2		Y	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	175	0	1	04	01	H5216_175_0	2		Y	Preferred Generic	4	11	3	2	1	3	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H5216	175	0	1	04	01	H5216_175_0	2		Y	Generic	4	11	3	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	0.00		0.00																									20.00		60.00				0.00		0.00				0.00				0.00		0				0.67	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	175	0	1	04	01	H5216_175_0	2		Y	Generic	4	11	3	2	2	3	110		01		110	1	30		90				2	2				30		90	30		31	0.00		0.00																									20.00		60.00				0.00		0.00				0.00				0.00		0				0.67	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H5216	175	0	1	04	01	H5216_175_0	2		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	47.00		141.00																									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												
H5216	175	0	1	04	01	H5216_175_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		290.00				100.00				100.00		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	2		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					29																										29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	176	0	1	04	01	H5216_176_0	3		N	Preferred Generic	3	11	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	7.00		21.00																									12.00		36.00				7.00		0.00				7.00				7.00		0.23				0.40	0.23	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	176	0	1	04	01	H5216_176_0	3		N	Generic	3	11	1	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	13.00		39.00																									18.00		54.00				13.00		0.00				13.00				13.00		0.43				0.60	0.43	0.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	176	0	1	04	01	H5216_176_0	3		N	Preferred Brand	3	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		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	3		N	Non-Preferred Drug	3	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		290.00				100.00				100.00		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	3		N	Specialty Tier	3	11	1	1	5	1	010		01		010	1	30											30			30		31					26																										26						26					26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	177	0	1	04	01	H5216_177_0	2		Y	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	177	0	1	04	01	H5216_177_0	2		Y	Preferred Generic	4	11	3	2	1	3	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H5216	177	0	1	04	01	H5216_177_0	2		Y	Generic	4	11	3	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	0.00		0.00																									20.00		60.00				0.00		0.00				0.00				0.00		0				0.67	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	177	0	1	04	01	H5216_177_0	2		Y	Generic	4	11	3	2	2	3	110		01		110	1	30		90				2	2				30		90	30		31	0.00		0.00																									20.00		60.00				0.00		0.00				0.00				0.00		0				0.67	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H5216	177	0	1	04	01	H5216_177_0	2		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	47.00		141.00																									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												
H5216	177	0	1	04	01	H5216_177_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		290.00				100.00				100.00		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	2		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	179	0	1	04	01	H5216_179_0	4		Y	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	179	0	1	04	01	H5216_179_0	4		Y	Generic	4	11	3	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	5.00		15.00																									20.00		60.00				5.00		0.00				5.00				5.00		0.17				0.67	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	179	0	1	04	01	H5216_179_0	4		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	179	0	1	04	01	H5216_179_0	4		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	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												
H5216	179	0	1	04	01	H5216_179_0	4		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					27																										27						27					27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	180	0	1	04	01	H5216_180_0	4		Y	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	180	0	1	04	01	H5216_180_0	4		Y	Generic	4	11	3	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	5.00		15.00																									20.00		60.00				5.00		0.00				5.00				5.00		0.17				0.67	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	180	0	1	04	01	H5216_180_0	4		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	180	0	1	04	01	H5216_180_0	4		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	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												
H5216	180	0	1	04	01	H5216_180_0	4		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					27																										27						27					27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	182	0	1	04	01	H5216_182_0	4		Y	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	182	0	1	04	01	H5216_182_0	4		Y	Preferred Generic	4	11	3	2	1	3	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H5216	182	0	1	04	01	H5216_182_0	4		Y	Generic	4	11	3	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	0.00		0.00																									20.00		60.00				0.00		0.00				0.00				0.00		0				0.67	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	182	0	1	04	01	H5216_182_0	4		Y	Generic	4	11	3	2	2	3	110		01		110	1	30		90				2	2				30		90	30		31	0.00		0.00																									20.00		60.00				0.00		0.00				0.00				0.00		0				0.67	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H5216	182	0	1	04	01	H5216_182_0	4		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		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		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	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												
H5216	182	0	1	04	01	H5216_182_0	4		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	185	0	1	04	01	H5216_185_0	3		Y	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	185	0	1	04	01	H5216_185_0	3		Y	Preferred Generic	4	11	3	2	1	3	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H5216	185	0	1	04	01	H5216_185_0	3		Y	Generic	4	11	3	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	0.00		0.00																									20.00		60.00				0.00		0.00				0.00				0.00		0				0.67	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	185	0	1	04	01	H5216_185_0	3		Y	Generic	4	11	3	2	2	3	110		01		110	1	30		90				2	2				30		90	30		31	0.00		0.00																									20.00		60.00				0.00		0.00				0.00				0.00		0				0.67	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H5216	185	0	1	04	01	H5216_185_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	185	0	1	04	01	H5216_185_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	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												
H5216	185	0	1	04	01	H5216_185_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	186	0	1	04	01	H5216_186_0	4		Y	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	186	0	1	04	01	H5216_186_0	4		Y	Preferred Generic	4	11	3	2	1	3	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H5216	186	0	1	04	01	H5216_186_0	4		Y	Generic	4	11	3	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	5.00		15.00																									20.00		60.00				5.00		0.00				5.00				5.00		0.17				0.67	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	186	0	1	04	01	H5216_186_0	4		Y	Generic	4	11	3	2	2	3	110		01		110	1	30		90				2	2				30		90	30		31	5.00		15.00																									20.00		60.00				5.00		0.00				5.00				5.00		0.17				0.67	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H5216	186	0	1	04	01	H5216_186_0	4		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		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	4		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		290.00				100.00				100.00		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	4		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	188	0	1	04	01	H5216_188_0	3		Y	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	188	0	1	04	01	H5216_188_0	3		Y	Preferred Generic	4	11	3	2	1	3	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H5216	188	0	1	04	01	H5216_188_0	3		Y	Generic	4	11	3	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	5.00		15.00																									20.00		60.00				5.00		0.00				5.00				5.00		0.17				0.67	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	188	0	1	04	01	H5216_188_0	3		Y	Generic	4	11	3	2	2	3	110		01		110	1	30		90				2	2				30		90	30		31	5.00		15.00																									20.00		60.00				5.00		0.00				5.00				5.00		0.17				0.67	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H5216	188	0	1	04	01	H5216_188_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	188	0	1	04	01	H5216_188_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	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												
H5216	188	0	1	04	01	H5216_188_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	189	0	1	04	01	H5216_189_0	2		Y	Preferred Generic	4	11	1	2	1	1	110		01		110	1	30		100				1	2				30		100	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	189	0	1	04	01	H5216_189_0	2		Y	Preferred Generic	4	11	1	2	1	3	110		01		110	1	30		100				1	2				30		100	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5216	189	0	1	04	01	H5216_189_0	2		Y	Generic	4	11	1	2	2	1	110		01		110	1	30		100				2	2				30		100	30		31	5.00		15.00																									20.00		60.00				5.00		0.00				5.00				5.00		0.17				0.67	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	189	0	1	04	01	H5216_189_0	2		Y	Generic	4	11	1	2	2	3	110		01		110	1	30		100				2	2				30		100	30		31	5.00		15.00																									20.00		60.00				5.00		0.00				5.00				5.00		0.17				0.67	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5216	189	0	1	04	01	H5216_189_0	2		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		100				2	2				30		100	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												
H5216	189	0	1	04	01	H5216_189_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		100				2	2				30		100	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												
H5216	189	0	1	04	01	H5216_189_0	2		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					29																										29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	192	0	1	04	01	H5216_192_0	4		Y	Preferred Generic	4	11	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	192	0	1	04	01	H5216_192_0	4		Y	Preferred Generic	4	11	1	2	1	3	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5216	192	0	1	04	01	H5216_192_0	4		Y	Generic	4	11	1	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	5.00		15.00																									20.00		60.00				5.00		0.00				5.00				5.00		0.17				0.67	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	192	0	1	04	01	H5216_192_0	4		Y	Generic	4	11	1	2	2	3	110		01		110	1	30		90				2	2				30		90	30		31	5.00		15.00																									20.00		60.00				5.00		0.00				5.00				5.00		0.17				0.67	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5216	192	0	1	04	01	H5216_192_0	4		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		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		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	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												
H5216	192	0	1	04	01	H5216_192_0	4		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					29																										29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	193	0	1	04	01	H5216_193_0	4		Y	Preferred Generic	4	11	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0				0	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	193	0	1	04	01	H5216_193_0	4		Y	Generic	4	11	1	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	15.00		45.00																									20.00		60.00				15.00		0.00				15.00				15.00		0.50				0.67	0.50	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	193	0	1	04	01	H5216_193_0	4		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		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		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	97.00		291.00																									100.00		300.00				97.00		281.00				97.00				97.00		3.23				3.33	3.23	3.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	193	0	1	04	01	H5216_193_0	4		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					29																										29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	194	0	1	04	01	H5216_194_0	3		N	Preferred Generic	4	11	1	2	1	1	110		01		110	1	30		100				1	2				30		100	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	194	0	1	04	01	H5216_194_0	3		N	Generic	4	11	1	2	2	1	110		01		110	1	30		100				2	2				30		100	30		31	5.00		15.00																									20.00		60.00				5.00		0.00				5.00				5.00		0.17				0.67	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	194	0	1	04	01	H5216_194_0	3		N	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		100				2	2				30		100	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												
H5216	194	0	1	04	01	H5216_194_0	3		N	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		100				2	2				30		100	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												
H5216	194	0	1	04	01	H5216_194_0	3		N	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					27																										27						27					27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	195	0	1	04	01	H5216_195_0	4		N	Preferred Generic	3	11	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	12.00		36.00																									12.00		36.00				12.00		0.00				12.00				12.00		0.40				0.40	0.40	0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	195	0	1	04	01	H5216_195_0	4		N	Generic	3	11	1	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	19.00		57.00																									20.00		60.00				19.00		0.00				19.00				19.00		0.63				0.67	0.63	0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	195	0	1	04	01	H5216_195_0	4		N	Preferred Brand	3	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		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	4		N	Non-Preferred Drug	3	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		290.00				100.00				100.00		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	4		N	Specialty Tier	3	11	1	1	5	1	010		01		010	1	30											30			30		31					25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	196	1	1	04	01	H5216_196_1	3		Y	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	196	1	1	04	01	H5216_196_1	3		Y	Preferred Generic	4	11	3	2	1	3	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H5216	196	1	1	04	01	H5216_196_1	3		Y	Generic	4	11	3	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	5.00		15.00																									20.00		60.00				5.00		0.00				5.00				5.00		0.17				0.67	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	196	1	1	04	01	H5216_196_1	3		Y	Generic	4	11	3	2	2	3	110		01		110	1	30		90				2	2				30		90	30		31	5.00		15.00																									20.00		60.00				5.00		0.00				5.00				5.00		0.17				0.67	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H5216	196	1	1	04	01	H5216_196_1	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	45.00		135.00																									47.00		141.00				45.00		90.00				45.00				45.00		1.50				1.57	1.50	1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	196	1	1	04	01	H5216_196_1	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		200.00				100.00				100.00		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	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	196	2	1	04	01	H5216_196_2	3		Y	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	196	2	1	04	01	H5216_196_2	3		Y	Preferred Generic	4	11	3	2	1	3	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H5216	196	2	1	04	01	H5216_196_2	3		Y	Generic	4	11	3	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	5.00		15.00																									20.00		60.00				5.00		0.00				5.00				5.00		0.17				0.67	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	196	2	1	04	01	H5216_196_2	3		Y	Generic	4	11	3	2	2	3	110		01		110	1	30		90				2	2				30		90	30		31	5.00		15.00																									20.00		60.00				5.00		0.00				5.00				5.00		0.17				0.67	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H5216	196	2	1	04	01	H5216_196_2	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	45.00		135.00																									47.00		141.00				45.00		90.00				45.00				45.00		1.50				1.57	1.50	1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	196	2	1	04	01	H5216_196_2	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		200.00				100.00				100.00		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	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	197	0	1	04	01	H5216_197_0	4		N	Preferred Generic	3	11	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	6.00		18.00																									10.00		30.00				6.00		0.00				6.00				6.00		0.20				0.33	0.20	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	197	0	1	04	01	H5216_197_0	4		N	Generic	3	11	1	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	16.00		48.00																									20.00		60.00				16.00		0.00				16.00				16.00		0.53				0.67	0.53	0.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	197	0	1	04	01	H5216_197_0	4		N	Preferred Brand	3	11	1	1	3	1	110		01		110	1	30		90				2	2				30		90	30		31				47.00	23		23																								23		23				23		23			23			23								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	197	0	1	04	01	H5216_197_0	4		N	Non-Preferred Drug	3	11	1	1	4	1	110		01		110	1	30		90				2	2				30		90	30		31				58.00	25		25																								25		25				25		25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	197	0	1	04	01	H5216_197_0	4		N	Specialty Tier	3	11	1	1	5	1	010		01		010	1	30											30			30		31					25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	198	0	1	04	01	H5216_198_0	3		Y	Preferred Generic	4	11	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	198	0	1	04	01	H5216_198_0	3		Y	Preferred Generic	4	11	1	2	1	3	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5216	198	0	1	04	01	H5216_198_0	3		Y	Generic	4	11	1	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	5.00		15.00																									20.00		60.00				5.00		0.00				5.00				5.00		0.17				0.67	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	198	0	1	04	01	H5216_198_0	3		Y	Generic	4	11	1	2	2	3	110		01		110	1	30		90				2	2				30		90	30		31	5.00		15.00																									20.00		60.00				5.00		0.00				5.00				5.00		0.17				0.67	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5216	198	0	1	04	01	H5216_198_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	45.00		135.00																									47.00		141.00				45.00		90.00				45.00				45.00		1.50				1.57	1.50	1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	198	0	1	04	01	H5216_198_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		200.00				100.00				100.00		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	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	199	0	1	04	01	H5216_199_0	4		N	Preferred Generic	3	11	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	7.00		21.00																									10.00		30.00				7.00		0.00				7.00				7.00		0.23				0.33	0.23	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	199	0	1	04	01	H5216_199_0	4		N	Generic	3	11	1	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	15.00		45.00																									20.00		60.00				15.00		0.00				15.00				15.00		0.50				0.67	0.50	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	199	0	1	04	01	H5216_199_0	4		N	Preferred Brand	3	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		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	4		N	Non-Preferred Drug	3	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		290.00				100.00				100.00		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	4		N	Specialty Tier	3	11	1	1	5	1	010		01		010	1	30											30			30		31					25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	203	1	1	04	01	H5216_203_1	4		Y	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	203	1	1	04	01	H5216_203_1	4		Y	Preferred Generic	4	11	3	2	1	3	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H5216	203	1	1	04	01	H5216_203_1	4		Y	Generic	4	11	3	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	0.00		0.00																									20.00		60.00				0.00		0.00				0.00				0.00		0				0.67	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	203	1	1	04	01	H5216_203_1	4		Y	Generic	4	11	3	2	2	3	110		01		110	1	30		90				2	2				30		90	30		31	0.00		0.00																									20.00		60.00				0.00		0.00				0.00				0.00		0				0.67	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H5216	203	1	1	04	01	H5216_203_1	4		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	47.00		141.00																									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												
H5216	203	1	1	04	01	H5216_203_1	4		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	100.00		300.00																									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												
H5216	203	1	1	04	01	H5216_203_1	4		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	203	2	1	04	01	H5216_203_2	4		Y	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	203	2	1	04	01	H5216_203_2	4		Y	Preferred Generic	4	11	3	2	1	3	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H5216	203	2	1	04	01	H5216_203_2	4		Y	Generic	4	11	3	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	0.00		0.00																									20.00		60.00				0.00		0.00				0.00				0.00		0				0.67	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	203	2	1	04	01	H5216_203_2	4		Y	Generic	4	11	3	2	2	3	110		01		110	1	30		90				2	2				30		90	30		31	0.00		0.00																									20.00		60.00				0.00		0.00				0.00				0.00		0				0.67	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H5216	203	2	1	04	01	H5216_203_2	4		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		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		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	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												
H5216	203	2	1	04	01	H5216_203_2	4		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	207	0	1	04	01	H5216_207_0	4		Y	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	207	0	1	04	01	H5216_207_0	4		Y	Preferred Generic	4	11	3	2	1	3	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H5216	207	0	1	04	01	H5216_207_0	4		Y	Generic	4	11	3	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	0.00		0.00																									20.00		60.00				0.00		0.00				0.00				0.00		0				0.67	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	207	0	1	04	01	H5216_207_0	4		Y	Generic	4	11	3	2	2	3	110		01		110	1	30		90				2	2				30		90	30		31	0.00		0.00																									20.00		60.00				0.00		0.00				0.00				0.00		0				0.67	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H5216	207	0	1	04	01	H5216_207_0	4		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		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		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	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												
H5216	207	0	1	04	01	H5216_207_0	4		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	211	0	1	04	01	H5216_211_0	3		Y	Preferred Generic	4	11	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	4.00		12.00																									10.00		30.00				4.00		0.00				4.00				4.00		0.13				0.33	0.13	0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	211	0	1	04	01	H5216_211_0	3		Y	Generic	4	11	1	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	12.00		36.00																									20.00		60.00				12.00		0.00				12.00				12.00		0.40				0.67	0.40	0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	211	0	1	04	01	H5216_211_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		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	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		290.00				100.00				100.00		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	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					30																										30						30					30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	212	0	1	04	01	H5216_212_0	4		Y	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	212	0	1	04	01	H5216_212_0	4		Y	Generic	4	11	3	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	0.00		0.00																									20.00		60.00				0.00		0.00				0.00				0.00		0				0.67	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	212	0	1	04	01	H5216_212_0	4		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		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		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	97.00		291.00																									100.00		300.00				97.00		281.00				97.00				97.00		3.23				3.33	3.23	3.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	212	0	1	04	01	H5216_212_0	4		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	214	1	1	04	01	H5216_214_1	4		Y	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	214	1	1	04	01	H5216_214_1	4		Y	Generic	4	11	3	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	5.00		15.00																									20.00		60.00				5.00		0.00				5.00				5.00		0.17				0.67	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	214	1	1	04	01	H5216_214_1	4		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	47.00		141.00																									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												
H5216	214	1	1	04	01	H5216_214_1	4		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	97.00		291.00																									100.00		300.00				97.00		281.00				97.00				97.00		3.23				3.33	3.23	3.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	214	1	1	04	01	H5216_214_1	4		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					30																										30						30					30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	214	2	1	04	01	H5216_214_2	4		Y	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	214	2	1	04	01	H5216_214_2	4		Y	Generic	4	11	3	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	5.00		15.00																									20.00		60.00				5.00		0.00				5.00				5.00		0.17				0.67	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	214	2	1	04	01	H5216_214_2	4		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		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		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	97.00		291.00																									100.00		300.00				97.00		281.00				97.00				97.00		3.23				3.33	3.23	3.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	214	2	1	04	01	H5216_214_2	4		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					30																										30						30					30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	214	3	1	04	01	H5216_214_3	4		Y	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	214	3	1	04	01	H5216_214_3	4		Y	Generic	4	11	3	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	5.00		15.00																									20.00		60.00				5.00		0.00				5.00				5.00		0.17				0.67	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	214	3	1	04	01	H5216_214_3	4		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		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		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	97.00		291.00																									100.00		300.00				97.00		281.00				97.00				97.00		3.23				3.33	3.23	3.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	214	3	1	04	01	H5216_214_3	4		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					30																										30						30					30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	215	0	1	04	01	H5216_215_0	3		Y	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	215	0	1	04	01	H5216_215_0	3		Y	Preferred Generic	4	11	3	2	1	3	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H5216	215	0	1	04	01	H5216_215_0	3		Y	Generic	4	11	3	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	5.00		15.00																									20.00		60.00				5.00		0.00				5.00				5.00		0.17				0.67	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	215	0	1	04	01	H5216_215_0	3		Y	Generic	4	11	3	2	2	3	110		01		110	1	30		90				2	2				30		90	30		31	5.00		15.00																									20.00		60.00				5.00		0.00				5.00				5.00		0.17				0.67	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H5216	215	0	1	04	01	H5216_215_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		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	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		290.00				100.00				100.00		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	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	223	0	1	04	01	H5216_223_0	3		Y	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	223	0	1	04	01	H5216_223_0	3		Y	Preferred Generic	4	11	3	2	1	3	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H5216	223	0	1	04	01	H5216_223_0	3		Y	Generic	4	11	3	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	5.00		15.00																									20.00		60.00				5.00		0.00				5.00				5.00		0.17				0.67	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	223	0	1	04	01	H5216_223_0	3		Y	Generic	4	11	3	2	2	3	110		01		110	1	30		90				2	2				30		90	30		31	5.00		15.00																									20.00		60.00				5.00		0.00				5.00				5.00		0.17				0.67	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H5216	223	0	1	04	01	H5216_223_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	45.00		135.00																									47.00		141.00				45.00		90.00				45.00				45.00		1.50				1.57	1.50	1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	223	0	1	04	01	H5216_223_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		200.00				100.00				100.00		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	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	224	0	1	04	01	H5216_224_0	3		Y	Preferred Generic	4	11	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	224	0	1	04	01	H5216_224_0	3		Y	Preferred Generic	4	11	1	2	1	3	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5216	224	0	1	04	01	H5216_224_0	3		Y	Generic	4	11	1	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	0.00		0.00																									20.00		60.00				0.00		0.00				0.00				0.00		0				0.67	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	224	0	1	04	01	H5216_224_0	3		Y	Generic	4	11	1	2	2	3	110		01		110	1	30		90				2	2				30		90	30		31	0.00		0.00																									20.00		60.00				0.00		0.00				0.00				0.00		0				0.67	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5216	224	0	1	04	01	H5216_224_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	45.00		135.00																									47.00		141.00				45.00		90.00				45.00				45.00		1.50				1.57	1.50	1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	224	0	1	04	01	H5216_224_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		200.00				100.00				100.00		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	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	226	0	1	04	01	H5216_226_0	3		Y	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	226	0	1	04	01	H5216_226_0	3		Y	Preferred Generic	4	11	3	2	1	3	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H5216	226	0	1	04	01	H5216_226_0	3		Y	Generic	4	11	3	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	0.00		0.00																									20.00		60.00				0.00		0.00				0.00				0.00		0				0.67	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	226	0	1	04	01	H5216_226_0	3		Y	Generic	4	11	3	2	2	3	110		01		110	1	30		90				2	2				30		90	30		31	0.00		0.00																									20.00		60.00				0.00		0.00				0.00				0.00		0				0.67	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H5216	226	0	1	04	01	H5216_226_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		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	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		290.00				100.00				100.00		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	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	229	0	1	04	01	H5216_229_0	4		Y	Preferred Generic	4	11	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	229	0	1	04	01	H5216_229_0	4		Y	Preferred Generic	4	11	1	2	1	3	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5216	229	0	1	04	01	H5216_229_0	4		Y	Generic	4	11	1	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	5.00		15.00																									20.00		60.00				5.00		0.00				5.00				5.00		0.17				0.67	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	229	0	1	04	01	H5216_229_0	4		Y	Generic	4	11	1	2	2	3	110		01		110	1	30		90				2	2				30		90	30		31	5.00		15.00																									20.00		60.00				5.00		0.00				5.00				5.00		0.17				0.67	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5216	229	0	1	04	01	H5216_229_0	4		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		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	4		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		290.00				100.00				100.00		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	4		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	231	0	1	04	01	H5216_231_0	3		Y	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	231	0	1	04	01	H5216_231_0	3		Y	Preferred Generic	4	11	3	2	1	3	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H5216	231	0	1	04	01	H5216_231_0	3		Y	Generic	4	11	3	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	5.00		15.00																									20.00		60.00				5.00		0.00				5.00				5.00		0.17				0.67	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	231	0	1	04	01	H5216_231_0	3		Y	Generic	4	11	3	2	2	3	110		01		110	1	30		90				2	2				30		90	30		31	5.00		15.00																									20.00		60.00				5.00		0.00				5.00				5.00		0.17				0.67	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H5216	231	0	1	04	01	H5216_231_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		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	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	99.00		297.00																									100.00		300.00				99.00		287.00				99.00				99.00		3.30				3.33	3.30	3.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	231	0	1	04	01	H5216_231_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	232	1	1	04	01	H5216_232_1	3		Y	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		100				1	2				30		100	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	232	1	1	04	01	H5216_232_1	3		Y	Generic	4	11	3	2	2	1	110		01		110	1	30		100				2	2				30		100	30		31	0.00		0.00																									20.00		60.00				0.00		0.00				0.00				0.00		0				0.67	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	232	1	1	04	01	H5216_232_1	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		100				2	2				30		100	30		31	45.00		135.00																									47.00		141.00				45.00		125.00				45.00				45.00		1.50				1.57	1.50	1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	232	1	1	04	01	H5216_232_1	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		100				2	2				30		100	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												
H5216	232	1	1	04	01	H5216_232_1	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	232	2	1	04	01	H5216_232_2	3		Y	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		100				1	2				30		100	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	232	2	1	04	01	H5216_232_2	3		Y	Generic	4	11	3	2	2	1	110		01		110	1	30		100				2	2				30		100	30		31	0.00		0.00																									20.00		60.00				0.00		0.00				0.00				0.00		0				0.67	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	232	2	1	04	01	H5216_232_2	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		100				2	2				30		100	30		31	45.00		135.00																									47.00		141.00				45.00		125.00				45.00				45.00		1.50				1.57	1.50	1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	232	2	1	04	01	H5216_232_2	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		100				2	2				30		100	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												
H5216	232	2	1	04	01	H5216_232_2	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	233	1	1	04	01	H5216_233_1	3		Y	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		100				1	2				30		100	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	233	1	1	04	01	H5216_233_1	3		Y	Generic	4	11	3	2	2	1	110		01		110	1	30		100				2	2				30		100	30		31	0.00		0.00																									20.00		60.00				0.00		0.00				0.00				0.00		0				0.67	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	233	1	1	04	01	H5216_233_1	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		100				2	2				30		100	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												
H5216	233	1	1	04	01	H5216_233_1	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		100				2	2				30		100	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												
H5216	233	1	1	04	01	H5216_233_1	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					31																										31						31					31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	233	2	1	04	01	H5216_233_2	3		Y	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		100				1	2				30		100	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	233	2	1	04	01	H5216_233_2	3		Y	Generic	4	11	3	2	2	1	110		01		110	1	30		100				2	2				30		100	30		31	0.00		0.00																									20.00		60.00				0.00		0.00				0.00				0.00		0				0.67	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	233	2	1	04	01	H5216_233_2	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		100				2	2				30		100	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												
H5216	233	2	1	04	01	H5216_233_2	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		100				2	2				30		100	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												
H5216	233	2	1	04	01	H5216_233_2	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					31																										31						31					31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	239	0	1	04	01	H5216_239_0	4		Y	Preferred Generic	4	11	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	4.00		12.00																									10.00		30.00				4.00		0.00				4.00				4.00		0.13				0.33	0.13	0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	239	0	1	04	01	H5216_239_0	4		Y	Generic	4	11	1	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	12.00		36.00																									20.00		60.00				12.00		0.00				12.00				12.00		0.40				0.67	0.40	0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	239	0	1	04	01	H5216_239_0	4		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		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		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	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												
H5216	239	0	1	04	01	H5216_239_0	4		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	240	0	1	04	01	H5216_240_0	4		N	Preferred Generic	4	11	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	240	0	1	04	01	H5216_240_0	4		N	Generic	4	11	1	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	20.00		60.00																									20.00		60.00				20.00		0.00				20.00				20.00		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	4		N	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		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	4		N	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		290.00				100.00				100.00		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	4		N	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	242	0	1	04	01	H5216_242_0	5		N	Preferred Generic	3	11	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	4.00		12.00																									10.00		30.00				4.00		0.00				4.00				4.00		0.13				0.33	0.13	0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	242	0	1	04	01	H5216_242_0	5		N	Generic	3	11	1	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	12.00		36.00																									20.00		60.00				12.00		0.00				12.00				12.00		0.40				0.67	0.40	0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	242	0	1	04	01	H5216_242_0	5		N	Preferred Brand	3	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		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	5		N	Non-Preferred Drug	3	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		290.00				100.00				100.00		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	5		N	Specialty Tier	3	11	1	1	5	1	010		01		010	1	30											30			30		31					25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	243	0	1	04	01	H5216_243_0	4		N	Preferred Generic	3	11	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	3.00		9.00																									10.00		30.00				3.00		0.00				3.00				3.00		0.10				0.33	0.10	0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	243	0	1	04	01	H5216_243_0	4		N	Generic	3	11	1	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	11.00		33.00																									20.00		60.00				11.00		0.00				11.00				11.00		0.37				0.67	0.37	0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	243	0	1	04	01	H5216_243_0	4		N	Preferred Brand	3	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	243	0	1	04	01	H5216_243_0	4		N	Non-Preferred Drug	3	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		290.00				100.00				100.00		3.33				3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	243	0	1	04	01	H5216_243_0	4		N	Specialty Tier	3	11	1	1	5	1	010		01		010	1	30											30			30		31					25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	244	0	1	04	01	H5216_244_0	4		Y	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5216	244	0	1	04	01	H5216_244_0	4		Y	Preferred Generic	4	11	3	2	1	3	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		3
H5216	244	0	1	04	01	H5216_244_0	4		Y	Generic	4	11	3	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	0.00		0.00																									20.00		60.00				0.00		0.00				0.00				0.00		0				0.67	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5216	244	0	1	04	01	H5216_244_0	4		Y	Generic	4	11	3	2	2	3	110		01		110	1	30		90				2	2				30		90	30		31	0.00		0.00																									20.00		60.00				0.00		0.00				0.00				0.00		0				0.67	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		3
H5216	244	0	1	04	01	H5216_244_0	4		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				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												
H5216	244	0	1	04	01	H5216_244_0	4		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		290.00				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												
H5216	244	0	1	04	01	H5216_244_0	4		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					30																										30						30					30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5216	244	0	1	04	01	H5216_244_0	4		Y	Select Care Drugs	4	11	1	2	6	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0				0	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5216	246	0	1	04	01	H5216_246_0	5		Y	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5216	246	0	1	04	01	H5216_246_0	5		Y	Preferred Generic	4	11	3	2	1	3	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		3
H5216	246	0	1	04	01	H5216_246_0	5		Y	Generic	4	11	3	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	0.00		0.00																									20.00		60.00				0.00		0.00				0.00				0.00		0				0.67	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5216	246	0	1	04	01	H5216_246_0	5		Y	Generic	4	11	3	2	2	3	110		01		110	1	30		90				2	2				30		90	30		31	0.00		0.00																									20.00		60.00				0.00		0.00				0.00				0.00		0				0.67	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		3
H5216	246	0	1	04	01	H5216_246_0	5		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				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												
H5216	246	0	1	04	01	H5216_246_0	5		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		290.00				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												
H5216	246	0	1	04	01	H5216_246_0	5		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					30																										30						30					30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5216	246	0	1	04	01	H5216_246_0	5		Y	Select Care Drugs	4	11	1	2	6	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0				0	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5216	247	0	1	04	01	H5216_247_0	2		Y	Preferred Generic	4	11	1	2	1	1	110		01		110	1	30		100				1	2				30		100	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	247	0	1	04	01	H5216_247_0	2		Y	Preferred Generic	4	11	1	2	1	3	110		01		110	1	30		100				1	2				30		100	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5216	247	0	1	04	01	H5216_247_0	2		Y	Generic	4	11	1	2	2	1	110		01		110	1	30		100				2	2				30		100	30		31	0.00		0.00																									20.00		60.00				0.00		0.00				0.00				0.00		0				0.67	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	247	0	1	04	01	H5216_247_0	2		Y	Generic	4	11	1	2	2	3	110		01		110	1	30		100				2	2				30		100	30		31	0.00		0.00																									20.00		60.00				0.00		0.00				0.00				0.00		0				0.67	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5216	247	0	1	04	01	H5216_247_0	2		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		100				2	2				30		100	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												
H5216	247	0	1	04	01	H5216_247_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		100				2	2				30		100	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												
H5216	247	0	1	04	01	H5216_247_0	2		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					30																										30						30					30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	249	0	1	04	01	H5216_249_0	2		Y	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	249	0	1	04	01	H5216_249_0	2		Y	Preferred Generic	4	11	3	2	1	3	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H5216	249	0	1	04	01	H5216_249_0	2		Y	Generic	4	11	3	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	0.00		0.00																									20.00		60.00				0.00		0.00				0.00				0.00		0				0.67	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	249	0	1	04	01	H5216_249_0	2		Y	Generic	4	11	3	2	2	3	110		01		110	1	30		90				2	2				30		90	30		31	0.00		0.00																									20.00		60.00				0.00		0.00				0.00				0.00		0				0.67	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H5216	249	0	1	04	01	H5216_249_0	2		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		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	2		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		290.00				100.00				100.00		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	2		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					28																										28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	250	0	1	04	01	H5216_250_0	3		Y	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	250	0	1	04	01	H5216_250_0	3		Y	Preferred Generic	4	11	3	2	1	3	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H5216	250	0	1	04	01	H5216_250_0	3		Y	Generic	4	11	3	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	0.00		0.00																									20.00		60.00				0.00		0.00				0.00				0.00		0				0.67	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	250	0	1	04	01	H5216_250_0	3		Y	Generic	4	11	3	2	2	3	110		01		110	1	30		90				2	2				30		90	30		31	0.00		0.00																									20.00		60.00				0.00		0.00				0.00				0.00		0				0.67	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H5216	250	0	1	04	01	H5216_250_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	250	0	1	04	01	H5216_250_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	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												
H5216	250	0	1	04	01	H5216_250_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					29																										29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	251	0	1	04	01	H5216_251_0	3		Y	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	251	0	1	04	01	H5216_251_0	3		Y	Preferred Generic	4	11	3	2	1	3	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H5216	251	0	1	04	01	H5216_251_0	3		Y	Generic	4	11	3	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	0.00		0.00																									20.00		60.00				0.00		0.00				0.00				0.00		0				0.67	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	251	0	1	04	01	H5216_251_0	3		Y	Generic	4	11	3	2	2	3	110		01		110	1	30		90				2	2				30		90	30		31	0.00		0.00																									20.00		60.00				0.00		0.00				0.00				0.00		0				0.67	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H5216	251	0	1	04	01	H5216_251_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	251	0	1	04	01	H5216_251_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	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												
H5216	251	0	1	04	01	H5216_251_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	252	0	1	04	01	H5216_252_0	3		Y	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	252	0	1	04	01	H5216_252_0	3		Y	Preferred Generic	4	11	3	2	1	3	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H5216	252	0	1	04	01	H5216_252_0	3		Y	Generic	4	11	3	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	5.00		15.00																									20.00		60.00				5.00		0.00				5.00				5.00		0.17				0.67	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	252	0	1	04	01	H5216_252_0	3		Y	Generic	4	11	3	2	2	3	110		01		110	1	30		90				2	2				30		90	30		31	5.00		15.00																									20.00		60.00				5.00		0.00				5.00				5.00		0.17				0.67	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H5216	252	0	1	04	01	H5216_252_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	252	0	1	04	01	H5216_252_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	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												
H5216	252	0	1	04	01	H5216_252_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	253	0	1	04	01	H5216_253_0	4		Y	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	253	0	1	04	01	H5216_253_0	4		Y	Preferred Generic	4	11	3	2	1	3	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H5216	253	0	1	04	01	H5216_253_0	4		Y	Generic	4	11	3	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	5.00		15.00																									20.00		60.00				5.00		0.00				5.00				5.00		0.17				0.67	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	253	0	1	04	01	H5216_253_0	4		Y	Generic	4	11	3	2	2	3	110		01		110	1	30		90				2	2				30		90	30		31	5.00		15.00																									20.00		60.00				5.00		0.00				5.00				5.00		0.17				0.67	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H5216	253	0	1	04	01	H5216_253_0	4		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		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		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	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												
H5216	253	0	1	04	01	H5216_253_0	4		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					29																										29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	254	0	1	04	01	H5216_254_0	3		Y	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	254	0	1	04	01	H5216_254_0	3		Y	Preferred Generic	4	11	3	2	1	3	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H5216	254	0	1	04	01	H5216_254_0	3		Y	Generic	4	11	3	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	5.00		15.00																									20.00		60.00				5.00		0.00				5.00				5.00		0.17				0.67	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	254	0	1	04	01	H5216_254_0	3		Y	Generic	4	11	3	2	2	3	110		01		110	1	30		90				2	2				30		90	30		31	5.00		15.00																									20.00		60.00				5.00		0.00				5.00				5.00		0.17				0.67	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H5216	254	0	1	04	01	H5216_254_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		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	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		290.00				100.00				100.00		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	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	255	0	1	04	01	H5216_255_0	4		Y	Preferred Generic	4	11	1	2	1	1	110		01		110	1	30		100				1	2				30		100	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	255	0	1	04	01	H5216_255_0	4		Y	Preferred Generic	4	11	1	2	1	3	110		01		110	1	30		100				1	2				30		100	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5216	255	0	1	04	01	H5216_255_0	4		Y	Generic	4	11	1	2	2	1	110		01		110	1	30		100				2	2				30		100	30		31	5.00		15.00																									20.00		60.00				5.00		0.00				5.00				5.00		0.17				0.67	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	255	0	1	04	01	H5216_255_0	4		Y	Generic	4	11	1	2	2	3	110		01		110	1	30		100				2	2				30		100	30		31	5.00		15.00																									20.00		60.00				5.00		0.00				5.00				5.00		0.17				0.67	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5216	255	0	1	04	01	H5216_255_0	4		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		100				2	2				30		100	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												
H5216	255	0	1	04	01	H5216_255_0	4		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		100				2	2				30		100	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												
H5216	255	0	1	04	01	H5216_255_0	4		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					27																										27						27					27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	260	0	1	04	01	H5216_260_0	4		Y	Preferred Generic	4	11	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	260	0	1	04	01	H5216_260_0	4		Y	Generic	4	11	1	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	5.00		15.00																									20.00		60.00				5.00		0.00				5.00				5.00		0.17				0.67	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	260	0	1	04	01	H5216_260_0	4		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	45.00		135.00																									47.00		141.00				45.00		90.00				45.00				45.00		1.50				1.57	1.50	1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	260	0	1	04	01	H5216_260_0	4		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		200.00				100.00				100.00		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	4		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	261	0	1	04	01	H5216_261_0	3		Y	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	261	0	1	04	01	H5216_261_0	3		Y	Preferred Generic	4	11	3	2	1	3	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H5216	261	0	1	04	01	H5216_261_0	3		Y	Generic	4	11	3	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	5.00		15.00																									20.00		60.00				5.00		0.00				5.00				5.00		0.17				0.67	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	261	0	1	04	01	H5216_261_0	3		Y	Generic	4	11	3	2	2	3	110		01		110	1	30		90				2	2				30		90	30		31	5.00		15.00																									20.00		60.00				5.00		0.00				5.00				5.00		0.17				0.67	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H5216	261	0	1	04	01	H5216_261_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	45.00		135.00																									47.00		141.00				45.00		90.00				45.00				45.00		1.50				1.57	1.50	1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	261	0	1	04	01	H5216_261_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		200.00				100.00				100.00		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	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	263	0	1	04	01	H5216_263_0	3		Y	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	263	0	1	04	01	H5216_263_0	3		Y	Preferred Generic	4	11	3	2	1	3	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H5216	263	0	1	04	01	H5216_263_0	3		Y	Generic	4	11	3	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	5.00		15.00																									20.00		60.00				5.00		0.00				5.00				5.00		0.17				0.67	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	263	0	1	04	01	H5216_263_0	3		Y	Generic	4	11	3	2	2	3	110		01		110	1	30		90				2	2				30		90	30		31	5.00		15.00																									20.00		60.00				5.00		0.00				5.00				5.00		0.17				0.67	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H5216	263	0	1	04	01	H5216_263_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	45.00		135.00																									47.00		141.00				45.00		90.00				45.00				45.00		1.50				1.57	1.50	1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	263	0	1	04	01	H5216_263_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	95.00		285.00																									100.00		300.00				95.00		190.00				95.00				95.00		3.17				3.33	3.17	3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	263	0	1	04	01	H5216_263_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	264	0	1	04	01	H5216_264_0	3		N	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	7.00		21.00																									10.00		30.00				7.00		0.00				7.00				7.00		0.23				0.33	0.23	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	264	0	1	04	01	H5216_264_0	3		N	Preferred Generic	4	11	3	2	1	3	110		01		110	1	30		90				1	2				30		90	30		31	7.00		21.00																									10.00		30.00				7.00		0.00				7.00				7.00		0.23				0.33	0.23	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H5216	264	0	1	04	01	H5216_264_0	3		N	Generic	4	11	3	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	12.00		36.00																									20.00		60.00				12.00		0.00				12.00				12.00		0.40				0.67	0.40	0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	264	0	1	04	01	H5216_264_0	3		N	Generic	4	11	3	2	2	3	110		01		110	1	30		90				2	2				30		90	30		31	12.00		36.00																									20.00		60.00				12.00		0.00				12.00				12.00		0.40				0.67	0.40	0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H5216	264	0	1	04	01	H5216_264_0	3		N	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		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		N	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	99.00		297.00																									100.00		300.00				99.00		287.00				99.00				99.00		3.30				3.33	3.30	3.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	264	0	1	04	01	H5216_264_0	3		N	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					30																										30						30					30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	265	0	1	04	01	H5216_265_0	3		Y	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	265	0	1	04	01	H5216_265_0	3		Y	Preferred Generic	4	11	3	2	1	3	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H5216	265	0	1	04	01	H5216_265_0	3		Y	Generic	4	11	3	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	5.00		15.00																									20.00		60.00				5.00		0.00				5.00				5.00		0.17				0.67	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	265	0	1	04	01	H5216_265_0	3		Y	Generic	4	11	3	2	2	3	110		01		110	1	30		90				2	2				30		90	30		31	5.00		15.00																									20.00		60.00				5.00		0.00				5.00				5.00		0.17				0.67	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H5216	265	0	1	04	01	H5216_265_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	45.00		135.00																									47.00		141.00				45.00		90.00				45.00				45.00		1.50				1.57	1.50	1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	265	0	1	04	01	H5216_265_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		200.00				100.00				100.00		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		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	266	0	1	04	01	H5216_266_0	3		Y	Preferred Generic	4	11	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	266	0	1	04	01	H5216_266_0	3		Y	Generic	4	11	1	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	0.00		0.00																									20.00		60.00				0.00		0.00				0.00				0.00		0				0.67	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	266	0	1	04	01	H5216_266_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		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	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		290.00				100.00				100.00		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	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	269	0	1	04	01	H5216_269_0	4		Y	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	269	0	1	04	01	H5216_269_0	4		Y	Generic	4	11	3	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	0.00		0.00																									20.00		60.00				0.00		0.00				0.00				0.00		0				0.67	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	269	0	1	04	01	H5216_269_0	4		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		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	4		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	97.00		291.00																									100.00		300.00				97.00		281.00				97.00				97.00		3.23				3.33	3.23	3.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	269	0	1	04	01	H5216_269_0	4		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					30																										30						30					30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	271	0	1	04	01	H5216_271_0	4		Y	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	271	0	1	04	01	H5216_271_0	4		Y	Generic	4	11	3	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	5.00		15.00																									20.00		60.00				5.00		0.00				5.00				5.00		0.17				0.67	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	271	0	1	04	01	H5216_271_0	4		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		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	4		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	97.00		291.00																									100.00		300.00				97.00		281.00				97.00				97.00		3.23				3.33	3.23	3.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	271	0	1	04	01	H5216_271_0	4		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					29																										29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	272	0	1	04	01	H5216_272_0	4		Y	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	272	0	1	04	01	H5216_272_0	4		Y	Generic	4	11	3	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	0.00		0.00																									20.00		60.00				0.00		0.00				0.00				0.00		0				0.67	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	272	0	1	04	01	H5216_272_0	4		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		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	4		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	97.00		291.00																									100.00		300.00				97.00		281.00				97.00				97.00		3.23				3.33	3.23	3.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	272	0	1	04	01	H5216_272_0	4		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					30																										30						30					30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	273	0	1	04	01	H5216_273_0	5		Y	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	273	0	1	04	01	H5216_273_0	5		Y	Preferred Generic	4	11	3	2	1	3	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H5216	273	0	1	04	01	H5216_273_0	5		Y	Generic	4	11	3	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	5.00		15.00																									20.00		60.00				5.00		0.00				5.00				5.00		0.17				0.67	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	273	0	1	04	01	H5216_273_0	5		Y	Generic	4	11	3	2	2	3	110		01		110	1	30		90				2	2				30		90	30		31	5.00		15.00																									20.00		60.00				5.00		0.00				5.00				5.00		0.17				0.67	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H5216	273	0	1	04	01	H5216_273_0	5		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		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	5		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		290.00				100.00				100.00		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	5		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					27																										27						27					27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	274	0	1	04	01	H5216_274_0	3		Y	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	274	0	1	04	01	H5216_274_0	3		Y	Generic	4	11	3	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	0.00		0.00																									20.00		60.00				0.00		0.00				0.00				0.00		0				0.67	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	274	0	1	04	01	H5216_274_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		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		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	97.00		291.00																									100.00		300.00				97.00		281.00				97.00				97.00		3.23				3.33	3.23	3.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	274	0	1	04	01	H5216_274_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	275	0	1	04	01	H5216_275_0	3		Y	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	275	0	1	04	01	H5216_275_0	3		Y	Preferred Generic	4	11	3	2	1	3	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H5216	275	0	1	04	01	H5216_275_0	3		Y	Generic	4	11	3	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	5.00		15.00																									20.00		60.00				5.00		0.00				5.00				5.00		0.17				0.67	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	275	0	1	04	01	H5216_275_0	3		Y	Generic	4	11	3	2	2	3	110		01		110	1	30		90				2	2				30		90	30		31	5.00		15.00																									20.00		60.00				5.00		0.00				5.00				5.00		0.17				0.67	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H5216	275	0	1	04	01	H5216_275_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		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		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	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												
H5216	275	0	1	04	01	H5216_275_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					27																										27						27					27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	279	0	1	04	01	H5216_279_0	3		Y	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	279	0	1	04	01	H5216_279_0	3		Y	Preferred Generic	4	11	3	2	1	3	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H5216	279	0	1	04	01	H5216_279_0	3		Y	Generic	4	11	3	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	0.00		0.00																									20.00		60.00				0.00		0.00				0.00				0.00		0				0.67	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	279	0	1	04	01	H5216_279_0	3		Y	Generic	4	11	3	2	2	3	110		01		110	1	30		90				2	2				30		90	30		31	0.00		0.00																									20.00		60.00				0.00		0.00				0.00				0.00		0				0.67	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H5216	279	0	1	04	01	H5216_279_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		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	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		290.00				100.00				100.00		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	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	280	1	1	04	01	H5216_280_1	4		Y	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									1.00		3.00				0.00		0.00				0.00				0.00		0				0.03	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	280	1	1	04	01	H5216_280_1	4		Y	Preferred Generic	4	11	3	2	1	3	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									1.00		3.00				0.00		0.00				0.00				0.00		0				0.03	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H5216	280	1	1	04	01	H5216_280_1	4		Y	Generic	4	11	3	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	20.00		60.00																									20.00		60.00				20.00		0.00				20.00				20.00		0.67				0.67	0.67	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	280	1	1	04	01	H5216_280_1	4		Y	Generic	4	11	3	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		0.00				20.00				20.00		0.67				0.67	0.67	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H5216	280	1	1	04	01	H5216_280_1	4		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	47.00		141.00																									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												
H5216	280	1	1	04	01	H5216_280_1	4		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	100.00		300.00																									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												
H5216	280	1	1	04	01	H5216_280_1	4		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	280	2	1	04	01	H5216_280_2	3		Y	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									1.00		3.00				0.00		0.00				0.00				0.00		0				0.03	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	280	2	1	04	01	H5216_280_2	3		Y	Preferred Generic	4	11	3	2	1	3	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									1.00		3.00				0.00		0.00				0.00				0.00		0				0.03	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H5216	280	2	1	04	01	H5216_280_2	3		Y	Generic	4	11	3	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	20.00		60.00																									20.00		60.00				20.00		0.00				20.00				20.00		0.67				0.67	0.67	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	280	2	1	04	01	H5216_280_2	3		Y	Generic	4	11	3	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		0.00				20.00				20.00		0.67				0.67	0.67	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H5216	280	2	1	04	01	H5216_280_2	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		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	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		290.00				100.00				100.00		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	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	281	0	1	04	01	H5216_281_0	3		Y	Preferred Generic	4	11	1	2	1	1	110		01		110	1	30		100				1	2				30		100	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	281	0	1	04	01	H5216_281_0	3		Y	Preferred Generic	4	11	1	2	1	3	110		01		110	1	30		100				1	2				30		100	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5216	281	0	1	04	01	H5216_281_0	3		Y	Generic	4	11	1	2	2	1	110		01		110	1	30		100				2	2				30		100	30		31	5.00		15.00																									20.00		60.00				5.00		0.00				5.00				5.00		0.17				0.67	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	281	0	1	04	01	H5216_281_0	3		Y	Generic	4	11	1	2	2	3	110		01		110	1	30		100				2	2				30		100	30		31	5.00		15.00																									20.00		60.00				5.00		0.00				5.00				5.00		0.17				0.67	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5216	281	0	1	04	01	H5216_281_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		100				2	2				30		100	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												
H5216	281	0	1	04	01	H5216_281_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		100				2	2				30		100	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												
H5216	281	0	1	04	01	H5216_281_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	283	0	1	04	01	H5216_283_0	3		Y	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	283	0	1	04	01	H5216_283_0	3		Y	Preferred Generic	4	11	3	2	1	3	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H5216	283	0	1	04	01	H5216_283_0	3		Y	Generic	4	11	3	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	0.00		0.00																									20.00		60.00				0.00		0.00				0.00				0.00		0				0.67	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	283	0	1	04	01	H5216_283_0	3		Y	Generic	4	11	3	2	2	3	110		01		110	1	30		90				2	2				30		90	30		31	0.00		0.00																									20.00		60.00				0.00		0.00				0.00				0.00		0				0.67	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H5216	283	0	1	04	01	H5216_283_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		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	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		290.00				100.00				100.00		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	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	284	0	1	04	01	H5216_284_0	3		Y	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									1.00		3.00				0.00		0.00				0.00				0.00		0				0.03	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	284	0	1	04	01	H5216_284_0	3		Y	Preferred Generic	4	11	3	2	1	3	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									1.00		3.00				0.00		0.00				0.00				0.00		0				0.03	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H5216	284	0	1	04	01	H5216_284_0	3		Y	Generic	4	11	3	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	20.00		60.00																									20.00		60.00				20.00		0.00				20.00				20.00		0.67				0.67	0.67	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	284	0	1	04	01	H5216_284_0	3		Y	Generic	4	11	3	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		0.00				20.00				20.00		0.67				0.67	0.67	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H5216	284	0	1	04	01	H5216_284_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		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		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	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												
H5216	284	0	1	04	01	H5216_284_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	285	0	1	04	01	H5216_285_0	4		Y	Preferred Generic	4	11	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	285	0	1	04	01	H5216_285_0	4		Y	Preferred Generic	4	11	1	2	1	3	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5216	285	0	1	04	01	H5216_285_0	4		Y	Generic	4	11	1	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	5.00		15.00																									20.00		60.00				5.00		0.00				5.00				5.00		0.17				0.67	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	285	0	1	04	01	H5216_285_0	4		Y	Generic	4	11	1	2	2	3	110		01		110	1	30		90				2	2				30		90	30		31	5.00		15.00																									20.00		60.00				5.00		0.00				5.00				5.00		0.17				0.67	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5216	285	0	1	04	01	H5216_285_0	4		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		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	4		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		290.00				100.00				100.00		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	4		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					29																										29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	287	0	1	04	01	H5216_287_0	5		Y	Preferred Generic	4	11	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	287	0	1	04	01	H5216_287_0	5		Y	Preferred Generic	4	11	1	2	1	3	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5216	287	0	1	04	01	H5216_287_0	5		Y	Generic	4	11	1	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	0.00		0.00																									20.00		60.00				0.00		0.00				0.00				0.00		0				0.67	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	287	0	1	04	01	H5216_287_0	5		Y	Generic	4	11	1	2	2	3	110		01		110	1	30		90				2	2				30		90	30		31	0.00		0.00																									20.00		60.00				0.00		0.00				0.00				0.00		0				0.67	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5216	287	0	1	04	01	H5216_287_0	5		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		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	5		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		290.00				100.00				100.00		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	5		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	288	0	1	04	01	H5216_288_0	2		Y	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	288	0	1	04	01	H5216_288_0	2		Y	Preferred Generic	4	11	3	2	1	3	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H5216	288	0	1	04	01	H5216_288_0	2		Y	Generic	4	11	3	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	0.00		0.00																									20.00		60.00				0.00		0.00				0.00				0.00		0				0.67	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	288	0	1	04	01	H5216_288_0	2		Y	Generic	4	11	3	2	2	3	110		01		110	1	30		90				2	2				30		90	30		31	0.00		0.00																									20.00		60.00				0.00		0.00				0.00				0.00		0				0.67	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H5216	288	0	1	04	01	H5216_288_0	2		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		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	2		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		290.00				100.00				100.00		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	2		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					28																										28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	289	0	1	04	01	H5216_289_0	2		Y	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	289	0	1	04	01	H5216_289_0	2		Y	Preferred Generic	4	11	3	2	1	3	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H5216	289	0	1	04	01	H5216_289_0	2		Y	Generic	4	11	3	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	0.00		0.00																									20.00		60.00				0.00		0.00				0.00				0.00		0				0.67	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	289	0	1	04	01	H5216_289_0	2		Y	Generic	4	11	3	2	2	3	110		01		110	1	30		90				2	2				30		90	30		31	0.00		0.00																									20.00		60.00				0.00		0.00				0.00				0.00		0				0.67	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H5216	289	0	1	04	01	H5216_289_0	2		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		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	2		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		290.00				100.00				100.00		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	2		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					28																										28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	293	0	1	04	01	H5216_293_0	4		N	Preferred Generic	3	11	1	2	1	1	110		01		110	1	30		100				1	2				30		100	30		31	4.00		12.00																									10.00		30.00				4.00		0.00				4.00				4.00		0.13				0.33	0.13	0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	293	0	1	04	01	H5216_293_0	4		N	Generic	3	11	1	2	2	1	110		01		110	1	30		100				2	2				30		100	30		31	14.00		42.00																									20.00		60.00				14.00		0.00				14.00				14.00		0.47				0.67	0.47	0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	293	0	1	04	01	H5216_293_0	4		N	Preferred Brand	3	11	1	1	3	1	110		01		110	1	30		100				2	2				30		100	30		31				56.00	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	4		N	Non-Preferred Drug	3	11	1	1	4	1	110		01		110	1	30		100				2	2				30		100	30		31				63.00	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	4		N	Specialty Tier	3	11	1	1	5	1	010		01		010	1	30											30			30		31					26																										26						26					26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	294	0	1	04	01	H5216_294_0	4		N	Preferred Generic	3	11	1	2	1	1	110		01		110	1	30		100				1	2				30		100	30		31	4.00		12.00																									10.00		30.00				4.00		0.00				4.00				4.00		0.13				0.33	0.13	0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	294	0	1	04	01	H5216_294_0	4		N	Generic	3	11	1	2	2	1	110		01		110	1	30		100				2	2				30		100	30		31	15.00		45.00																									20.00		60.00				15.00		0.00				15.00				15.00		0.50				0.67	0.50	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	294	0	1	04	01	H5216_294_0	4		N	Preferred Brand	3	11	1	1	3	1	110		01		110	1	30		100				2	2				30		100	30		31				64.00	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	4		N	Non-Preferred Drug	3	11	1	1	4	1	110		01		110	1	30		100				2	2				30		100	30		31				72.00	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	4		N	Specialty Tier	3	11	1	1	5	1	010		01		010	1	30											30			30		31					26																										26						26					26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	296	0	1	04	01	H5216_296_0	4		N	Preferred Generic	4	11	1	2	1	1	110		01		110	1	30		100				1	2				30		100	30		31	19.00		57.00																									19.00		57.00				19.00		0.00				19.00				19.00		0.63				0.63	0.63	0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	296	0	1	04	01	H5216_296_0	4		N	Generic	4	11	1	2	2	1	110		01		110	1	30		100				2	2				30		100	30		31	20.00		60.00																									20.00		60.00				20.00		0.00				20.00				20.00		0.67				0.67	0.67	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	296	0	1	04	01	H5216_296_0	4		N	Preferred Brand	4	11	1	1	3	1	110		01		110	1	30		100				2	2				30		100	30		31				43.00	19		19																								20		20				19		19			19			19								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	296	0	1	04	01	H5216_296_0	4		N	Non-Preferred Drug	4	11	1	1	4	1	110		01		110	1	30		100				2	2				30		100	30		31				71.00	27		27																								27		27				27		27			27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	296	0	1	04	01	H5216_296_0	4		N	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	300	0	1	04	01	H5216_300_0	3		Y	Preferred Generic	4	11	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									15.00		45.00				0.00		0.00				0.00				0.00		0				0.50	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	300	0	1	04	01	H5216_300_0	3		Y	Generic	4	11	1	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	0.00		0.00																									20.00		60.00				0.00		0.00				0.00				0.00		0				0.67	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	300	0	1	04	01	H5216_300_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		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		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	99.00		297.00																									100.00		300.00				99.00		287.00				99.00				99.00		3.30				3.33	3.30	3.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	300	0	1	04	01	H5216_300_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	303	0	1	04	01	H5216_303_0	3		Y	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	303	0	1	04	01	H5216_303_0	3		Y	Preferred Generic	4	11	3	2	1	3	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H5216	303	0	1	04	01	H5216_303_0	3		Y	Generic	4	11	3	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	5.00		15.00																									20.00		60.00				5.00		0.00				5.00				5.00		0.17				0.67	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	303	0	1	04	01	H5216_303_0	3		Y	Generic	4	11	3	2	2	3	110		01		110	1	30		90				2	2				30		90	30		31	5.00		15.00																									20.00		60.00				5.00		0.00				5.00				5.00		0.17				0.67	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H5216	303	0	1	04	01	H5216_303_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		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		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	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												
H5216	303	0	1	04	01	H5216_303_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					27																										27						27					27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	304	0	1	04	01	H5216_304_0	5		Y	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	304	0	1	04	01	H5216_304_0	5		Y	Preferred Generic	4	11	3	2	1	3	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H5216	304	0	1	04	01	H5216_304_0	5		Y	Generic	4	11	3	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	0.00		0.00																									20.00		60.00				0.00		0.00				0.00				0.00		0				0.67	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	304	0	1	04	01	H5216_304_0	5		Y	Generic	4	11	3	2	2	3	110		01		110	1	30		90				2	2				30		90	30		31	0.00		0.00																									20.00		60.00				0.00		0.00				0.00				0.00		0				0.67	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H5216	304	0	1	04	01	H5216_304_0	5		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	304	0	1	04	01	H5216_304_0	5		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		290.00				100.00				100.00		3.33				3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	304	0	1	04	01	H5216_304_0	5		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	305	0	1	04	01	H5216_305_0	5		Y	Preferred Generic	4	11	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	305	0	1	04	01	H5216_305_0	5		Y	Preferred Generic	4	11	1	2	1	3	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5216	305	0	1	04	01	H5216_305_0	5		Y	Generic	4	11	1	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	5.00		15.00																									20.00		60.00				5.00		0.00				5.00				5.00		0.17				0.67	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	305	0	1	04	01	H5216_305_0	5		Y	Generic	4	11	1	2	2	3	110		01		110	1	30		90				2	2				30		90	30		31	5.00		15.00																									20.00		60.00				5.00		0.00				5.00				5.00		0.17				0.67	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5216	305	0	1	04	01	H5216_305_0	5		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	305	0	1	04	01	H5216_305_0	5		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		290.00				100.00				100.00		3.33				3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	305	0	1	04	01	H5216_305_0	5		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					27																										27						27					27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	306	0	1	04	01	H5216_306_0	4		Y	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	306	0	1	04	01	H5216_306_0	4		Y	Preferred Generic	4	11	3	2	1	3	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H5216	306	0	1	04	01	H5216_306_0	4		Y	Generic	4	11	3	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	5.00		15.00																									20.00		60.00				5.00		0.00				5.00				5.00		0.17				0.67	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	306	0	1	04	01	H5216_306_0	4		Y	Generic	4	11	3	2	2	3	110		01		110	1	30		90				2	2				30		90	30		31	5.00		15.00																									20.00		60.00				5.00		0.00				5.00				5.00		0.17				0.67	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H5216	306	0	1	04	01	H5216_306_0	4		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	306	0	1	04	01	H5216_306_0	4		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		290.00				100.00				100.00		3.33				3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	306	0	1	04	01	H5216_306_0	4		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					27																										27						27					27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	307	0	1	04	01	H5216_307_0	4		Y	Preferred Generic	4	11	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	307	0	1	04	01	H5216_307_0	4		Y	Preferred Generic	4	11	1	2	1	3	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5216	307	0	1	04	01	H5216_307_0	4		Y	Generic	4	11	1	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	5.00		15.00																									20.00		60.00				5.00		0.00				5.00				5.00		0.17				0.67	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	307	0	1	04	01	H5216_307_0	4		Y	Generic	4	11	1	2	2	3	110		01		110	1	30		90				2	2				30		90	30		31	5.00		15.00																									20.00		60.00				5.00		0.00				5.00				5.00		0.17				0.67	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5216	307	0	1	04	01	H5216_307_0	4		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	307	0	1	04	01	H5216_307_0	4		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		290.00				100.00				100.00		3.33				3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	307	0	1	04	01	H5216_307_0	4		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					27																										27						27					27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	308	0	1	04	01	H5216_308_0	4		Y	Preferred Generic	4	11	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	308	0	1	04	01	H5216_308_0	4		Y	Generic	4	11	1	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	5.00		15.00																									20.00		60.00				5.00		0.00				5.00				5.00		0.17				0.67	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	308	0	1	04	01	H5216_308_0	4		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	308	0	1	04	01	H5216_308_0	4		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	99.00		297.00																									100.00		300.00				99.00		287.00				99.00				99.00		3.30				3.33	3.30	3.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	308	0	1	04	01	H5216_308_0	4		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	309	0	1	04	01	H5216_309_0	4		Y	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	309	0	1	04	01	H5216_309_0	4		Y	Preferred Generic	4	11	3	2	1	3	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H5216	309	0	1	04	01	H5216_309_0	4		Y	Generic	4	11	3	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	5.00		15.00																									20.00		60.00				5.00		0.00				5.00				5.00		0.17				0.67	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	309	0	1	04	01	H5216_309_0	4		Y	Generic	4	11	3	2	2	3	110		01		110	1	30		90				2	2				30		90	30		31	5.00		15.00																									20.00		60.00				5.00		0.00				5.00				5.00		0.17				0.67	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H5216	309	0	1	04	01	H5216_309_0	4		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	309	0	1	04	01	H5216_309_0	4		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		290.00				100.00				100.00		3.33				3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	309	0	1	04	01	H5216_309_0	4		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					27																										27						27					27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	311	0	1	04	01	H5216_311_0	3		Y	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	311	0	1	04	01	H5216_311_0	3		Y	Generic	4	11	3	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	5.00		15.00																									20.00		60.00				5.00		0.00				5.00				5.00		0.17				0.67	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	311	0	1	04	01	H5216_311_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	311	0	1	04	01	H5216_311_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	97.00		291.00																									100.00		300.00				97.00		281.00				97.00				97.00		3.23				3.33	3.23	3.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	311	0	1	04	01	H5216_311_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					27																										27						27					27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	312	0	1	04	01	H5216_312_0	5		Y	Preferred Generic	4	11	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	312	0	1	04	01	H5216_312_0	5		Y	Generic	4	11	1	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	0.00		0.00																									20.00		60.00				0.00		0.00				0.00				0.00		0				0.67	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	312	0	1	04	01	H5216_312_0	5		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	45.00		135.00																									47.00		141.00				45.00		125.00				45.00				45.00		1.50				1.57	1.50	1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	312	0	1	04	01	H5216_312_0	5		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	95.00		285.00																									100.00		300.00				95.00		275.00				95.00				95.00		3.17				3.33	3.17	3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	312	0	1	04	01	H5216_312_0	5		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	313	0	1	04	01	H5216_313_0	3		Y	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		100				1	2				30		100	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	313	0	1	04	01	H5216_313_0	3		Y	Preferred Generic	4	11	3	2	1	3	110		01		110	1	30		100				1	2				30		100	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H5216	313	0	1	04	01	H5216_313_0	3		Y	Generic	4	11	3	2	2	1	110		01		110	1	30		100				2	2				30		100	30		31	0.00		0.00																									20.00		60.00				0.00		0.00				0.00				0.00		0				0.67	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	313	0	1	04	01	H5216_313_0	3		Y	Generic	4	11	3	2	2	3	110		01		110	1	30		100				2	2				30		100	30		31	0.00		0.00																									20.00		60.00				0.00		0.00				0.00				0.00		0				0.67	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H5216	313	0	1	04	01	H5216_313_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		100				2	2				30		100	30		31	45.00		135.00																									47.00		141.00				45.00		90.00				45.00				45.00		1.50				1.57	1.50	1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	313	0	1	04	01	H5216_313_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		100				2	2				30		100	30		31	95.00		285.00																									100.00		300.00				95.00		190.00				95.00				95.00		3.17				3.33	3.17	3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	313	0	1	04	01	H5216_313_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					30																										30						30					30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	314	0	1	04	01	H5216_314_0	3		Y	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		100				1	2				30		100	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	314	0	1	04	01	H5216_314_0	3		Y	Preferred Generic	4	11	3	2	1	3	110		01		110	1	30		100				1	2				30		100	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H5216	314	0	1	04	01	H5216_314_0	3		Y	Generic	4	11	3	2	2	1	110		01		110	1	30		100				2	2				30		100	30		31	0.00		0.00																									20.00		60.00				0.00		0.00				0.00				0.00		0				0.67	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	314	0	1	04	01	H5216_314_0	3		Y	Generic	4	11	3	2	2	3	110		01		110	1	30		100				2	2				30		100	30		31	0.00		0.00																									20.00		60.00				0.00		0.00				0.00				0.00		0				0.67	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H5216	314	0	1	04	01	H5216_314_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		100				2	2				30		100	30		31	47.00		141.00																									47.00		141.00				47.00		94.00				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	314	0	1	04	01	H5216_314_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		100				2	2				30		100	30		31	100.00		300.00																									100.00		300.00				100.00		200.00				100.00				100.00		3.33				3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	314	0	1	04	01	H5216_314_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					27																										27						27					27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	316	1	1	04	01	H5216_316_1	3		Y	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	316	1	1	04	01	H5216_316_1	3		Y	Preferred Generic	4	11	3	2	1	3	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H5216	316	1	1	04	01	H5216_316_1	3		Y	Generic	4	11	3	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	5.00		15.00																									20.00		60.00				5.00		0.00				5.00				5.00		0.17				0.67	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	316	1	1	04	01	H5216_316_1	3		Y	Generic	4	11	3	2	2	3	110		01		110	1	30		90				2	2				30		90	30		31	5.00		15.00																									20.00		60.00				5.00		0.00				5.00				5.00		0.17				0.67	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H5216	316	1	1	04	01	H5216_316_1	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	316	1	1	04	01	H5216_316_1	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	99.00		297.00																									100.00		300.00				99.00		287.00				99.00				99.00		3.30				3.33	3.30	3.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	316	1	1	04	01	H5216_316_1	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	316	2	1	04	01	H5216_316_2	3		Y	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	316	2	1	04	01	H5216_316_2	3		Y	Preferred Generic	4	11	3	2	1	3	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H5216	316	2	1	04	01	H5216_316_2	3		Y	Generic	4	11	3	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	5.00		15.00																									20.00		60.00				5.00		0.00				5.00				5.00		0.17				0.67	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	316	2	1	04	01	H5216_316_2	3		Y	Generic	4	11	3	2	2	3	110		01		110	1	30		90				2	2				30		90	30		31	5.00		15.00																									20.00		60.00				5.00		0.00				5.00				5.00		0.17				0.67	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H5216	316	2	1	04	01	H5216_316_2	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	316	2	1	04	01	H5216_316_2	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	99.00		297.00																									100.00		300.00				99.00		287.00				99.00				99.00		3.30				3.33	3.30	3.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	316	2	1	04	01	H5216_316_2	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	316	3	1	04	01	H5216_316_3	3		Y	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	316	3	1	04	01	H5216_316_3	3		Y	Preferred Generic	4	11	3	2	1	3	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H5216	316	3	1	04	01	H5216_316_3	3		Y	Generic	4	11	3	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	5.00		15.00																									20.00		60.00				5.00		0.00				5.00				5.00		0.17				0.67	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	316	3	1	04	01	H5216_316_3	3		Y	Generic	4	11	3	2	2	3	110		01		110	1	30		90				2	2				30		90	30		31	5.00		15.00																									20.00		60.00				5.00		0.00				5.00				5.00		0.17				0.67	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H5216	316	3	1	04	01	H5216_316_3	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	316	3	1	04	01	H5216_316_3	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	99.00		297.00																									100.00		300.00				99.00		287.00				99.00				99.00		3.30				3.33	3.30	3.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	316	3	1	04	01	H5216_316_3	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	317	0	1	04	01	H5216_317_0	3		Y	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	317	0	1	04	01	H5216_317_0	3		Y	Preferred Generic	4	11	3	2	1	3	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H5216	317	0	1	04	01	H5216_317_0	3		Y	Generic	4	11	3	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	0.00		0.00																									20.00		60.00				0.00		0.00				0.00				0.00		0				0.67	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	317	0	1	04	01	H5216_317_0	3		Y	Generic	4	11	3	2	2	3	110		01		110	1	30		90				2	2				30		90	30		31	0.00		0.00																									20.00		60.00				0.00		0.00				0.00				0.00		0				0.67	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H5216	317	0	1	04	01	H5216_317_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	317	0	1	04	01	H5216_317_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		290.00				100.00				100.00		3.33				3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	317	0	1	04	01	H5216_317_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	318	1	1	04	01	H5216_318_1	3		Y	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	318	1	1	04	01	H5216_318_1	3		Y	Preferred Generic	4	11	3	2	1	3	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H5216	318	1	1	04	01	H5216_318_1	3		Y	Generic	4	11	3	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	5.00		15.00																									20.00		60.00				5.00		0.00				5.00				5.00		0.17				0.67	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	318	1	1	04	01	H5216_318_1	3		Y	Generic	4	11	3	2	2	3	110		01		110	1	30		90				2	2				30		90	30		31	5.00		15.00																									20.00		60.00				5.00		0.00				5.00				5.00		0.17				0.67	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H5216	318	1	1	04	01	H5216_318_1	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	318	1	1	04	01	H5216_318_1	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	99.00		297.00																									100.00		300.00				99.00		287.00				99.00				99.00		3.30				3.33	3.30	3.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	318	1	1	04	01	H5216_318_1	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	318	2	1	04	01	H5216_318_2	3		Y	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	318	2	1	04	01	H5216_318_2	3		Y	Preferred Generic	4	11	3	2	1	3	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H5216	318	2	1	04	01	H5216_318_2	3		Y	Generic	4	11	3	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	5.00		15.00																									20.00		60.00				5.00		0.00				5.00				5.00		0.17				0.67	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	318	2	1	04	01	H5216_318_2	3		Y	Generic	4	11	3	2	2	3	110		01		110	1	30		90				2	2				30		90	30		31	5.00		15.00																									20.00		60.00				5.00		0.00				5.00				5.00		0.17				0.67	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H5216	318	2	1	04	01	H5216_318_2	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	318	2	1	04	01	H5216_318_2	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	99.00		297.00																									100.00		300.00				99.00		287.00				99.00				99.00		3.30				3.33	3.30	3.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	318	2	1	04	01	H5216_318_2	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	318	3	1	04	01	H5216_318_3	3		Y	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	318	3	1	04	01	H5216_318_3	3		Y	Preferred Generic	4	11	3	2	1	3	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H5216	318	3	1	04	01	H5216_318_3	3		Y	Generic	4	11	3	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	5.00		15.00																									20.00		60.00				5.00		0.00				5.00				5.00		0.17				0.67	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	318	3	1	04	01	H5216_318_3	3		Y	Generic	4	11	3	2	2	3	110		01		110	1	30		90				2	2				30		90	30		31	5.00		15.00																									20.00		60.00				5.00		0.00				5.00				5.00		0.17				0.67	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H5216	318	3	1	04	01	H5216_318_3	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	318	3	1	04	01	H5216_318_3	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	99.00		297.00																									100.00		300.00				99.00		287.00				99.00				99.00		3.30				3.33	3.30	3.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	318	3	1	04	01	H5216_318_3	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	319	0	1	04	01	H5216_319_0	3		Y	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	319	0	1	04	01	H5216_319_0	3		Y	Preferred Generic	4	11	3	2	1	3	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H5216	319	0	1	04	01	H5216_319_0	3		Y	Generic	4	11	3	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	5.00		15.00																									20.00		60.00				5.00		0.00				5.00				5.00		0.17				0.67	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	319	0	1	04	01	H5216_319_0	3		Y	Generic	4	11	3	2	2	3	110		01		110	1	30		90				2	2				30		90	30		31	5.00		15.00																									20.00		60.00				5.00		0.00				5.00				5.00		0.17				0.67	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H5216	319	0	1	04	01	H5216_319_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	319	0	1	04	01	H5216_319_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		290.00				100.00				100.00		3.33				3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	319	0	1	04	01	H5216_319_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	320	0	1	04	01	H5216_320_0	3		Y	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	320	0	1	04	01	H5216_320_0	3		Y	Preferred Generic	4	11	3	2	1	3	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H5216	320	0	1	04	01	H5216_320_0	3		Y	Generic	4	11	3	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	5.00		15.00																									20.00		60.00				5.00		0.00				5.00				5.00		0.17				0.67	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	320	0	1	04	01	H5216_320_0	3		Y	Generic	4	11	3	2	2	3	110		01		110	1	30		90				2	2				30		90	30		31	5.00		15.00																									20.00		60.00				5.00		0.00				5.00				5.00		0.17				0.67	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H5216	320	0	1	04	01	H5216_320_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	320	0	1	04	01	H5216_320_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		290.00				100.00				100.00		3.33				3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	320	0	1	04	01	H5216_320_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					29																										29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	321	0	1	04	01	H5216_321_0	4		Y	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	321	0	1	04	01	H5216_321_0	4		Y	Generic	4	11	3	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	0.00		0.00																									20.00		60.00				0.00		0.00				0.00				0.00		0				0.67	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	321	0	1	04	01	H5216_321_0	4		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	321	0	1	04	01	H5216_321_0	4		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	97.00		291.00																									100.00		300.00				97.00		281.00				97.00				97.00		3.23				3.33	3.23	3.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	321	0	1	04	01	H5216_321_0	4		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	322	0	1	04	01	H5216_322_0	3		Y	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	322	0	1	04	01	H5216_322_0	3		Y	Preferred Generic	4	11	3	2	1	3	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H5216	322	0	1	04	01	H5216_322_0	3		Y	Generic	4	11	3	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	5.00		15.00																									20.00		60.00				5.00		0.00				5.00				5.00		0.17				0.67	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	322	0	1	04	01	H5216_322_0	3		Y	Generic	4	11	3	2	2	3	110		01		110	1	30		90				2	2				30		90	30		31	5.00		15.00																									20.00		60.00				5.00		0.00				5.00				5.00		0.17				0.67	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H5216	322	0	1	04	01	H5216_322_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	322	0	1	04	01	H5216_322_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		290.00				100.00				100.00		3.33				3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	322	0	1	04	01	H5216_322_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	323	0	1	04	01	H5216_323_0	3		Y	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	323	0	1	04	01	H5216_323_0	3		Y	Preferred Generic	4	11	3	2	1	3	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H5216	323	0	1	04	01	H5216_323_0	3		Y	Generic	4	11	3	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	5.00		15.00																									20.00		60.00				5.00		0.00				5.00				5.00		0.17				0.67	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	323	0	1	04	01	H5216_323_0	3		Y	Generic	4	11	3	2	2	3	110		01		110	1	30		90				2	2				30		90	30		31	5.00		15.00																									20.00		60.00				5.00		0.00				5.00				5.00		0.17				0.67	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H5216	323	0	1	04	01	H5216_323_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	323	0	1	04	01	H5216_323_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	99.00		297.00																									100.00		300.00				100.00		290.00				99.00				99.00		3.30				3.33	3.33	3.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	323	0	1	04	01	H5216_323_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	324	0	1	04	01	H5216_324_0	3		Y	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	2.00		6.00																									10.00		30.00				2.00		0.00				2.00				2.00		0.07				0.33	0.07	0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	324	0	1	04	01	H5216_324_0	3		Y	Preferred Generic	4	11	3	2	1	3	110		01		110	1	30		90				1	2				30		90	30		31	2.00		6.00																									10.00		30.00				2.00		0.00				2.00				2.00		0.07				0.33	0.07	0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H5216	324	0	1	04	01	H5216_324_0	3		Y	Generic	4	11	3	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	8.00		24.00																									20.00		60.00				8.00		0.00				8.00				8.00		0.27				0.67	0.27	0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	324	0	1	04	01	H5216_324_0	3		Y	Generic	4	11	3	2	2	3	110		01		110	1	30		90				2	2				30		90	30		31	8.00		24.00																									20.00		60.00				8.00		0.00				8.00				8.00		0.27				0.67	0.27	0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H5216	324	0	1	04	01	H5216_324_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	324	0	1	04	01	H5216_324_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		290.00				100.00				100.00		3.33				3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	324	0	1	04	01	H5216_324_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					29																										29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	325	0	1	04	01	H5216_325_0	3		Y	Preferred Generic	4	11	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	325	0	1	04	01	H5216_325_0	3		Y	Generic	4	11	1	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	0.00		0.00																									20.00		60.00				0.00		0.00				0.00				0.00		0				0.67	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	325	0	1	04	01	H5216_325_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	325	0	1	04	01	H5216_325_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	99.00		297.00																									100.00		300.00				99.00		287.00				99.00				99.00		3.30				3.33	3.30	3.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	325	0	1	04	01	H5216_325_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	326	0	1	04	01	H5216_326_0	3		Y	Preferred Generic	4	11	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	326	0	1	04	01	H5216_326_0	3		Y	Generic	4	11	1	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	5.00		15.00																									20.00		60.00				5.00		0.00				5.00				5.00		0.17				0.67	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	326	0	1	04	01	H5216_326_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	45.00		135.00																									47.00		141.00				45.00		125.00				45.00				45.00		1.50				1.57	1.50	1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	326	0	1	04	01	H5216_326_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		290.00				100.00				100.00		3.33				3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	326	0	1	04	01	H5216_326_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	327	0	1	04	01	H5216_327_0	3		Y	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	327	0	1	04	01	H5216_327_0	3		Y	Preferred Generic	4	11	3	2	1	3	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H5216	327	0	1	04	01	H5216_327_0	3		Y	Generic	4	11	3	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	0.00		0.00																									20.00		60.00				0.00		0.00				0.00				0.00		0				0.67	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	327	0	1	04	01	H5216_327_0	3		Y	Generic	4	11	3	2	2	3	110		01		110	1	30		90				2	2				30		90	30		31	0.00		0.00																									20.00		60.00				0.00		0.00				0.00				0.00		0				0.67	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H5216	327	0	1	04	01	H5216_327_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	327	0	1	04	01	H5216_327_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		290.00				100.00				100.00		3.33				3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	327	0	1	04	01	H5216_327_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	328	0	1	04	01	H5216_328_0	3		Y	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	328	0	1	04	01	H5216_328_0	3		Y	Preferred Generic	4	11	3	2	1	3	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H5216	328	0	1	04	01	H5216_328_0	3		Y	Generic	4	11	3	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	5.00		15.00																									20.00		60.00				5.00		0.00				5.00				5.00		0.17				0.67	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	328	0	1	04	01	H5216_328_0	3		Y	Generic	4	11	3	2	2	3	110		01		110	1	30		90				2	2				30		90	30		31	5.00		15.00																									20.00		60.00				5.00		0.00				5.00				5.00		0.17				0.67	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H5216	328	0	1	04	01	H5216_328_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	328	0	1	04	01	H5216_328_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		290.00				100.00				100.00		3.33				3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	328	0	1	04	01	H5216_328_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	333	0	1	04	01	H5216_333_0	3		Y	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	333	0	1	04	01	H5216_333_0	3		Y	Preferred Generic	4	11	3	2	1	3	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H5216	333	0	1	04	01	H5216_333_0	3		Y	Generic	4	11	3	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	2.00		6.00																									20.00		60.00				2.00		0.00				2.00				2.00		0.07				0.67	0.07	0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	333	0	1	04	01	H5216_333_0	3		Y	Generic	4	11	3	2	2	3	110		01		110	1	30		90				2	2				30		90	30		31	2.00		6.00																									20.00		60.00				2.00		0.00				2.00				2.00		0.07				0.67	0.07	0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H5216	333	0	1	04	01	H5216_333_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	45.00		135.00																									47.00		141.00				45.00		90.00				45.00				45.00		1.50				1.57	1.50	1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	333	0	1	04	01	H5216_333_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		200.00				100.00				100.00		3.33				3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	333	0	1	04	01	H5216_333_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	334	0	1	04	01	H5216_334_0	4		Y	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5216	334	0	1	04	01	H5216_334_0	4		Y	Preferred Generic	4	11	3	2	1	3	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	3	3
H5216	334	0	1	04	01	H5216_334_0	4		Y	Generic	4	11	3	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	5.00		15.00																									20.00		60.00				5.00		0.00				5.00				5.00		0.17				0.67	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5216	334	0	1	04	01	H5216_334_0	4		Y	Generic	4	11	3	2	2	3	110		01		110	1	30		90				2	2				30		90	30		31	5.00		15.00																									20.00		60.00				5.00		0.00				5.00				5.00		0.17				0.67	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	3	3
H5216	334	0	1	04	01	H5216_334_0	4		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				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												
H5216	334	0	1	04	01	H5216_334_0	4		Y	Preferred Brand	4	11	1	2	3	3	110		01		110	1	30		90				2	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				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										2	3	
H5216	334	0	1	04	01	H5216_334_0	4		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	99.00		297.00																									100.00		300.00				99.00		287.00				99.00				99.00		3.30				3.33	3.30	3.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5216	334	0	1	04	01	H5216_334_0	4		Y	Non-Preferred Drug	4	11	1	2	4	3	110		01		110	1	30		90				2	2				30		90	30		31	99.00		297.00																									100.00		300.00				99.00		287.00				99.00				99.00		3.30				3.33	3.30	3.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	3	
H5216	334	0	1	04	01	H5216_334_0	4		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5216	334	0	1	04	01	H5216_334_0	4		Y	Specialty Tier	4	11	1	1	5	3	010		01		010	1	30											30			30		31					15																										15						15					15			15								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	3	
H5216	334	0	1	04	01	H5216_334_0	4		Y	Select Care Drugs	4	11	1	2	6	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0				0	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5216	334	0	1	04	01	H5216_334_0	4		Y	Select Care Drugs	4	11	1	2	6	3	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0				0	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H5216	335	0	1	04	01	H5216_335_0	3		Y	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	335	0	1	04	01	H5216_335_0	3		Y	Preferred Generic	4	11	3	2	1	3	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H5216	335	0	1	04	01	H5216_335_0	3		Y	Generic	4	11	3	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	2.00		6.00																									20.00		60.00				2.00		0.00				2.00				2.00		0.07				0.67	0.07	0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	335	0	1	04	01	H5216_335_0	3		Y	Generic	4	11	3	2	2	3	110		01		110	1	30		90				2	2				30		90	30		31	2.00		6.00																									20.00		60.00				2.00		0.00				2.00				2.00		0.07				0.67	0.07	0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H5216	335	0	1	04	01	H5216_335_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	45.00		135.00																									47.00		141.00				45.00		90.00				45.00				45.00		1.50				1.57	1.50	1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	335	0	1	04	01	H5216_335_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		200.00				100.00				100.00		3.33				3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	335	0	1	04	01	H5216_335_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	336	0	1	04	01	H5216_336_0	3		Y	Preferred Generic	4	11	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	4.00		12.00																									10.00		30.00				4.00		0.00				4.00				4.00		0.13				0.33	0.13	0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	336	0	1	04	01	H5216_336_0	3		Y	Generic	4	11	1	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	12.00		36.00																									20.00		60.00				12.00		0.00				12.00				12.00		0.40				0.67	0.40	0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	336	0	1	04	01	H5216_336_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	336	0	1	04	01	H5216_336_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	99.00		297.00																									100.00		300.00				99.00		287.00				99.00				99.00		3.30				3.33	3.30	3.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	336	0	1	04	01	H5216_336_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					30																										30						30					30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	337	1	1	04	01	H5216_337_1	3		Y	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	337	1	1	04	01	H5216_337_1	3		Y	Preferred Generic	4	11	3	2	1	3	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H5216	337	1	1	04	01	H5216_337_1	3		Y	Generic	4	11	3	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	5.00		15.00																									20.00		60.00				5.00		0.00				5.00				5.00		0.17				0.67	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	337	1	1	04	01	H5216_337_1	3		Y	Generic	4	11	3	2	2	3	110		01		110	1	30		90				2	2				30		90	30		31	5.00		15.00																									20.00		60.00				5.00		0.00				5.00				5.00		0.17				0.67	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H5216	337	1	1	04	01	H5216_337_1	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	337	1	1	04	01	H5216_337_1	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	99.00		297.00																									100.00		300.00				99.00		287.00				99.00				99.00		3.30				3.33	3.30	3.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	337	1	1	04	01	H5216_337_1	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	337	2	1	04	01	H5216_337_2	3		Y	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	337	2	1	04	01	H5216_337_2	3		Y	Preferred Generic	4	11	3	2	1	3	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H5216	337	2	1	04	01	H5216_337_2	3		Y	Generic	4	11	3	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	5.00		15.00																									20.00		60.00				5.00		0.00				5.00				5.00		0.17				0.67	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	337	2	1	04	01	H5216_337_2	3		Y	Generic	4	11	3	2	2	3	110		01		110	1	30		90				2	2				30		90	30		31	5.00		15.00																									20.00		60.00				5.00		0.00				5.00				5.00		0.17				0.67	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H5216	337	2	1	04	01	H5216_337_2	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	337	2	1	04	01	H5216_337_2	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	99.00		297.00																									100.00		300.00				99.00		287.00				99.00				99.00		3.30				3.33	3.30	3.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	337	2	1	04	01	H5216_337_2	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	337	3	1	04	01	H5216_337_3	4		Y	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	337	3	1	04	01	H5216_337_3	4		Y	Preferred Generic	4	11	3	2	1	3	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H5216	337	3	1	04	01	H5216_337_3	4		Y	Generic	4	11	3	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	5.00		15.00																									20.00		60.00				5.00		0.00				5.00				5.00		0.17				0.67	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	337	3	1	04	01	H5216_337_3	4		Y	Generic	4	11	3	2	2	3	110		01		110	1	30		90				2	2				30		90	30		31	5.00		15.00																									20.00		60.00				5.00		0.00				5.00				5.00		0.17				0.67	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H5216	337	3	1	04	01	H5216_337_3	4		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	337	3	1	04	01	H5216_337_3	4		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	99.00		297.00																									100.00		300.00				99.00		287.00				99.00				99.00		3.30				3.33	3.30	3.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	337	3	1	04	01	H5216_337_3	4		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	338	0	1	04	01	H5216_338_0	3		Y	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	338	0	1	04	01	H5216_338_0	3		Y	Preferred Generic	4	11	3	2	1	3	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H5216	338	0	1	04	01	H5216_338_0	3		Y	Generic	4	11	3	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	5.00		15.00																									20.00		60.00				5.00		0.00				5.00				5.00		0.17				0.67	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	338	0	1	04	01	H5216_338_0	3		Y	Generic	4	11	3	2	2	3	110		01		110	1	30		90				2	2				30		90	30		31	5.00		15.00																									20.00		60.00				5.00		0.00				5.00				5.00		0.17				0.67	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H5216	338	0	1	04	01	H5216_338_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	45.00		135.00																									47.00		141.00				45.00		90.00				45.00				45.00		1.50				1.57	1.50	1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	338	0	1	04	01	H5216_338_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		200.00				100.00				100.00		3.33				3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	338	0	1	04	01	H5216_338_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	339	0	1	04	01	H5216_339_0	3		Y	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	339	0	1	04	01	H5216_339_0	3		Y	Preferred Generic	4	11	3	2	1	3	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H5216	339	0	1	04	01	H5216_339_0	3		Y	Generic	4	11	3	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	5.00		15.00																									20.00		60.00				5.00		0.00				5.00				5.00		0.17				0.67	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	339	0	1	04	01	H5216_339_0	3		Y	Generic	4	11	3	2	2	3	110		01		110	1	30		90				2	2				30		90	30		31	5.00		15.00																									20.00		60.00				5.00		0.00				5.00				5.00		0.17				0.67	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H5216	339	0	1	04	01	H5216_339_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	45.00		135.00																									47.00		141.00				45.00		90.00				45.00				45.00		1.50				1.57	1.50	1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	339	0	1	04	01	H5216_339_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		200.00				100.00				100.00		3.33				3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	339	0	1	04	01	H5216_339_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	340	0	1	04	01	H5216_340_0	3		Y	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	2.00		6.00																									10.00		30.00				2.00		0.00				2.00				2.00		0.07				0.33	0.07	0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	340	0	1	04	01	H5216_340_0	3		Y	Preferred Generic	4	11	3	2	1	3	110		01		110	1	30		90				1	2				30		90	30		31	2.00		6.00																									10.00		30.00				2.00		0.00				2.00				2.00		0.07				0.33	0.07	0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H5216	340	0	1	04	01	H5216_340_0	3		Y	Generic	4	11	3	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	9.00		27.00																									20.00		60.00				9.00		0.00				9.00				9.00		0.30				0.67	0.30	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	340	0	1	04	01	H5216_340_0	3		Y	Generic	4	11	3	2	2	3	110		01		110	1	30		90				2	2				30		90	30		31	9.00		27.00																									20.00		60.00				9.00		0.00				9.00				9.00		0.30				0.67	0.30	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H5216	340	0	1	04	01	H5216_340_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	340	0	1	04	01	H5216_340_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	99.00		297.00																									100.00		300.00				99.00		287.00				99.00				99.00		3.30				3.33	3.30	3.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	340	0	1	04	01	H5216_340_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					28																										28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	341	0	1	04	01	H5216_341_0	3		Y	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	341	0	1	04	01	H5216_341_0	3		Y	Preferred Generic	4	11	3	2	1	3	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H5216	341	0	1	04	01	H5216_341_0	3		Y	Generic	4	11	3	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	5.00		15.00																									20.00		60.00				5.00		0.00				5.00				5.00		0.17				0.67	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	341	0	1	04	01	H5216_341_0	3		Y	Generic	4	11	3	2	2	3	110		01		110	1	30		90				2	2				30		90	30		31	5.00		15.00																									20.00		60.00				5.00		0.00				5.00				5.00		0.17				0.67	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H5216	341	0	1	04	01	H5216_341_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	45.00		135.00																									47.00		141.00				45.00		90.00				45.00				45.00		1.50				1.57	1.50	1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	341	0	1	04	01	H5216_341_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		200.00				100.00				100.00		3.33				3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	341	0	1	04	01	H5216_341_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	342	0	1	04	01	H5216_342_0	3		Y	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	342	0	1	04	01	H5216_342_0	3		Y	Preferred Generic	4	11	3	2	1	3	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H5216	342	0	1	04	01	H5216_342_0	3		Y	Generic	4	11	3	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	5.00		15.00																									20.00		60.00				5.00		0.00				5.00				5.00		0.17				0.67	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	342	0	1	04	01	H5216_342_0	3		Y	Generic	4	11	3	2	2	3	110		01		110	1	30		90				2	2				30		90	30		31	5.00		15.00																									20.00		60.00				5.00		0.00				5.00				5.00		0.17				0.67	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H5216	342	0	1	04	01	H5216_342_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	342	0	1	04	01	H5216_342_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		290.00				100.00				100.00		3.33				3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	342	0	1	04	01	H5216_342_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	345	0	1	04	01	H5216_345_0	3		Y	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	345	0	1	04	01	H5216_345_0	3		Y	Preferred Generic	4	11	3	2	1	3	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H5216	345	0	1	04	01	H5216_345_0	3		Y	Generic	4	11	3	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	0.00		0.00																									20.00		60.00				0.00		0.00				0.00				0.00		0				0.67	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	345	0	1	04	01	H5216_345_0	3		Y	Generic	4	11	3	2	2	3	110		01		110	1	30		90				2	2				30		90	30		31	0.00		0.00																									20.00		60.00				0.00		0.00				0.00				0.00		0				0.67	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H5216	345	0	1	04	01	H5216_345_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	345	0	1	04	01	H5216_345_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		290.00				100.00				100.00		3.33				3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	345	0	1	04	01	H5216_345_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	346	0	1	04	01	H5216_346_0	3		Y	Preferred Generic	4	11	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	5.00		15.00																									10.00		30.00				5.00		0.00				5.00				5.00		0.17				0.33	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	346	0	1	04	01	H5216_346_0	3		Y	Generic	4	11	1	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	12.00		36.00																									20.00		60.00				12.00		0.00				12.00				12.00		0.40				0.67	0.40	0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	346	0	1	04	01	H5216_346_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	346	0	1	04	01	H5216_346_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		290.00				100.00				100.00		3.33				3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	346	0	1	04	01	H5216_346_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					29																										29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	347	0	1	04	01	H5216_347_0	3		Y	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	347	0	1	04	01	H5216_347_0	3		Y	Preferred Generic	4	11	3	2	1	3	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H5216	347	0	1	04	01	H5216_347_0	3		Y	Generic	4	11	3	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	0.00		0.00																									20.00		60.00				0.00		0.00				0.00				0.00		0				0.67	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	347	0	1	04	01	H5216_347_0	3		Y	Generic	4	11	3	2	2	3	110		01		110	1	30		90				2	2				30		90	30		31	0.00		0.00																									20.00		60.00				0.00		0.00				0.00				0.00		0				0.67	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H5216	347	0	1	04	01	H5216_347_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	347	0	1	04	01	H5216_347_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		290.00				100.00				100.00		3.33				3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	347	0	1	04	01	H5216_347_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	349	0	1	04	01	H5216_349_0	3		Y	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	349	0	1	04	01	H5216_349_0	3		Y	Preferred Generic	4	11	3	2	1	3	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H5216	349	0	1	04	01	H5216_349_0	3		Y	Generic	4	11	3	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	0.00		0.00																									20.00		60.00				0.00		0.00				0.00				0.00		0				0.67	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	349	0	1	04	01	H5216_349_0	3		Y	Generic	4	11	3	2	2	3	110		01		110	1	30		90				2	2				30		90	30		31	0.00		0.00																									20.00		60.00				0.00		0.00				0.00				0.00		0				0.67	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H5216	349	0	1	04	01	H5216_349_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	349	0	1	04	01	H5216_349_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		290.00				100.00				100.00		3.33				3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	349	0	1	04	01	H5216_349_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	350	0	1	04	01	H5216_350_0	3		Y	Preferred Generic	4	11	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	350	0	1	04	01	H5216_350_0	3		Y	Preferred Generic	4	11	1	2	1	3	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5216	350	0	1	04	01	H5216_350_0	3		Y	Generic	4	11	1	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	5.00		15.00																									20.00		60.00				5.00		0.00				5.00				5.00		0.17				0.67	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	350	0	1	04	01	H5216_350_0	3		Y	Generic	4	11	1	2	2	3	110		01		110	1	30		90				2	2				30		90	30		31	5.00		15.00																									20.00		60.00				5.00		0.00				5.00				5.00		0.17				0.67	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5216	350	0	1	04	01	H5216_350_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	350	0	1	04	01	H5216_350_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		290.00				100.00				100.00		3.33				3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	350	0	1	04	01	H5216_350_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					28																										28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	351	0	1	04	01	H5216_351_0	3		Y	Preferred Generic	4	11	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	351	0	1	04	01	H5216_351_0	3		Y	Preferred Generic	4	11	1	2	1	3	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5216	351	0	1	04	01	H5216_351_0	3		Y	Generic	4	11	1	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	2.00		6.00																									20.00		60.00				2.00		0.00				2.00				2.00		0.07				0.67	0.07	0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	351	0	1	04	01	H5216_351_0	3		Y	Generic	4	11	1	2	2	3	110		01		110	1	30		90				2	2				30		90	30		31	2.00		6.00																									20.00		60.00				2.00		0.00				2.00				2.00		0.07				0.67	0.07	0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5216	351	0	1	04	01	H5216_351_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	351	0	1	04	01	H5216_351_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		290.00				100.00				100.00		3.33				3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	351	0	1	04	01	H5216_351_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	352	0	1	04	01	H5216_352_0	3		Y	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	352	0	1	04	01	H5216_352_0	3		Y	Preferred Generic	4	11	3	2	1	3	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H5216	352	0	1	04	01	H5216_352_0	3		Y	Generic	4	11	3	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	0.00		0.00																									20.00		60.00				0.00		0.00				0.00				0.00		0				0.67	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	352	0	1	04	01	H5216_352_0	3		Y	Generic	4	11	3	2	2	3	110		01		110	1	30		90				2	2				30		90	30		31	0.00		0.00																									20.00		60.00				0.00		0.00				0.00				0.00		0				0.67	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H5216	352	0	1	04	01	H5216_352_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	45.00		135.00																									47.00		141.00				45.00		90.00				45.00				45.00		1.50				1.57	1.50	1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	352	0	1	04	01	H5216_352_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	99.00		297.00																									100.00		300.00				99.00		198.00				99.00				99.00		3.30				3.33	3.30	3.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	352	0	1	04	01	H5216_352_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	353	0	1	04	01	H5216_353_0	4		Y	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	353	0	1	04	01	H5216_353_0	4		Y	Preferred Generic	4	11	3	2	1	3	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H5216	353	0	1	04	01	H5216_353_0	4		Y	Generic	4	11	3	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	0.00		0.00																									20.00		60.00				0.00		0.00				0.00				0.00		0				0.67	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	353	0	1	04	01	H5216_353_0	4		Y	Generic	4	11	3	2	2	3	110		01		110	1	30		90				2	2				30		90	30		31	0.00		0.00																									20.00		60.00				0.00		0.00				0.00				0.00		0				0.67	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H5216	353	0	1	04	01	H5216_353_0	4		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	45.00		135.00																									47.00		141.00				45.00		90.00				45.00				45.00		1.50				1.57	1.50	1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	353	0	1	04	01	H5216_353_0	4		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		200.00				100.00				100.00		3.33				3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	353	0	1	04	01	H5216_353_0	4		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	356	0	1	04	01	H5216_356_0	3		Y	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	356	0	1	04	01	H5216_356_0	3		Y	Preferred Generic	4	11	3	2	1	3	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H5216	356	0	1	04	01	H5216_356_0	3		Y	Generic	4	11	3	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	5.00		15.00																									20.00		60.00				5.00		0.00				5.00				5.00		0.17				0.67	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	356	0	1	04	01	H5216_356_0	3		Y	Generic	4	11	3	2	2	3	110		01		110	1	30		90				2	2				30		90	30		31	5.00		15.00																									20.00		60.00				5.00		0.00				5.00				5.00		0.17				0.67	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H5216	356	0	1	04	01	H5216_356_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	356	0	1	04	01	H5216_356_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		290.00				100.00				100.00		3.33				3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	356	0	1	04	01	H5216_356_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					29																										29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	357	0	1	04	01	H5216_357_0	4		Y	Preferred Generic	4	11	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	5.00		15.00																									10.00		30.00				5.00		0.00				5.00				5.00		0.17				0.33	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	357	0	1	04	01	H5216_357_0	4		Y	Preferred Generic	4	11	1	2	1	3	110		01		110	1	30		90				1	2				30		90	30		31	5.00		15.00																									10.00		30.00				5.00		0.00				5.00				5.00		0.17				0.33	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5216	357	0	1	04	01	H5216_357_0	4		Y	Generic	4	11	1	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	15.00		45.00																									20.00		60.00				15.00		0.00				15.00				15.00		0.50				0.67	0.50	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	357	0	1	04	01	H5216_357_0	4		Y	Generic	4	11	1	2	2	3	110		01		110	1	30		90				2	2				30		90	30		31	15.00		45.00																									20.00		60.00				15.00		0.00				15.00				15.00		0.50				0.67	0.50	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5216	357	0	1	04	01	H5216_357_0	4		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	357	0	1	04	01	H5216_357_0	4		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		290.00				100.00				100.00		3.33				3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	357	0	1	04	01	H5216_357_0	4		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	358	0	1	04	01	H5216_358_0	3		Y	Preferred Generic	4	11	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	358	0	1	04	01	H5216_358_0	3		Y	Preferred Generic	4	11	1	2	1	3	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5216	358	0	1	04	01	H5216_358_0	3		Y	Generic	4	11	1	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	5.00		15.00																									20.00		60.00				5.00		0.00				5.00				5.00		0.17				0.67	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	358	0	1	04	01	H5216_358_0	3		Y	Generic	4	11	1	2	2	3	110		01		110	1	30		90				2	2				30		90	30		31	5.00		15.00																									20.00		60.00				5.00		0.00				5.00				5.00		0.17				0.67	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5216	358	0	1	04	01	H5216_358_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	358	0	1	04	01	H5216_358_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		290.00				100.00				100.00		3.33				3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	358	0	1	04	01	H5216_358_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					28																										28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	359	0	1	04	01	H5216_359_0	3		Y	Preferred Generic	4	11	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	4.00		12.00																									10.00		30.00				4.00		0.00				4.00				4.00		0.13				0.33	0.13	0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	359	0	1	04	01	H5216_359_0	3		Y	Generic	4	11	1	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	15.00		45.00																									20.00		60.00				15.00		0.00				15.00				15.00		0.50				0.67	0.50	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	359	0	1	04	01	H5216_359_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	359	0	1	04	01	H5216_359_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		290.00				100.00				100.00		3.33				3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	359	0	1	04	01	H5216_359_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					27																										27						27					27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	360	0	1	04	01	H5216_360_0	3		Y	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	360	0	1	04	01	H5216_360_0	3		Y	Preferred Generic	4	11	3	2	1	3	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H5216	360	0	1	04	01	H5216_360_0	3		Y	Generic	4	11	3	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	0.00		0.00																									20.00		60.00				0.00		0.00				0.00				0.00		0				0.67	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	360	0	1	04	01	H5216_360_0	3		Y	Generic	4	11	3	2	2	3	110		01		110	1	30		90				2	2				30		90	30		31	0.00		0.00																									20.00		60.00				0.00		0.00				0.00				0.00		0				0.67	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H5216	360	0	1	04	01	H5216_360_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	45.00		135.00																									47.00		141.00				45.00		90.00				45.00				45.00		1.50				1.57	1.50	1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	360	0	1	04	01	H5216_360_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	99.00		297.00																									100.00		300.00				99.00		198.00				99.00				99.00		3.30				3.33	3.30	3.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	360	0	1	04	01	H5216_360_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5232	001	0	1	04	01	H5232_001_0	8			Preferred Generic	4	11	1	2	1	1	110		01	110		1	30		90				1	2	30		90				30		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5232	001	0	1	04	01	H5232_001_0	8			Preferred Generic	4	11	1	2	1	3	110		01	110		1	30		90				1	2	30		90				30		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5232	001	0	1	04	01	H5232_001_0	8			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	8			Generic	4	11	1	2	2	3	110		01	110		1	30		90				2	2	30		90				30		31	10.00		30.00																			10.00		20.00																10.00				10.00		0.33			0.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5232	001	0	1	04	01	H5232_001_0	8			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	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		200.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5232	001	0	1	04	01	H5232_001_0	8			Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31				1040.01	33																																					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	004	0	1	02	01	H5253_004_0	2		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	004	0	1	02	01	H5253_004_0	2		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5253	004	0	1	02	01	H5253_004_0	2		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	004	0	1	02	01	H5253_004_0	2		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H5253	004	0	1	02	01	H5253_004_0	2		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	004	0	1	02	01	H5253_004_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	004	0	1	02	01	H5253_004_0	2		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				435.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	011	0	1	02	01	H5253_011_0	2		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	011	0	1	02	01	H5253_011_0	2		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5253	011	0	1	02	01	H5253_011_0	2		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	011	0	1	02	01	H5253_011_0	2		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H5253	011	0	1	02	01	H5253_011_0	2		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	011	0	1	02	01	H5253_011_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	011	0	1	02	01	H5253_011_0	2		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				415.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	030	0	1	02	01	H5253_030_0	2		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	030	0	1	02	01	H5253_030_0	2		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5253	030	0	1	02	01	H5253_030_0	2		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	030	0	1	02	01	H5253_030_0	2		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H5253	030	0	1	02	01	H5253_030_0	2		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	030	0	1	02	01	H5253_030_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	030	0	1	02	01	H5253_030_0	2		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				424.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	033	0	1	02	01	H5253_033_0	2		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	033	0	1	02	01	H5253_033_0	2		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5253	033	0	1	02	01	H5253_033_0	2		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	033	0	1	02	01	H5253_033_0	2		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H5253	033	0	1	02	01	H5253_033_0	2		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	033	0	1	02	01	H5253_033_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	033	0	1	02	01	H5253_033_0	2		Y	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												
H5253	034	0	1	02	01	H5253_034_0	2		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	034	0	1	02	01	H5253_034_0	2		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5253	034	0	1	02	01	H5253_034_0	2		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	14.00		42.00																											42.00						0.00				14.00				14.00		0.46						0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	034	0	1	02	01	H5253_034_0	2		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	14.00		42.00																											42.00						0.00				14.00				14.00		0.46						0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H5253	034	0	1	02	01	H5253_034_0	2		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	034	0	1	02	01	H5253_034_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	034	0	1	02	01	H5253_034_0	2		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				383.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	035	0	1	02	01	H5253_035_0	2		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	035	0	1	02	01	H5253_035_0	2		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5253	035	0	1	02	01	H5253_035_0	2		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	8.00		24.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	035	0	1	02	01	H5253_035_0	2		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	8.00		24.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H5253	035	0	1	02	01	H5253_035_0	2		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	035	0	1	02	01	H5253_035_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	035	0	1	02	01	H5253_035_0	2		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				469.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	036	0	1	02	01	H5253_036_0	2		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	036	0	1	02	01	H5253_036_0	2		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5253	036	0	1	02	01	H5253_036_0	2		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	8.00		24.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	036	0	1	02	01	H5253_036_0	2		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	8.00		24.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H5253	036	0	1	02	01	H5253_036_0	2		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	036	0	1	02	01	H5253_036_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	036	0	1	02	01	H5253_036_0	2		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				295.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	037	0	1	02	01	H5253_037_0	2		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	037	0	1	02	01	H5253_037_0	2		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5253	037	0	1	02	01	H5253_037_0	2		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	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												
H5253	037	0	1	02	01	H5253_037_0	2		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	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
H5253	037	0	1	02	01	H5253_037_0	2		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	037	0	1	02	01	H5253_037_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	037	0	1	02	01	H5253_037_0	2		Y	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	038	0	1	02	01	H5253_038_0	2		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	038	0	1	02	01	H5253_038_0	2		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5253	038	0	1	02	01	H5253_038_0	2		Y	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												
H5253	038	0	1	02	01	H5253_038_0	2		Y	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
H5253	038	0	1	02	01	H5253_038_0	2		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	038	0	1	02	01	H5253_038_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	038	0	1	02	01	H5253_038_0	2		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				477.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	039	0	1	02	01	H5253_039_0	2		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	039	0	1	02	01	H5253_039_0	2		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5253	039	0	1	02	01	H5253_039_0	2		Y	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												
H5253	039	0	1	02	01	H5253_039_0	2		Y	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
H5253	039	0	1	02	01	H5253_039_0	2		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	039	0	1	02	01	H5253_039_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	039	0	1	02	01	H5253_039_0	2		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				466.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	043	0	1	02	01	H5253_043_0	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	043	0	1	02	01	H5253_043_0	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	043	0	1	02	01	H5253_043_0	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H5253	043	0	1	02	01	H5253_043_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	043	0	1	02	01	H5253_043_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	043	0	1	02	01	H5253_043_0	3		Y	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												
H5253	047	0	1	02	01	H5253_047_0	2		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	047	0	1	02	01	H5253_047_0	2		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5253	047	0	1	02	01	H5253_047_0	2		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	8.00		16.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	047	0	1	02	01	H5253_047_0	2		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	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	02	01	H5253_047_0	2		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	047	0	1	02	01	H5253_047_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	047	0	1	02	01	H5253_047_0	2		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				409.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	048	0	1	02	01	H5253_048_0	2		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	048	0	1	02	01	H5253_048_0	2		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5253	048	0	1	02	01	H5253_048_0	2		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	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												
H5253	048	0	1	02	01	H5253_048_0	2		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	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
H5253	048	0	1	02	01	H5253_048_0	2		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	048	0	1	02	01	H5253_048_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	048	0	1	02	01	H5253_048_0	2		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				434.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	049	0	1	02	01	H5253_049_0	2		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	049	0	1	02	01	H5253_049_0	2		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5253	049	0	1	02	01	H5253_049_0	2		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	049	0	1	02	01	H5253_049_0	2		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H5253	049	0	1	02	01	H5253_049_0	2		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	049	0	1	02	01	H5253_049_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	049	0	1	02	01	H5253_049_0	2		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				440.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	050	0	1	02	01	H5253_050_0	2		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	050	0	1	02	01	H5253_050_0	2		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5253	050	0	1	02	01	H5253_050_0	2		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	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												
H5253	050	0	1	02	01	H5253_050_0	2		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	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
H5253	050	0	1	02	01	H5253_050_0	2		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	050	0	1	02	01	H5253_050_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	050	0	1	02	01	H5253_050_0	2		Y	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												
H5253	051	0	1	02	01	H5253_051_0	2		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	051	0	1	02	01	H5253_051_0	2		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5253	051	0	1	02	01	H5253_051_0	2		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	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	02	01	H5253_051_0	2		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	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	02	01	H5253_051_0	2		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	051	0	1	02	01	H5253_051_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	051	0	1	02	01	H5253_051_0	2		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				435.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	052	0	1	02	01	H5253_052_0	2		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	052	0	1	02	01	H5253_052_0	2		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5253	052	0	1	02	01	H5253_052_0	2		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	052	0	1	02	01	H5253_052_0	2		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H5253	052	0	1	02	01	H5253_052_0	2		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	052	0	1	02	01	H5253_052_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	052	0	1	02	01	H5253_052_0	2		Y	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												
H5253	061	0	1	02	01	H5253_061_0	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	061	0	1	02	01	H5253_061_0	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	061	0	1	02	01	H5253_061_0	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H5253	061	0	1	02	01	H5253_061_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	061	0	1	02	01	H5253_061_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	061	0	1	02	01	H5253_061_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				272.00	29																										29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	062	0	1	02	01	H5253_062_0	2		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	062	0	1	02	01	H5253_062_0	2		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5253	062	0	1	02	01	H5253_062_0	2		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	062	0	1	02	01	H5253_062_0	2		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H5253	062	0	1	02	01	H5253_062_0	2		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	062	0	1	02	01	H5253_062_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	062	0	1	02	01	H5253_062_0	2		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				364.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	064	0	1	02	01	H5253_064_0	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	064	0	1	02	01	H5253_064_0	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	064	0	1	02	01	H5253_064_0	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H5253	064	0	1	02	01	H5253_064_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	064	0	1	02	01	H5253_064_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		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	064	0	1	02	01	H5253_064_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				512.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	072	0	1	02	01	H5253_072_0	2		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	072	0	1	02	01	H5253_072_0	2		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5253	072	0	1	02	01	H5253_072_0	2		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	14.00		42.00																											42.00						0.00				14.00				14.00		0.46						0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	072	0	1	02	01	H5253_072_0	2		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	14.00		42.00																											42.00						0.00				14.00				14.00		0.46						0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H5253	072	0	1	02	01	H5253_072_0	2		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	072	0	1	02	01	H5253_072_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	072	0	1	02	01	H5253_072_0	2		Y	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	073	0	1	02	01	H5253_073_0	2		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	073	0	1	02	01	H5253_073_0	2		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5253	073	0	1	02	01	H5253_073_0	2		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	073	0	1	02	01	H5253_073_0	2		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H5253	073	0	1	02	01	H5253_073_0	2		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	073	0	1	02	01	H5253_073_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	073	0	1	02	01	H5253_073_0	2		Y	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												
H5253	079	0	1	02	01	H5253_079_0	2		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	079	0	1	02	01	H5253_079_0	2		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5253	079	0	1	02	01	H5253_079_0	2		Y	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												
H5253	079	0	1	02	01	H5253_079_0	2		Y	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
H5253	079	0	1	02	01	H5253_079_0	2		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	079	0	1	02	01	H5253_079_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	079	0	1	02	01	H5253_079_0	2		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				466.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	080	0	1	02	01	H5253_080_0	2		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	080	0	1	02	01	H5253_080_0	2		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5253	080	0	1	02	01	H5253_080_0	2		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	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	2		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	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	2		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	080	0	1	02	01	H5253_080_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	080	0	1	02	01	H5253_080_0	2		Y	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												
H5253	081	0	1	02	01	H5253_081_0	2		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	081	0	1	02	01	H5253_081_0	2		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5253	081	0	1	02	01	H5253_081_0	2		Y	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												
H5253	081	0	1	02	01	H5253_081_0	2		Y	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
H5253	081	0	1	02	01	H5253_081_0	2		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	081	0	1	02	01	H5253_081_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	081	0	1	02	01	H5253_081_0	2		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				513.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	082	0	1	02	01	H5253_082_0	2		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	082	0	1	02	01	H5253_082_0	2		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5253	082	0	1	02	01	H5253_082_0	2		Y	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												
H5253	082	0	1	02	01	H5253_082_0	2		Y	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
H5253	082	0	1	02	01	H5253_082_0	2		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	082	0	1	02	01	H5253_082_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	082	0	1	02	01	H5253_082_0	2		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				492.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	083	0	1	02	01	H5253_083_0	2		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	083	0	1	02	01	H5253_083_0	2		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5253	083	0	1	02	01	H5253_083_0	2		Y	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												
H5253	083	0	1	02	01	H5253_083_0	2		Y	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
H5253	083	0	1	02	01	H5253_083_0	2		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	083	0	1	02	01	H5253_083_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	083	0	1	02	01	H5253_083_0	2		Y	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	084	0	1	02	01	H5253_084_0	2		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	084	0	1	02	01	H5253_084_0	2		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5253	084	0	1	02	01	H5253_084_0	2		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	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	02	01	H5253_084_0	2		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	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	02	01	H5253_084_0	2		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	084	0	1	02	01	H5253_084_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	084	0	1	02	01	H5253_084_0	2		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				357.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	087	0	1	02	01	H5253_087_0	2		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	087	0	1	02	01	H5253_087_0	2		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5253	087	0	1	02	01	H5253_087_0	2		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	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	2		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	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	2		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	087	0	1	02	01	H5253_087_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	087	0	1	02	01	H5253_087_0	2		Y	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												
H5253	088	0	1	02	01	H5253_088_0	2		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	088	0	1	02	01	H5253_088_0	2		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5253	088	0	1	02	01	H5253_088_0	2		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	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	2		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	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	2		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	088	0	1	02	01	H5253_088_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	088	0	1	02	01	H5253_088_0	2		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				374.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	089	0	1	02	01	H5253_089_0	2		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	089	0	1	02	01	H5253_089_0	2		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5253	089	0	1	02	01	H5253_089_0	2		Y	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												
H5253	089	0	1	02	01	H5253_089_0	2		Y	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
H5253	089	0	1	02	01	H5253_089_0	2		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	089	0	1	02	01	H5253_089_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	089	0	1	02	01	H5253_089_0	2		Y	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												
H5253	097	0	1	02	01	H5253_097_0	2		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	097	0	1	02	01	H5253_097_0	2		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5253	097	0	1	02	01	H5253_097_0	2		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	14.00		42.00																											42.00						0.00				14.00				14.00		0.46						0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	097	0	1	02	01	H5253_097_0	2		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	14.00		42.00																											42.00						0.00				14.00				14.00		0.46						0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H5253	097	0	1	02	01	H5253_097_0	2		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	097	0	1	02	01	H5253_097_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	097	0	1	02	01	H5253_097_0	2		Y	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												
H5253	099	0	1	02	01	H5253_099_0	2		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	099	0	1	02	01	H5253_099_0	2		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5253	099	0	1	02	01	H5253_099_0	2		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	099	0	1	02	01	H5253_099_0	2		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H5253	099	0	1	02	01	H5253_099_0	2		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	099	0	1	02	01	H5253_099_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	099	0	1	02	01	H5253_099_0	2		Y	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												
H5253	100	0	1	02	01	H5253_100_0	2		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	100	0	1	02	01	H5253_100_0	2		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5253	100	0	1	02	01	H5253_100_0	2		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	8.00		16.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	100	0	1	02	01	H5253_100_0	2		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	8.00		16.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H5253	100	0	1	02	01	H5253_100_0	2		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	100	0	1	02	01	H5253_100_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	100	0	1	02	01	H5253_100_0	2		Y	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												
H5253	102	0	1	02	01	H5253_102_0	2		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	102	0	1	02	01	H5253_102_0	2		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5253	102	0	1	02	01	H5253_102_0	2		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	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	2		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	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	2		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	102	0	1	02	01	H5253_102_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	102	0	1	02	01	H5253_102_0	2		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				461.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	103	0	1	02	01	H5253_103_0	2		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	103	0	1	02	01	H5253_103_0	2		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5253	103	0	1	02	01	H5253_103_0	2		Y	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												
H5253	103	0	1	02	01	H5253_103_0	2		Y	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
H5253	103	0	1	02	01	H5253_103_0	2		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	103	0	1	02	01	H5253_103_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	103	0	1	02	01	H5253_103_0	2		Y	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												
H5253	104	0	1	02	01	H5253_104_0	2		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	104	0	1	02	01	H5253_104_0	2		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5253	104	0	1	02	01	H5253_104_0	2		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	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	2		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	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	2		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	104	0	1	02	01	H5253_104_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	104	0	1	02	01	H5253_104_0	2		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				384.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	105	0	1	02	01	H5253_105_0	2		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	105	0	1	02	01	H5253_105_0	2		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5253	105	0	1	02	01	H5253_105_0	2		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	105	0	1	02	01	H5253_105_0	2		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H5253	105	0	1	02	01	H5253_105_0	2		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	105	0	1	02	01	H5253_105_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	105	0	1	02	01	H5253_105_0	2		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				301.00	26																										26						26					26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	107	1	1	02	01	H5253_107_1	4		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	107	1	1	02	01	H5253_107_1	4		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5253	107	1	1	02	01	H5253_107_1	4		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	107	1	1	02	01	H5253_107_1	4		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H5253	107	1	1	02	01	H5253_107_1	4		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	107	1	1	02	01	H5253_107_1	4		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	107	1	1	02	01	H5253_107_1	4		Y	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												
H5253	107	2	1	02	01	H5253_107_2	4		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	107	2	1	02	01	H5253_107_2	4		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5253	107	2	1	02	01	H5253_107_2	4		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	107	2	1	02	01	H5253_107_2	4		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H5253	107	2	1	02	01	H5253_107_2	4		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	107	2	1	02	01	H5253_107_2	4		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	107	2	1	02	01	H5253_107_2	4		Y	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												
H5253	108	1	1	02	01	H5253_108_1	5		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	108	1	1	02	01	H5253_108_1	5		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5253	108	1	1	02	01	H5253_108_1	5		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	108	1	1	02	01	H5253_108_1	5		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H5253	108	1	1	02	01	H5253_108_1	5		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	108	1	1	02	01	H5253_108_1	5		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	108	1	1	02	01	H5253_108_1	5		Y	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												
H5253	108	2	1	02	01	H5253_108_2	4		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	108	2	1	02	01	H5253_108_2	4		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5253	108	2	1	02	01	H5253_108_2	4		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	108	2	1	02	01	H5253_108_2	4		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H5253	108	2	1	02	01	H5253_108_2	4		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	108	2	1	02	01	H5253_108_2	4		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	108	2	1	02	01	H5253_108_2	4		Y	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												
H5253	108	3	1	02	01	H5253_108_3	4		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	108	3	1	02	01	H5253_108_3	4		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5253	108	3	1	02	01	H5253_108_3	4		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	108	3	1	02	01	H5253_108_3	4		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H5253	108	3	1	02	01	H5253_108_3	4		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	108	3	1	02	01	H5253_108_3	4		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	108	3	1	02	01	H5253_108_3	4		Y	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												
H5253	109	1	1	02	01	H5253_109_1	2		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	109	1	1	02	01	H5253_109_1	2		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5253	109	1	1	02	01	H5253_109_1	2		Y	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												
H5253	109	1	1	02	01	H5253_109_1	2		Y	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										1		3
H5253	109	1	1	02	01	H5253_109_1	2		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	109	1	1	02	01	H5253_109_1	2		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	109	1	1	02	01	H5253_109_1	2		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				383.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	109	2	1	02	01	H5253_109_2	2		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	109	2	1	02	01	H5253_109_2	2		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5253	109	2	1	02	01	H5253_109_2	2		Y	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												
H5253	109	2	1	02	01	H5253_109_2	2		Y	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										1		3
H5253	109	2	1	02	01	H5253_109_2	2		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	109	2	1	02	01	H5253_109_2	2		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	109	2	1	02	01	H5253_109_2	2		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				383.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	110	0	1	02	01	H5253_110_0	2		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	110	0	1	02	01	H5253_110_0	2		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5253	110	0	1	02	01	H5253_110_0	2		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	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												
H5253	110	0	1	02	01	H5253_110_0	2		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	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
H5253	110	0	1	02	01	H5253_110_0	2		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	110	0	1	02	01	H5253_110_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	110	0	1	02	01	H5253_110_0	2		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				257.00	26																										26						26					26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	111	1	1	02	01	H5253_111_1	2		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	111	1	1	02	01	H5253_111_1	2		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5253	111	1	1	02	01	H5253_111_1	2		Y	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												
H5253	111	1	1	02	01	H5253_111_1	2		Y	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
H5253	111	1	1	02	01	H5253_111_1	2		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	111	1	1	02	01	H5253_111_1	2		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	111	1	1	02	01	H5253_111_1	2		Y	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												
H5253	111	2	1	02	01	H5253_111_2	2		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	111	2	1	02	01	H5253_111_2	2		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5253	111	2	1	02	01	H5253_111_2	2		Y	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												
H5253	111	2	1	02	01	H5253_111_2	2		Y	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
H5253	111	2	1	02	01	H5253_111_2	2		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	111	2	1	02	01	H5253_111_2	2		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	111	2	1	02	01	H5253_111_2	2		Y	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												
H5253	112	1	1	02	01	H5253_112_1	2		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	112	1	1	02	01	H5253_112_1	2		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5253	112	1	1	02	01	H5253_112_1	2		Y	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												
H5253	112	1	1	02	01	H5253_112_1	2		Y	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
H5253	112	1	1	02	01	H5253_112_1	2		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	112	1	1	02	01	H5253_112_1	2		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	112	1	1	02	01	H5253_112_1	2		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				403.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	112	2	1	02	01	H5253_112_2	2		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	112	2	1	02	01	H5253_112_2	2		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5253	112	2	1	02	01	H5253_112_2	2		Y	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												
H5253	112	2	1	02	01	H5253_112_2	2		Y	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
H5253	112	2	1	02	01	H5253_112_2	2		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	112	2	1	02	01	H5253_112_2	2		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	112	2	1	02	01	H5253_112_2	2		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				403.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	115	0	1	02	01	H5253_115_0	2		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	115	0	1	02	01	H5253_115_0	2		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5253	115	0	1	02	01	H5253_115_0	2		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	115	0	1	02	01	H5253_115_0	2		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H5253	115	0	1	02	01	H5253_115_0	2		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	115	0	1	02	01	H5253_115_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	115	0	1	02	01	H5253_115_0	2		Y	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												
H5253	117	0	1	02	01	H5253_117_0	2		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	117	0	1	02	01	H5253_117_0	2		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5253	117	0	1	02	01	H5253_117_0	2		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	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												
H5253	117	0	1	02	01	H5253_117_0	2		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	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
H5253	117	0	1	02	01	H5253_117_0	2		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	117	0	1	02	01	H5253_117_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	117	0	1	02	01	H5253_117_0	2		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				477.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	118	0	1	02	01	H5253_118_0	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	118	0	1	02	01	H5253_118_0	3		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5253	118	0	1	02	01	H5253_118_0	3		Y	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												
H5253	118	0	1	02	01	H5253_118_0	3		Y	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
H5253	118	0	1	02	01	H5253_118_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	118	0	1	02	01	H5253_118_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	118	0	1	02	01	H5253_118_0	3		Y	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												
H5253	119	0	1	02	01	H5253_119_0	2		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	119	0	1	02	01	H5253_119_0	2		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5253	119	0	1	02	01	H5253_119_0	2		Y	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												
H5253	119	0	1	02	01	H5253_119_0	2		Y	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
H5253	119	0	1	02	01	H5253_119_0	2		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	119	0	1	02	01	H5253_119_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	119	0	1	02	01	H5253_119_0	2		Y	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												
H5253	120	0	1	02	01	H5253_120_0	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	120	0	1	02	01	H5253_120_0	3		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5253	120	0	1	02	01	H5253_120_0	3		Y	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												
H5253	120	0	1	02	01	H5253_120_0	3		Y	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
H5253	120	0	1	02	01	H5253_120_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	120	0	1	02	01	H5253_120_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	120	0	1	02	01	H5253_120_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				534.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	121	0	1	02	01	H5253_121_0	2		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	121	0	1	02	01	H5253_121_0	2		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5253	121	0	1	02	01	H5253_121_0	2		Y	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												
H5253	121	0	1	02	01	H5253_121_0	2		Y	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
H5253	121	0	1	02	01	H5253_121_0	2		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	121	0	1	02	01	H5253_121_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	121	0	1	02	01	H5253_121_0	2		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				244.00	26																										26						26					26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5262	001	0	1	01	01	H5262_001_0	3		Y	Preferred Generic	4	01	1	2	1	1	111		01	100		1	30	60	90				1	2			90				30		31	2.00	4.00	6.00																					5.00																2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H5262	001	0	1	01	01	H5262_001_0	3		Y	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	3		Y	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	3		Y	Non-Preferred Drug	4	11	1	2	4	1	111		01	100		1	30	60	90				1	2			90				30		31	100.00	200.00	300.00																					300.00																100.00				100.00		3.33						3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H5262	001	0	1	01	01	H5262_001_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31					33																																					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H5262	001	0	1	01	01	H5262_001_0	3		Y	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	3		Y	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	3		Y	Preferred Generic	4	01	1	2	1	1	111		01	100		1	30	60	90				1	2			90				30		31	2.00	4.00	6.00																					5.00																2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H5262	003	0	1	01	01	H5262_003_0	3		Y	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	3		Y	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	3		Y	Non-Preferred Drug	4	11	1	2	4	1	111		01	100		1	30	60	90				1	2			90				30		31	100.00	200.00	300.00																					300.00																100.00				100.00		3.33						3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H5262	003	0	1	01	01	H5262_003_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31					33																																					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H5262	003	0	1	01	01	H5262_003_0	3		Y	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	3		Y	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		Y	Preferred Generic	4	01	1	2	1	1	111		01	100		1	30	60	90				1	2			90				30		31	3.00	6.00	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		Y	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		Y	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		Y	Non-Preferred Drug	4	11	1	2	4	1	111		01	100		1	30	60	90				1	2			90				30		31	100.00	200.00	300.00																					300.00																100.00				100.00		3.33						3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H5262	007	0	1	01	01	H5262_007_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31					33																																					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H5262	007	0	1	01	01	H5262_007_0	3		Y	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		Y	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		Y	Preferred Generic	4	01	1	2	1	1	111		01	100		1	30	60	90				1	2			90				30		31	3.00	6.00	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		Y	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		Y	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		Y	Non-Preferred Drug	4	11	1	2	4	1	111		01	100		1	30	60	90				1	2			90				30		31	100.00	200.00	300.00																					300.00																100.00				100.00		3.33						3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H5262	008	0	1	01	01	H5262_008_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31					33																																					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H5262	008	0	1	01	01	H5262_008_0	3		Y	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		Y	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	2		Y	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	2		Y	Generic	4	01	1	2	2	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		0.16						0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H5262	011	0	1	01	01	H5262_011_0	2		Y	Preferred Brand	4	10	1	2	3	1	111		01	100		1	30	60	90				1	2			90				30		31	47.00	94.00	141.00																					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	2		Y	Non-Preferred Drug	4	11	1	2	4	1	111		01	100		1	30	60	90				1	2			90				30		31	100.00	200.00	300.00																					300.00																100.00				100.00		3.33						3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H5262	011	0	1	01	01	H5262_011_0	2		Y	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31					33																																					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H5262	011	0	1	01	01	H5262_011_0	2		Y	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	2		Y	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		Y	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		Y	Generic	4	01	1	2	2	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		0.16						0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H5262	012	0	1	01	01	H5262_012_0	3		Y	Preferred Brand	4	10	1	2	3	1	111		01	100		1	30	60	90				1	2			90				30		31	47.00	94.00	141.00																					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		Y	Non-Preferred Drug	4	11	1	2	4	1	111		01	100		1	30	60	90				1	2			90				30		31	100.00	200.00	300.00																					300.00																100.00				100.00		3.33						3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H5262	012	0	1	01	01	H5262_012_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31					33																																					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H5262	012	0	1	01	01	H5262_012_0	3		Y	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		Y	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	2		Y	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	2		Y	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	2		Y	Preferred Brand	4	10	1	2	3	1	111		01	100		1	30	60	90				1	2			90				30		31	47.00	94.00	141.00																					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	2		Y	Non-Preferred Drug	4	11	1	2	4	1	111		01	100		1	30	60	90				1	2			90				30		31	100.00	200.00	300.00																					300.00																100.00				100.00		3.33						3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H5262	018	0	1	01	01	H5262_018_0	2		Y	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31					33																																					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H5262	018	0	1	01	01	H5262_018_0	2		Y	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	2		Y	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		Y	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		Y	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		Y	Preferred Brand	4	10	1	2	3	1	111		01	100		1	30	60	90				1	2			90				30		31	47.00	94.00	141.00																					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		Y	Non-Preferred Drug	4	11	1	2	4	1	111		01	100		1	30	60	90				1	2			90				30		31	100.00	200.00	300.00																					300.00																100.00				100.00		3.33						3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H5262	019	0	1	01	01	H5262_019_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31					33																																					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H5262	019	0	1	01	01	H5262_019_0	3		Y	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		Y	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	3		Y	Preferred Generic	4	01	1	2	1	1	111		01	100		1	30	60	90				1	2			90				30		31	2.00	4.00	6.00																					5.00																2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H5262	021	0	1	01	01	H5262_021_0	3		Y	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	3		Y	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	3		Y	Non-Preferred Drug	4	11	1	2	4	1	111		01	100		1	30	60	90				1	2			90				30		31	100.00	200.00	300.00																					300.00																100.00				100.00		3.33						3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H5262	021	0	1	01	01	H5262_021_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31					33																																					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H5262	021	0	1	01	01	H5262_021_0	3		Y	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	3		Y	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		Y	Preferred Generic	4	01	1	2	1	1	111		01	100		1	30	60	90				1	2			90				30		31	3.00	6.00	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		Y	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		Y	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		Y	Non-Preferred Drug	4	11	1	2	4	1	111		01	100		1	30	60	90				1	2			90				30		31	100.00	200.00	300.00																					300.00																100.00				100.00		3.33						3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H5262	023	0	1	01	01	H5262_023_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31					33																																					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H5262	023	0	1	01	01	H5262_023_0	3		Y	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		Y	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		Y	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		Y	Generic	4	01	1	2	2	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		0.16						0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H5262	024	0	1	01	01	H5262_024_0	3		Y	Preferred Brand	4	10	1	2	3	1	111		01	100		1	30	60	90				1	2			90				30		31	47.00	94.00	141.00																					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		Y	Non-Preferred Drug	4	11	1	2	4	1	111		01	100		1	30	60	90				1	2			90				30		31	100.00	200.00	300.00																					300.00																100.00				100.00		3.33						3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H5262	024	0	1	01	01	H5262_024_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31					33																																					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H5262	024	0	1	01	01	H5262_024_0	3		Y	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		Y	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		Y	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		Y	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		Y	Preferred Brand	4	10	1	2	3	1	111		01	100		1	30	60	90				1	2			90				30		31	47.00	94.00	141.00																					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		Y	Non-Preferred Drug	4	11	1	2	4	1	111		01	100		1	30	60	90				1	2			90				30		31	100.00	200.00	300.00																					300.00																100.00				100.00		3.33						3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H5262	026	0	1	01	01	H5262_026_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31					33																																					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H5262	026	0	1	01	01	H5262_026_0	3		Y	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		Y	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	029	0	1	01	01	H5262_029_0	4		N	Preferred Generic	2	01	1	1	1	1	111		01	100		1	30	60	90				1	2			90				30		31				1.86	25	25	25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H5262	029	0	1	01	01	H5262_029_0	4		N	Generic	2	01	1	1	2	1	111		01	100		1	30	60	90				1	1			90				30		31				6.83	25	25	25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H5262	029	0	1	01	01	H5262_029_0	4		N	Preferred Brand	2	10	1	1	3	1	111		01	100		1	30	60	90				1	1			90				30		31				118.35	25	25	25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H5262	029	0	1	01	01	H5262_029_0	4		N	Non-Preferred Drug	2	11	1	1	4	1	111		01	100		1	30	60	90				1	1			90				30		31				9.64	25	25	25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H5262	029	0	1	01	01	H5262_029_0	4		N	Specialty Tier	2	11	1	1	5	1	010		01			1	30														30		31					25																																					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H5262	029	0	1	01	01	H5262_029_0	4		N	Vaccines	2	11	1	1	6	1	010		01			1	30														30		31				0.00	0																																					0			0								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H5262	030	0	1	01	01	H5262_030_0	4		N	Preferred Generic	2	01	1	1	1	1	111		01	100		1	30	60	90				1	2			90				30		31				1.86	25	25	25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H5262	030	0	1	01	01	H5262_030_0	4		N	Generic	2	01	1	1	2	1	111		01	100		1	30	60	90				1	1			90				30		31				6.83	25	25	25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H5262	030	0	1	01	01	H5262_030_0	4		N	Preferred Brand	2	10	1	1	3	1	111		01	100		1	30	60	90				1	1			90				30		31				118.34	25	25	25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H5262	030	0	1	01	01	H5262_030_0	4		N	Non-Preferred Drug	2	11	1	1	4	1	111		01	100		1	30	60	90				1	1			90				30		31				91.64	25	25	25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H5262	030	0	1	01	01	H5262_030_0	4		N	Specialty Tier	2	11	1	1	5	1	010		01			1	30														30		31					25																																					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H5262	030	0	1	01	01	H5262_030_0	4		N	Vaccines	2	11	1	1	6	1	010		01			1	30														30		31				0.00	0																																					0			0								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H5262	031	0	1	01	01	H5262_031_0	4		N	Preferred Generic	2	01	1	1	1	1	111		01	100		1	30	60	90				1	2			90				30		31				1.86	25	25	25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H5262	031	0	1	01	01	H5262_031_0	4		N	Generic	2	01	1	1	2	1	111		01	100		1	30	60	90				1	1			90				30		31				6.83	25	25	25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H5262	031	0	1	01	01	H5262_031_0	4		N	Preferred Brand	2	10	1	1	3	1	111		01	100		1	30	60	90				1	1			90				30		31				118.34	25	25	25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H5262	031	0	1	01	01	H5262_031_0	4		N	Non-Preferred Drug	2	11	1	1	4	1	111		01	100		1	30	60	90				1	1			90				30		31				91.64	25	25	25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H5262	031	0	1	01	01	H5262_031_0	4		N	Specialty Tier	2	11	1	1	5	1	010		01			1	30														30		31					25																																					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H5262	031	0	1	01	01	H5262_031_0	4		N	Vaccines	2	11	1	1	6	1	010		01			1	30														30		31				0.00	0																																					0			0								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H5273	001	0	1	01	01	H5273_001_0	6		Y	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								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		Y	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								15.00	30.00	45.00					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		Y	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					47.00	94.00	141.00					47.00	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		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	300.00					100.00	200.00	300.00					100.00	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		Y	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H5273	001	0	1	01	01	H5273_001_0	6		Y	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	001	0	1	01	01	H5273_001_0	6		Y	Vaccines	4	11	1	2	6	3		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										1		
H5273	002	0	1	01	01	H5273_002_0	6		Y	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								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	6		Y	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								15.00	30.00	45.00					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	6		Y	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					47.00	94.00	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	6		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	300.00					100.00	200.00	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	6		Y	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H5273	002	0	1	01	01	H5273_002_0	6		Y	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	6		Y	Vaccines	4	11	1	2	6	3		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										1		
H5280	001	0	1	48	05	H5280_001_0	1			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	1			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	1			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	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												29							29												29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5294	012	0	1	01	01	H5294_012_0	4			Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			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	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, 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	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												
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	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, 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											97.71	39	39	39				97.71	39	39	39										39	39	39				39	39	39			39			39								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			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	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	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, 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	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												
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	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, 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											99.23	47	47	47				99.23	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	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			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	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												
H5294	020	0	1	01	01	H5294_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								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00				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	020	0	1	01	01	H5294_020_0	5			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	020	0	1	01	01	H5294_020_0	5			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	020	0	1	01	01	H5294_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								47.00	94.00	141.00					37.00	74.00	111.00											47.00	94.00	141.00				37.00	74.00	74.00				47.00				47.00			1.57	1.23		1.57	1.23	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5294	020	0	1	01	01	H5294_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								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	020	0	1	01	01	H5294_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, Select Care Drugs												
H5294	020	0	1	01	01	H5294_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	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5294	020	0	1	01	01	H5294_020_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	
H5296	003	0	1	02	01	H5296_003_0	6		N	Preferred Generic	4	11	1	2	1	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5296	003	0	1	02	01	H5296_003_0	6		N	Preferred Generic	4	11	1	2	1	3	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H5296	003	0	1	02	01	H5296_003_0	6		N	Generic	4	01	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5296	003	0	1	02	01	H5296_003_0	6		N	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	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	6		N	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	300.00																			100.00	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												
H5296	003	0	1	02	01	H5296_003_0	6		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				613.32	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	6		N	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	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	6		N	Select Care Drugs	4	01	1	2	6	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, Select Care Drugs										1		
H5296	004	0	1	01	01	H5296_004_0	5		N	Preferred Generic	4	11	1	2	1	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5296	004	0	1	01	01	H5296_004_0	5		N	Generic	4	01	1	2	2	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	20.00	40.00	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		N	Preferred Brand	4	11	3	1	3	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31				82.21	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		N	Non-Preferred Drug	4	11	3	1	4	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31				58.35	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		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				548.43	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		N	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	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	005	0	1	01	01	H5296_005_0	5		N	Preferred Generic	4	11	1	2	1	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5296	005	0	1	01	01	H5296_005_0	5		N	Preferred Generic	4	11	1	2	1	3	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H5296	005	0	1	01	01	H5296_005_0	5		N	Generic	4	01	1	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, Select Care Drugs												
H5296	005	0	1	01	01	H5296_005_0	5		N	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	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												
H5296	005	0	1	01	01	H5296_005_0	5		N	Non-Preferred Drug	4	11	3	2	4	1	111		01	111		1	30	60	100				1	2	30	60	100				30		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												
H5296	005	0	1	01	01	H5296_005_0	5		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				847.59	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5296	005	0	1	01	01	H5296_005_0	5		N	Select Care Drugs	4	01	1	2	6	1	111		01	111		1	30	60	100				1	2	30	60	100				30		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	005	0	1	01	01	H5296_005_0	5		N	Select Care Drugs	4	01	1	2	6	3	111		01	111		1	30	60	100				1	2	30	60	100				30		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		
H5299	001	0	1	01	01	H5299_001_0	10		Y	Preferred Generic	4	11	1	2	1	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5299	001	0	1	01	01	H5299_001_0	10		Y	Preferred Generic	4	11	1	2	1	3	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H5299	001	0	1	01	01	H5299_001_0	10		Y	Generic	4	11	3	2	2	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5299	001	0	1	01	01	H5299_001_0	10		Y	Generic	4	11	3	2	2	3	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	3
H5299	001	0	1	01	01	H5299_001_0	10		Y	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	45.00	90.00	135.00																			45.00	90.00	112.50																45.00				45.00		1.50			1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5299	001	0	1	01	01	H5299_001_0	10		Y	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	95.00	190.00	285.00																			95.00	190.00	285.00																95.00				95.00		3.17			3.17			3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5299	001	0	1	01	01	H5299_001_0	10		Y	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												
H5299	002	0	1	01	01	H5299_002_0	11		N	Preferred Generic	4	11	1	2	1	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5299	002	0	1	01	01	H5299_002_0	11		N	Preferred Generic	4	11	1	2	1	3	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H5299	002	0	1	01	01	H5299_002_0	11		N	Generic	4	11	3	2	2	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5299	002	0	1	01	01	H5299_002_0	11		N	Generic	4	11	3	2	2	3	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	2	2
H5299	002	0	1	01	01	H5299_002_0	11		N	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	47.00	94.00	141.00																			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												
H5299	002	0	1	01	01	H5299_002_0	11		N	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	100.00	200.00	300.00																			100.00	200.00	300.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5299	002	0	1	01	01	H5299_002_0	11		N	Specialty Tier	4	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												
H5299	003	0	1	01	01	H5299_003_0	10		Y	Preferred Generic	4	11	1	2	1	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5299	003	0	1	01	01	H5299_003_0	10		Y	Preferred Generic	4	11	1	2	1	3	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H5299	003	0	1	01	01	H5299_003_0	10		Y	Generic	4	11	3	2	2	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5299	003	0	1	01	01	H5299_003_0	10		Y	Generic	4	11	3	2	2	3	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	3
H5299	003	0	1	01	01	H5299_003_0	10		Y	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	45.00	90.00	135.00																			45.00	90.00	112.50																45.00				45.00		1.50			1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5299	003	0	1	01	01	H5299_003_0	10		Y	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	95.00	190.00	285.00																			95.00	190.00	285.00																95.00				95.00		3.17			3.17			3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5299	003	0	1	01	01	H5299_003_0	10		Y	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												
H5302	018	0	1	01	01	H5302_018_0	2		Y	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	2		Y	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	2		Y	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	2		Y	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	2		Y	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					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	2		Y	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					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	2		Y	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											983.15	33						565.70	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5302	019	0	1	01	01	H5302_019_0	2		Y	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	2		Y	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	2		Y	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	2		Y	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	2		Y	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					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	2		Y	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					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	2		Y	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											983.15	33						565.70	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5372	001	0	1	02	01	H5372_001_0	6		Y	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												
H5372	001	0	1	02	01	H5372_001_0	6		Y	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												
H5372	001	0	1	02	01	H5372_001_0	6		Y	Preferred Brand	4	10	1	2	3	1		111	01	100		1				30	60	90	1	2			90				30		31								47.00	94.00	141.00					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												
H5372	001	0	1	02	01	H5372_001_0	6		Y	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												
H5372	001	0	1	02	01	H5372_001_0	6		Y	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5373	001	0	1	01	01	H5373_001_0	7		Y	Preferred Generic	4	11	1	2	1	1	110		01	110		1	30		90				1	2	30		90				30		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5373	001	0	1	01	01	H5373_001_0	7		Y	Preferred Generic	4	11	1	2	1	3	110		01	110		1	30		90				1	2	30		90				30		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5373	001	0	1	01	01	H5373_001_0	7		Y	Generic	4	11	1	2	2	1	110		01	110		1	30		90				2	2	30		90				30		31	10.00		30.00																			10.00		20.00																10.00				10.00		0.33			0.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5373	001	0	1	01	01	H5373_001_0	7		Y	Generic	4	11	1	2	2	3	110		01	110		1	30		90				2	2	30		90				30		31	10.00		30.00																			10.00		20.00																10.00				10.00		0.33			0.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5373	001	0	1	01	01	H5373_001_0	7		Y	Preferred Brand	4	11	1	2	3	1	110		01	110		1	30		90				2	2	30		90				30		31	45.00		135.00																			45.00		90.00																45.00				45.00		1.50			1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5373	001	0	1	01	01	H5373_001_0	7		Y	Non-Preferred Drug	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												
H5373	001	0	1	01	01	H5373_001_0	7		Y	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31				1042.27	33																																					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5373	002	0	1	02	01	H5373_002_0	5		N	Preferred Generic	4	11	1	2	1	1	110		01	110		1	30		90				1	2	30		90				30		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5373	002	0	1	02	01	H5373_002_0	5		N	Preferred Generic	4	11	1	2	1	3	110		01	110		1	30		90				1	2	30		90				30		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5373	002	0	1	02	01	H5373_002_0	5		N	Generic	4	11	1	2	2	1	110		01	110		1	30		90				2	2	30		90				30		31	10.00		30.00																			10.00		20.00																10.00				10.00		0.33			0.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5373	002	0	1	02	01	H5373_002_0	5		N	Preferred Brand	4	11	1	2	3	1	110		01	110		1	30		90				2	2	30		90				30		31	45.00		135.00																			45.00		90.00																45.00				45.00		1.50			1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5373	002	0	1	02	01	H5373_002_0	5		N	Non-Preferred Drug	4	11	1	2	4	1	110		01	110		1	30		90				2	2	30		90				30		31	100.00		300.00																			100.00		200.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5373	002	0	1	02	01	H5373_002_0	5		N	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31				1035.85	33																																					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5377	001	0	1	01	01	H5377_001_0	4		Y	Preferred Generic	4	11	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	4.00		12.00																									10.00		30.00				4.00		0.00				4.00				4.00		0.13				0.33	0.13	0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5377	001	0	1	01	01	H5377_001_0	4		Y	Generic	4	11	1	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	12.00		36.00																									20.00		60.00				12.00		0.00				12.00				12.00		0.40				0.67	0.40	0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5377	001	0	1	01	01	H5377_001_0	4		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5377	001	0	1	01	01	H5377_001_0	4		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	99.00		297.00																									100.00		300.00				99.00		287.00				99.00				99.00		3.30				3.33	3.30	3.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5377	001	0	1	01	01	H5377_001_0	4		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					30																										30						30					30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5377	002	0	1	02	01	H5377_002_0	4		Y	Preferred Generic	4	11	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5377	002	0	1	02	01	H5377_002_0	4		Y	Generic	4	11	1	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	0.00		0.00																									20.00		60.00				0.00		0.00				0.00				0.00		0				0.67	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5377	002	0	1	02	01	H5377_002_0	4		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	45.00		135.00																									47.00		141.00				45.00		125.00				45.00				45.00		1.50				1.57	1.50	1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5377	002	0	1	02	01	H5377_002_0	4		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	95.00		285.00																									100.00		300.00				95.00		275.00				95.00				95.00		3.17				3.33	3.17	3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5377	002	0	1	02	01	H5377_002_0	4		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5386	003	0	1	01	01	H5386_003_0	3		Y	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	3		Y	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	3		Y	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	3		Y	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	3		Y	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	3		Y	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	3		Y	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	3		Y	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	3		Y	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	3		Y	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	3		Y	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	3		Y	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	3		Y	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	3		Y	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	3		Y	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	3		Y	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	3		Y	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	3		Y	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	002	0	1	01	01	H5398_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								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00				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	5			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	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					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	5			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	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												
H5398	002	0	1	01	01	H5398_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												
H5398	002	0	1	01	01	H5398_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												
H5398	002	0	1	01	01	H5398_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												
H5398	002	0	1	01	01	H5398_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	
H5398	004	0	1	01	01	H5398_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												
H5398	004	0	1	01	01	H5398_004_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					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	004	0	1	01	01	H5398_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												
H5398	004	0	1	01	01	H5398_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												
H5398	004	0	1	01	01	H5398_004_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												
H5398	004	0	1	01	01	H5398_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												
H5410	018	0	1	01	01	H5410_018_0	4		Y	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								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												
H5410	018	0	1	01	01	H5410_018_0	4		Y	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		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5410	018	0	1	01	01	H5410_018_0	4		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								100.00	200.00	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		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											819.91	33						710.78	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5410	024	0	1	01	01	H5410_024_0	4		Y	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	4		Y	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
H5410	024	0	1	01	01	H5410_024_0	4		Y	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00				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	4		Y	Generic	4	01	1	2	2	3		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00				20.00				20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5410	024	0	1	01	01	H5410_024_0	4		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					25.00	50.00	75.00											47.00	94.00	141.00				25.00	50.00	75.00				47.00				47.00			1.57	0.83		1.57	0.83	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5410	024	0	1	01	01	H5410_024_0	4		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								100.00	200.00	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	4		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											972.31	33						784.67	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5410	026	0	1	01	01	H5410_026_0	4		Y	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		Y	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										1		3
H5410	026	0	1	01	01	H5410_026_0	4		Y	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					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												
H5410	026	0	1	01	01	H5410_026_0	4		Y	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					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		
H5410	026	0	1	01	01	H5410_026_0	4		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5410	026	0	1	01	01	H5410_026_0	4		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								100.00	200.00	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		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											961.17	33						688.04	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		Y	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		Y	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		Y	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00				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		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					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		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								100.00	200.00	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		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											926.56	33						698.65	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5410	028	0	1	01	01	H5410_028_0	5		Y	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	5		Y	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	5		Y	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	5		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5410	028	0	1	01	01	H5410_028_0	5		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								100.00	200.00	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	5		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											912.19	33						625.90	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5410	029	0	1	01	01	H5410_029_0	5		Y	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	5		Y	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	5		Y	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00				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	5		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					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	5		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								100.00	200.00	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	5		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											964.56	33						720.52	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		Y	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		Y	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		Y	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					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												
H5410	030	0	1	01	01	H5410_030_0	5		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5410	030	0	1	01	01	H5410_030_0	5		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								100.00	200.00	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		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											859.43	33						760.46	33												33						33					33			33								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					3.00	6.00	6.00											18.00	36.00	54.00				0.00	0.00	0.00				18.00				18.00			0.60	0.10		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					18.00	36.00	36.00											20.00	40.00	60.00				12.00	24.00	0.00				20.00				20.00			0.67	0.60		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											43.86	20	20	20				43.54	20	20	20										20	20	20				20	20	20			20			20								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											98.60	43	43	43				87.03	43	43	43										43	43	43				43	43	43			43			43								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											449.22	25						406.10	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					2.00	4.00	4.00											18.00	36.00	54.00				0.00	0.00	0.00				18.00				18.00			0.60	0.07		0.60	0.00	0.58	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5410	034	0	1	01	01	H5410_034_0	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					18.00	36.00	36.00											20.00	40.00	60.00				11.00	22.00	0.00				20.00				20.00			0.67	0.60		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											30.03	18	18	18				29.25	18	18	18										18	18	18				18	18	18			18			18								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											81.72	50	50	50				77.78	50	50	50										50	50	50				50	50	50			50			50								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											363.35	25						320.27	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5410	035	0	1	01	01	H5410_035_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					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	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					15.00	30.00	30.00											20.00	40.00	60.00				12.00	24.00	0.00				20.00				20.00			0.67	0.50		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	5			Preferred Brand	3	11	1	1	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											35.58	20	20	20				31.96	18	18	18										20	20	20				18	18	18			20			20								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5410	035	0	1	01	01	H5410_035_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											68.39	45	45	45				61.94	45	45	45										45	45	45				45	45	45			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5410	035	0	1	01	01	H5410_035_0	5			Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31											371.94	25						331.06	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		Y	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	037	0	1	01	01	H5410_037_0	4		Y	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
H5410	037	0	1	01	01	H5410_037_0	4		Y	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00				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		Y	Generic	4	01	1	2	2	3		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00				20.00				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		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					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		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								100.00	200.00	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		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											937.93	33						721.06	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		Y	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	039	0	1	01	01	H5410_039_0	4		Y	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
H5410	039	0	1	01	01	H5410_039_0	4		Y	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00				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		Y	Generic	4	01	1	2	2	3		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00				20.00				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		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					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		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								100.00	200.00	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		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											937.93	33						721.06	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		Y	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	040	0	1	01	01	H5410_040_0	4		Y	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										1		3
H5410	040	0	1	01	01	H5410_040_0	4		Y	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					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												
H5410	040	0	1	01	01	H5410_040_0	4		Y	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					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		
H5410	040	0	1	01	01	H5410_040_0	4		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5410	040	0	1	01	01	H5410_040_0	4		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								100.00	200.00	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		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											937.84	33						721.22	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5410	041	0	1	01	01	H5410_041_0	4		Y	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	041	0	1	01	01	H5410_041_0	4		Y	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										1		3
H5410	041	0	1	01	01	H5410_041_0	4		Y	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	4		Y	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	4		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5410	041	0	1	01	01	H5410_041_0	4		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								100.00	200.00	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	4		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											937.83	33						721.28	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5410	043	0	1	01	01	H5410_043_0	4		Y	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	043	0	1	01	01	H5410_043_0	4		Y	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
H5410	043	0	1	01	01	H5410_043_0	4		Y	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00				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	043	0	1	01	01	H5410_043_0	4		Y	Generic	4	01	1	2	2	3		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00				20.00				20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5410	043	0	1	01	01	H5410_043_0	4		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					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	043	0	1	01	01	H5410_043_0	4		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								100.00	200.00	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	043	0	1	01	01	H5410_043_0	4		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											937.93	33						721.06	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5410	044	0	1	01	01	H5410_044_0	4		Y	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	044	0	1	01	01	H5410_044_0	4		Y	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
H5410	044	0	1	01	01	H5410_044_0	4		Y	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00				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	044	0	1	01	01	H5410_044_0	4		Y	Generic	4	01	1	2	2	3		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00				20.00				20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5410	044	0	1	01	01	H5410_044_0	4		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					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	044	0	1	01	01	H5410_044_0	4		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5410	044	0	1	01	01	H5410_044_0	4		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											937.93	33						721.06	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5410	048	0	1	01	01	H5410_048_0	4		Y	Preferred Generic	4	01	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												
H5410	048	0	1	01	01	H5410_048_0	4		Y	Preferred Generic	4	01	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										1		3
H5410	048	0	1	01	01	H5410_048_0	4		Y	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00				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	048	0	1	01	01	H5410_048_0	4		Y	Generic	4	01	1	2	2	3		111	01		111	1				30	60	90	2	2				30	60	90	30		31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00				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	048	0	1	01	01	H5410_048_0	4		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					5.00	10.00	15.00											47.00	94.00	141.00				5.00	10.00	15.00				47.00				47.00			1.57	0.17		1.57	0.17	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5410	048	0	1	01	01	H5410_048_0	4		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								100.00	200.00	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												
H5410	048	0	1	01	01	H5410_048_0	4		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											937.84	33						721.18	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5410	050	0	1	01	01	H5410_050_0	4		Y	Preferred Generic	4	01	3	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												
H5410	050	0	1	01	01	H5410_050_0	4		Y	Preferred Generic	4	01	3	2	1	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
H5410	050	0	1	01	01	H5410_050_0	4		Y	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00				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	050	0	1	01	01	H5410_050_0	4		Y	Generic	4	01	1	2	2	3		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00				20.00				20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5410	050	0	1	01	01	H5410_050_0	4		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					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	050	0	1	01	01	H5410_050_0	4		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5410	050	0	1	01	01	H5410_050_0	4		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											937.95	33						721.02	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5410	051	0	1	01	01	H5410_051_0	4		Y	Preferred Generic	4	01	3	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5410	051	0	1	01	01	H5410_051_0	4		Y	Preferred Generic	4	01	3	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H5410	051	0	1	01	01	H5410_051_0	4		Y	Generic	4	01	1	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	10.00	15.00				0.00	0.00	0.00				5.00				5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5410	051	0	1	01	01	H5410_051_0	4		Y	Generic	4	01	1	2	2	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				5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5410	051	0	1	01	01	H5410_051_0	4		Y	Preferred Brand	4	11	1	2	3	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	15.00				0.00	0.00	0.00				5.00				5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5410	051	0	1	01	01	H5410_051_0	4		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								50.00	100.00	150.00					35.00	70.00	105.00											50.00	100.00	150.00				35.00	70.00	105.00				50.00				50.00			1.67	1.17		1.67	1.17	1.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5410	051	0	1	01	01	H5410_051_0	4		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											937.70	33						721.44	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5410	052	0	1	01	01	H5410_052_0	4		Y	Preferred Generic	4	01	3	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												
H5410	052	0	1	01	01	H5410_052_0	4		Y	Preferred Generic	4	01	3	2	1	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
H5410	052	0	1	01	01	H5410_052_0	4		Y	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00				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	052	0	1	01	01	H5410_052_0	4		Y	Generic	4	01	1	2	2	3		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00				20.00				20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5410	052	0	1	01	01	H5410_052_0	4		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					10.00	20.00	30.00											47.00	94.00	141.00				10.00	20.00	30.00				47.00				47.00			1.57	0.33		1.57	0.33	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5410	052	0	1	01	01	H5410_052_0	4		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5410	052	0	1	01	01	H5410_052_0	4		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											937.97	33						720.95	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5410	053	0	1	01	01	H5410_053_0	4		Y	Preferred Generic	4	01	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												
H5410	053	0	1	01	01	H5410_053_0	4		Y	Preferred Generic	4	01	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										1		3
H5410	053	0	1	01	01	H5410_053_0	4		Y	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00				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	053	0	1	01	01	H5410_053_0	4		Y	Generic	4	01	1	2	2	3		111	01		111	1				30	60	90	2	2				30	60	90	30		31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00				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	053	0	1	01	01	H5410_053_0	4		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					20.00	40.00	60.00											47.00	94.00	141.00				20.00	40.00	60.00				47.00				47.00			1.57	0.67		1.57	0.67	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5410	053	0	1	01	01	H5410_053_0	4		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								100.00	200.00	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												
H5410	053	0	1	01	01	H5410_053_0	4		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											937.83	33						721.24	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5410	054	0	1	01	01	H5410_054_0	4		Y	Preferred Generic	4	01	3	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												
H5410	054	0	1	01	01	H5410_054_0	4		Y	Preferred Generic	4	01	3	2	1	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
H5410	054	0	1	01	01	H5410_054_0	4		Y	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00				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	054	0	1	01	01	H5410_054_0	4		Y	Generic	4	01	1	2	2	3		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00				20.00				20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5410	054	0	1	01	01	H5410_054_0	4		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					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	054	0	1	01	01	H5410_054_0	4		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5410	054	0	1	01	01	H5410_054_0	4		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											937.95	33						721.02	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5420	001	0	1	01	01	H5420_001_0	2		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5420	001	0	1	01	01	H5420_001_0	2		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5420	001	0	1	01	01	H5420_001_0	2		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5420	001	0	1	01	01	H5420_001_0	2		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H5420	001	0	1	01	01	H5420_001_0	2		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5420	001	0	1	01	01	H5420_001_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	65.00		195.00																											195.00						185.00				65.00				65.00		2.16						2.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5420	001	0	1	01	01	H5420_001_0	2		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				536.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5420	003	0	1	01	01	H5420_003_0	2		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5420	003	0	1	01	01	H5420_003_0	2		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5420	003	0	1	01	01	H5420_003_0	2		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5420	003	0	1	01	01	H5420_003_0	2		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H5420	003	0	1	01	01	H5420_003_0	2		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	25.00		75.00																											75.00						65.00				25.00				25.00		0.83						0.80	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5420	003	0	1	01	01	H5420_003_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5420	003	0	1	01	01	H5420_003_0	2		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				458.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5420	014	0	1	01	01	H5420_014_0	2		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5420	014	0	1	01	01	H5420_014_0	2		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5420	014	0	1	01	01	H5420_014_0	2		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5420	014	0	1	01	01	H5420_014_0	2		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H5420	014	0	1	01	01	H5420_014_0	2		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5420	014	0	1	01	01	H5420_014_0	2		Y	Preferred Brand	4	11	1	2	3	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	014	0	1	01	01	H5420_014_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	65.00		195.00																											195.00						185.00				65.00				65.00		2.16						2.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5420	014	0	1	01	01	H5420_014_0	2		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				463.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5422	007	0	1	01	01	H5422_007_0	6		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								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		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								20.00	40.00	60.00					20.00	40.00	60.00					20.00	60.00	60.00																20.00				20.00			0.67	0.67	0.67			0.59	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5422	007	0	1	01	01	H5422_007_0	6		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								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		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	285.00	285.00																100.00				100.00			3.33	3.17	3.17			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5422	007	0	1	01	01	H5422_007_0	6		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												25							25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5422	007	0	1	01	01	H5422_007_0	6		N	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								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	7		Y	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	7		Y	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	7		Y	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	008	0	1	01	01	H5422_008_0	7		Y	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	008	0	1	01	01	H5422_008_0	7		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		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	7		Y	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5422	008	0	1	01	01	H5422_008_0	7		Y	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				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	7		Y	Select Care Drugs	4	01	1	2	6	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H5422	011	0	1	01	01	H5422_011_0	6		Y	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	6		Y	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	6		Y	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	6		Y	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	6		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	190.00	190.00																100.00				100.00			3.33	3.17	3.17			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5422	011	0	1	01	01	H5422_011_0	6		Y	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5422	011	0	1	01	01	H5422_011_0	6		Y	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5422	011	0	1	01	01	H5422_011_0	6		Y	Select Care Drugs	4	01	1	2	6	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H5422	013	0	1	01	01	H5422_013_0	6		N	Preferred Generic	4	01	3	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								10.00	20.00	30.00					5.00	10.00	15.00					5.00	15.00	15.00																10.00				10.00			0.33	0.17	0.17			0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5422	013	0	1	01	01	H5422_013_0	6		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								20.00	40.00	60.00					15.00	30.00	45.00					15.00	45.00	45.00																20.00				20.00			0.67	0.50	0.50			0.59	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5422	013	0	1	01	01	H5422_013_0	6		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								47.00	94.00	141.00					47.00	94.00	141.00					47.00	141.00	141.00																47.00				47.00			1.57	1.57	1.57			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5422	013	0	1	01	01	H5422_013_0	6		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	285.00	285.00																100.00				100.00			3.33	3.17	3.17			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5422	013	0	1	01	01	H5422_013_0	6		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												25							25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5422	013	0	1	01	01	H5422_013_0	6		N	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								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												
H5422	015	0	1	01	01	H5422_015_0	6		N	Preferred Generic	4	01	3	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								9.00	18.00	27.00					4.00	8.00	12.00					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	6		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								15.00	30.00	45.00					10.00	20.00	30.00					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	6		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00	126.00	126.00																47.00				47.00			1.57	1.40	1.40			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5422	015	0	1	01	01	H5422_015_0	6		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	285.00	285.00																100.00				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	6		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5422	015	0	1	01	01	H5422_015_0	6		N	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5422	015	0	1	01	01	H5422_015_0	6		N	Select Care Drugs	4	01	1	2	6	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H5422	016	0	1	01	01	H5422_016_0	6		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								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	6		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								20.00	40.00	60.00					20.00	40.00	60.00					20.00	60.00	60.00																20.00				20.00			0.67	0.67	0.67			0.59	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5422	016	0	1	01	01	H5422_016_0	6		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								47.00	94.00	141.00					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	6		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	285.00	285.00																100.00				100.00			3.33	3.17	3.17			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5422	016	0	1	01	01	H5422_016_0	6		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												25							25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5422	016	0	1	01	01	H5422_016_0	6		N	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								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	6		Y	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	6		Y	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	6		Y	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	017	0	1	01	01	H5422_017_0	6		Y	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	017	0	1	01	01	H5422_017_0	6		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				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	6		Y	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5422	017	0	1	01	01	H5422_017_0	6		Y	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				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	6		Y	Select Care Drugs	4	01	1	2	6	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				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	018	0	1	01	01	H5422_018_0	7		N	Preferred Generic	4	01	3	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								10.00	20.00	30.00					5.00	10.00	15.00					5.00	15.00	15.00																10.00				10.00			0.33	0.17	0.17			0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5422	018	0	1	01	01	H5422_018_0	7		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								20.00	40.00	60.00					15.00	30.00	45.00					15.00	45.00	45.00																20.00				20.00			0.67	0.50	0.50			0.59	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5422	018	0	1	01	01	H5422_018_0	7		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								47.00	94.00	141.00					47.00	94.00	141.00					47.00	141.00	141.00																47.00				47.00			1.57	1.57	1.57			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5422	018	0	1	01	01	H5422_018_0	7		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	285.00	285.00																100.00				100.00			3.33	3.17	3.17			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5422	018	0	1	01	01	H5422_018_0	7		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												25							25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5422	018	0	1	01	01	H5422_018_0	7		N	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								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												
H5425	001	0	1	01	01	H5425_001_0	8		Y	Preferred Generic	4	11	3	2	1	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								10.00	20.00	20.00					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	8		Y	Preferred Generic	4	11	3	2	1	3		111	01		111	1				30	60	100	1	2				30	60	100	30		31								10.00	20.00	20.00					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	8		Y	Generic	4	11	1	2	2	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								15.00	30.00	30.00					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	8		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								47.00	94.00	121.00					37.00	74.00	91.00											47.00	94.00	121.00				37.00	74.00	91.00				47.00				47.00			1.57	1.23		1.57	1.23	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5425	001	0	1	01	01	H5425_001_0	8		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								100.00	200.00	280.00					95.00	190.00	265.00											100.00	200.00	280.00				95.00	190.00	265.00				100.00				100.00			3.33	3.17		3.33	3.17	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5425	001	0	1	01	01	H5425_001_0	8		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5425	004	0	1	01	01	H5425_004_0	8		Y	Preferred Generic	4	11	3	2	1	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								9.00	18.00	18.00					0.00	0.00	0.00											9.00	18.00	18.00				0.00	0.00	0.00				9.00				9.00			0.30	0.00		0.30	0.00	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5425	004	0	1	01	01	H5425_004_0	8		Y	Preferred Generic	4	11	3	2	1	3		111	01		111	1				30	60	100	1	2				30	60	100	30		31								9.00	18.00	18.00					0.00	0.00	0.00											9.00	18.00	18.00				0.00	0.00	0.00				9.00				9.00			0.30	0.00		0.30	0.00	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H5425	004	0	1	01	01	H5425_004_0	8		Y	Generic	4	11	1	2	2	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								12.00	24.00	24.00					3.00	6.00	6.00											12.00	24.00	24.00				3.00	6.00	0.00				12.00				12.00			0.40	0.10		0.40	0.10	0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5425	004	0	1	01	01	H5425_004_0	8		Y	Generic	4	11	1	2	2	3		111	01		111	1				30	60	100	1	2				30	60	100	30		31								12.00	24.00	24.00					3.00	6.00	6.00											12.00	24.00	24.00				3.00	6.00	0.00				12.00				12.00			0.40	0.10		0.40	0.10	0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5425	004	0	1	01	01	H5425_004_0	8		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								47.00	94.00	121.00					37.00	74.00	91.00											47.00	94.00	121.00				37.00	74.00	91.00				47.00				47.00			1.57	1.23		1.57	1.23	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5425	004	0	1	01	01	H5425_004_0	8		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								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	8		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5425	005	0	1	01	01	H5425_005_0	8		Y	Preferred Generic	4	11	3	2	1	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								9.00	18.00	18.00					0.00	0.00	0.00											9.00	18.00	18.00				0.00	0.00	0.00				9.00				9.00			0.30	0.00		0.30	0.00	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5425	005	0	1	01	01	H5425_005_0	8		Y	Preferred Generic	4	11	3	2	1	3		111	01		111	1				30	60	100	1	2				30	60	100	30		31								9.00	18.00	18.00					0.00	0.00	0.00											9.00	18.00	18.00				0.00	0.00	0.00				9.00				9.00			0.30	0.00		0.30	0.00	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H5425	005	0	1	01	01	H5425_005_0	8		Y	Generic	4	11	1	2	2	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								15.00	30.00	30.00					5.00	10.00	10.00											15.00	30.00	30.00				5.00	10.00	0.00				15.00				15.00			0.50	0.17		0.50	0.17	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5425	005	0	1	01	01	H5425_005_0	8		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								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	8		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								100.00	200.00	280.00					95.00	190.00	265.00											100.00	200.00	280.00				95.00	190.00	265.00				100.00				100.00			3.33	3.17		3.33	3.17	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5425	005	0	1	01	01	H5425_005_0	8		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5425	006	0	1	01	01	H5425_006_0	8		Y	Preferred Generic	4	11	3	2	1	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								7.00	14.00	14.00					0.00	0.00	0.00											7.00	14.00	14.00				0.00	0.00	0.00				7.00				7.00			0.23	0.00		0.23	0.00	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5425	006	0	1	01	01	H5425_006_0	8		Y	Preferred Generic	4	11	3	2	1	3		111	01		111	1				30	60	100	1	2				30	60	100	30		31								7.00	14.00	14.00					0.00	0.00	0.00											7.00	14.00	14.00				0.00	0.00	0.00				7.00				7.00			0.23	0.00		0.23	0.00	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H5425	006	0	1	01	01	H5425_006_0	8		Y	Generic	4	11	1	2	2	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								15.00	30.00	30.00					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	8		Y	Generic	4	11	1	2	2	3		111	01		111	1				30	60	100	1	2				30	60	100	30		31								15.00	30.00	30.00					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	8		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								47.00	94.00	121.00					25.00	50.00	55.00											47.00	94.00	121.00				25.00	50.00	55.00				47.00				47.00			1.57	0.83		1.57	0.83	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5425	006	0	1	01	01	H5425_006_0	8		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								100.00	200.00	280.00					95.00	190.00	265.00											100.00	200.00	280.00				95.00	190.00	265.00				100.00				100.00			3.33	3.17		3.33	3.17	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5425	006	0	1	01	01	H5425_006_0	8		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5425	007	0	1	01	01	H5425_007_0	7		Y	Preferred Generic	4	11	3	2	1	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								7.00	14.00	14.00					0.00	0.00	0.00											7.00	14.00	14.00				0.00	0.00	0.00				7.00				7.00			0.23	0.00		0.23	0.00	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5425	007	0	1	01	01	H5425_007_0	7		Y	Preferred Generic	4	11	3	2	1	3		111	01		111	1				30	60	100	1	2				30	60	100	30		31								7.00	14.00	14.00					0.00	0.00	0.00											7.00	14.00	14.00				0.00	0.00	0.00				7.00				7.00			0.23	0.00		0.23	0.00	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H5425	007	0	1	01	01	H5425_007_0	7		Y	Generic	4	11	1	2	2	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								15.00	30.00	30.00					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	7		Y	Generic	4	11	1	2	2	3		111	01		111	1				30	60	100	1	2				30	60	100	30		31								15.00	30.00	30.00					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	7		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								47.00	94.00	121.00					25.00	50.00	55.00											47.00	94.00	121.00				25.00	50.00	55.00				47.00				47.00			1.57	0.83		1.57	0.83	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5425	007	0	1	01	01	H5425_007_0	7		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								100.00	200.00	280.00					95.00	190.00	265.00											100.00	200.00	280.00				95.00	190.00	265.00				100.00				100.00			3.33	3.17		3.33	3.17	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5425	007	0	1	01	01	H5425_007_0	7		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5425	008	0	1	01	01	H5425_008_0	7		Y	Preferred Generic	4	11	3	2	1	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								9.00	18.00	18.00					0.00	0.00	0.00											9.00	18.00	18.00				0.00	0.00	0.00				9.00				9.00			0.30	0.00		0.30	0.00	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5425	008	0	1	01	01	H5425_008_0	7		Y	Preferred Generic	4	11	3	2	1	3		111	01		111	1				30	60	100	1	2				30	60	100	30		31								9.00	18.00	18.00					0.00	0.00	0.00											9.00	18.00	18.00				0.00	0.00	0.00				9.00				9.00			0.30	0.00		0.30	0.00	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H5425	008	0	1	01	01	H5425_008_0	7		Y	Generic	4	11	1	2	2	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								15.00	30.00	30.00					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	7		Y	Generic	4	11	1	2	2	3		111	01		111	1				30	60	100	1	2				30	60	100	30		31								15.00	30.00	30.00					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	7		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								47.00	94.00	121.00					25.00	50.00	55.00											47.00	94.00	121.00				25.00	50.00	55.00				47.00				47.00			1.57	0.83		1.57	0.83	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5425	008	0	1	01	01	H5425_008_0	7		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								100.00	200.00	280.00					95.00	190.00	265.00											100.00	200.00	280.00				95.00	190.00	265.00				100.00				100.00			3.33	3.17		3.33	3.17	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5425	008	0	1	01	01	H5425_008_0	7		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5425	009	0	1	01	01	H5425_009_0	7		Y	Preferred Generic	4	11	3	2	1	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								9.00	18.00	18.00					0.00	0.00	0.00											9.00	18.00	18.00				0.00	0.00	0.00				9.00				9.00			0.30	0.00		0.30	0.00	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5425	009	0	1	01	01	H5425_009_0	7		Y	Preferred Generic	4	11	3	2	1	3		111	01		111	1				30	60	100	1	2				30	60	100	30		31								9.00	18.00	18.00					0.00	0.00	0.00											9.00	18.00	18.00				0.00	0.00	0.00				9.00				9.00			0.30	0.00		0.30	0.00	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H5425	009	0	1	01	01	H5425_009_0	7		Y	Generic	4	11	1	2	2	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								15.00	30.00	30.00					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	7		Y	Generic	4	11	1	2	2	3		111	01		111	1				30	60	100	1	2				30	60	100	30		31								15.00	30.00	30.00					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	7		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								47.00	94.00	121.00					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	7		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								100.00	200.00	280.00					95.00	190.00	265.00											100.00	200.00	280.00				95.00	190.00	265.00				100.00				100.00			3.33	3.17		3.33	3.17	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5425	009	0	1	01	01	H5425_009_0	7		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5425	019	0	1	01	01	H5425_019_0	8		Y	Preferred Generic	4	11	1	2	1	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								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	8		Y	Generic	4	11	1	2	2	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								12.00	24.00	24.00					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	8		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								47.00	94.00	121.00					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	8		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								100.00	200.00	280.00					95.00	190.00	265.00											100.00	200.00	280.00				95.00	190.00	265.00				100.00				100.00			3.33	3.17		3.33	3.17	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5425	019	0	1	01	01	H5425_019_0	8		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5425	020	0	1	01	01	H5425_020_0	9		Y	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	9		Y	Generic	4	11	1	2	2	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								12.00	24.00	24.00					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	9		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								47.00	94.00	121.00					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	9		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								100.00	200.00	280.00					95.00	190.00	265.00											100.00	200.00	280.00				95.00	190.00	265.00				100.00				100.00			3.33	3.17		3.33	3.17	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5425	020	0	1	01	01	H5425_020_0	9		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5425	028	0	1	01	01	H5425_028_0	7		Y	Preferred Generic	4	11	1	2	1	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								5.00	10.00	10.00					0.00	0.00	0.00											5.00	10.00	10.00				0.00	0.00	0.00				5.00				5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5425	028	0	1	01	01	H5425_028_0	7		Y	Preferred Generic	4	11	1	2	1	3		111	01		111	1				30	60	100	1	2				30	60	100	30		31								5.00	10.00	10.00					0.00	0.00	0.00											5.00	10.00	10.00				0.00	0.00	0.00				5.00				5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5425	028	0	1	01	01	H5425_028_0	7		Y	Generic	4	11	1	2	2	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								9.00	18.00	18.00					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	7		Y	Generic	4	11	1	2	2	3		111	01		111	1				30	60	100	1	2				30	60	100	30		31								9.00	18.00	18.00					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	7		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								47.00	94.00	121.00					25.00	50.00	55.00											47.00	94.00	121.00				25.00	50.00	55.00				47.00				47.00			1.57	0.83		1.57	0.83	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5425	028	0	1	01	01	H5425_028_0	7		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								100.00	200.00	280.00					95.00	190.00	265.00											100.00	200.00	280.00				95.00	190.00	265.00				100.00				100.00			3.33	3.17		3.33	3.17	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5425	028	0	1	01	01	H5425_028_0	7		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5425	033	0	1	01	01	H5425_033_0	7		Y	Preferred Generic	4	11	1	2	1	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								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	7		Y	Preferred Generic	4	11	1	2	1	3		111	01		111	1				30	60	100	1	2				30	60	100	30		31								7.00	14.00	14.00					0.00	0.00	0.00											7.00	14.00	14.00				0.00	0.00	0.00				7.00				7.00			0.23	0.00		0.23	0.00	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5425	033	0	1	01	01	H5425_033_0	7		Y	Generic	4	11	1	2	2	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								14.00	28.00	28.00					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	7		Y	Generic	4	11	1	2	2	3		111	01		111	1				30	60	100	1	2				30	60	100	30		31								14.00	28.00	28.00					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	7		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								47.00	94.00	121.00					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	033	0	1	01	01	H5425_033_0	7		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								100.00	200.00	280.00					95.00	190.00	265.00											100.00	200.00	280.00				95.00	190.00	265.00				100.00				100.00			3.33	3.17		3.33	3.17	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5425	033	0	1	01	01	H5425_033_0	7		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5425	034	0	1	01	01	H5425_034_0	7		Y	Preferred Generic	4	11	1	2	1	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								5.00	10.00	10.00					0.00	0.00	0.00											5.00	10.00	10.00				0.00	0.00	0.00				5.00				5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5425	034	0	1	01	01	H5425_034_0	7		Y	Preferred Generic	4	11	1	2	1	3		111	01		111	1				30	60	100	1	2				30	60	100	30		31								5.00	10.00	10.00					0.00	0.00	0.00											5.00	10.00	10.00				0.00	0.00	0.00				5.00				5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5425	034	0	1	01	01	H5425_034_0	7		Y	Generic	4	11	1	2	2	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								9.00	18.00	18.00					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	7		Y	Generic	4	11	1	2	2	3		111	01		111	1				30	60	100	1	2				30	60	100	30		31								9.00	18.00	18.00					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	7		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								35.00	70.00	85.00					25.00	50.00	55.00											35.00	70.00	85.00				25.00	50.00	55.00				35.00				35.00			1.17	0.83		1.17	0.83	1.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5425	034	0	1	01	01	H5425_034_0	7		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								100.00	200.00	280.00					95.00	190.00	265.00											100.00	200.00	280.00				95.00	190.00	265.00				100.00				100.00			3.33	3.17		3.33	3.17	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5425	034	0	1	01	01	H5425_034_0	7		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5425	052	0	1	01	01	H5425_052_0	8		Y	Preferred Generic	4	11	1	2	1	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								7.00	14.00	14.00					0.00	0.00	0.00											7.00	14.00	14.00				0.00	0.00	0.00				7.00				7.00			0.23	0.00		0.23	0.00	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5425	052	0	1	01	01	H5425_052_0	8		Y	Generic	4	11	1	2	2	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								17.00	34.00	34.00					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	8		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								47.00	94.00	121.00					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	8		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								100.00	200.00	280.00					95.00	190.00	265.00											100.00	200.00	280.00				95.00	190.00	265.00				100.00				100.00			3.33	3.17		3.33	3.17	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5425	052	0	1	01	01	H5425_052_0	8		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5425	053	0	1	01	01	H5425_053_0	7		Y	Preferred Generic	4	11	1	2	1	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								7.00	14.00	14.00					0.00	0.00	0.00											7.00	14.00	14.00				0.00	0.00	0.00				7.00				7.00			0.23	0.00		0.23	0.00	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5425	053	0	1	01	01	H5425_053_0	7		Y	Preferred Generic	4	11	1	2	1	3		111	01		111	1				30	60	100	1	2				30	60	100	30		31								7.00	14.00	14.00					0.00	0.00	0.00											7.00	14.00	14.00				0.00	0.00	0.00				7.00				7.00			0.23	0.00		0.23	0.00	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5425	053	0	1	01	01	H5425_053_0	7		Y	Generic	4	11	1	2	2	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								17.00	34.00	34.00					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	7		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								47.00	94.00	121.00					42.00	84.00	106.00											47.00	94.00	121.00				42.00	84.00	106.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5425	053	0	1	01	01	H5425_053_0	7		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								100.00	200.00	280.00					95.00	190.00	265.00											100.00	200.00	280.00				95.00	190.00	265.00				100.00				100.00			3.33	3.17		3.33	3.17	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5425	053	0	1	01	01	H5425_053_0	7		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5425	054	0	1	01	01	H5425_054_0	8		Y	Preferred Generic	4	11	1	2	1	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								7.00	14.00	14.00					0.00	0.00	0.00											7.00	14.00	14.00				0.00	0.00	0.00				7.00				7.00			0.23	0.00		0.23	0.00	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5425	054	0	1	01	01	H5425_054_0	8		Y	Preferred Generic	4	11	1	2	1	3		111	01		111	1				30	60	100	1	2				30	60	100	30		31								7.00	14.00	14.00					0.00	0.00	0.00											7.00	14.00	14.00				0.00	0.00	0.00				7.00				7.00			0.23	0.00		0.23	0.00	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5425	054	0	1	01	01	H5425_054_0	8		Y	Generic	4	11	1	2	2	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								17.00	34.00	34.00					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	8		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								47.00	94.00	121.00					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	8		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								100.00	200.00	280.00					95.00	190.00	265.00											100.00	200.00	280.00				95.00	190.00	265.00				100.00				100.00			3.33	3.17		3.33	3.17	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5425	054	0	1	01	01	H5425_054_0	8		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5425	055	0	1	01	01	H5425_055_0	8		Y	Preferred Generic	4	11	1	2	1	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								7.00	14.00	14.00					0.00	0.00	0.00											7.00	14.00	14.00				0.00	0.00	0.00				7.00				7.00			0.23	0.00		0.23	0.00	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5425	055	0	1	01	01	H5425_055_0	8		Y	Preferred Generic	4	11	1	2	1	3		111	01		111	1				30	60	100	1	2				30	60	100	30		31								7.00	14.00	14.00					0.00	0.00	0.00											7.00	14.00	14.00				0.00	0.00	0.00				7.00				7.00			0.23	0.00		0.23	0.00	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5425	055	0	1	01	01	H5425_055_0	8		Y	Generic	4	11	1	2	2	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								12.00	24.00	24.00					5.00	10.00	10.00											12.00	24.00	24.00				5.00	10.00	0.00				12.00				12.00			0.40	0.17		0.40	0.17	0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5425	055	0	1	01	01	H5425_055_0	8		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								47.00	94.00	121.00					42.00	84.00	106.00											47.00	94.00	121.00				42.00	84.00	106.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5425	055	0	1	01	01	H5425_055_0	8		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								100.00	200.00	280.00					95.00	190.00	265.00											100.00	200.00	280.00				95.00	190.00	265.00				100.00				100.00			3.33	3.17		3.33	3.17	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5425	055	0	1	01	01	H5425_055_0	8		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5425	065	0	1	01	01	H5425_065_0	7		Y	Preferred Generic	4	11	3	2	1	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								5.00	10.00	10.00					0.00	0.00	0.00											5.00	10.00	10.00				0.00	0.00	0.00				5.00				5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5425	065	0	1	01	01	H5425_065_0	7		Y	Preferred Generic	4	11	3	2	1	3		111	01		111	1				30	60	100	1	2				30	60	100	30		31								5.00	10.00	10.00					0.00	0.00	0.00											5.00	10.00	10.00				0.00	0.00	0.00				5.00				5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H5425	065	0	1	01	01	H5425_065_0	7		Y	Generic	4	11	1	2	2	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								12.00	24.00	24.00					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	7		Y	Generic	4	11	1	2	2	3		111	01		111	1				30	60	100	1	2				30	60	100	30		31								12.00	24.00	24.00					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	7		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								47.00	94.00	121.00					25.00	50.00	55.00											47.00	94.00	121.00				25.00	50.00	55.00				47.00				47.00			1.57	0.83		1.57	0.83	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5425	065	0	1	01	01	H5425_065_0	7		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								100.00	200.00	280.00					95.00	190.00	265.00											100.00	200.00	280.00				95.00	190.00	265.00				100.00				100.00			3.33	3.17		3.33	3.17	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5425	065	0	1	01	01	H5425_065_0	7		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5425	066	0	1	01	01	H5425_066_0	7		Y	Preferred Generic	4	11	3	2	1	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								5.00	10.00	10.00					0.00	0.00	0.00											5.00	10.00	10.00				0.00	0.00	0.00				5.00				5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5425	066	0	1	01	01	H5425_066_0	7		Y	Preferred Generic	4	11	3	2	1	3		111	01		111	1				30	60	100	1	2				30	60	100	30		31								5.00	10.00	10.00					0.00	0.00	0.00											5.00	10.00	10.00				0.00	0.00	0.00				5.00				5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H5425	066	0	1	01	01	H5425_066_0	7		Y	Generic	4	11	1	2	2	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								12.00	24.00	24.00					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	7		Y	Generic	4	11	1	2	2	3		111	01		111	1				30	60	100	1	2				30	60	100	30		31								12.00	24.00	24.00					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	7		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								47.00	94.00	121.00					25.00	50.00	55.00											47.00	94.00	121.00				25.00	50.00	55.00				47.00				47.00			1.57	0.83		1.57	0.83	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5425	066	0	1	01	01	H5425_066_0	7		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								100.00	200.00	280.00					95.00	190.00	265.00											100.00	200.00	280.00				95.00	190.00	265.00				100.00				100.00			3.33	3.17		3.33	3.17	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5425	066	0	1	01	01	H5425_066_0	7		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5425	067	0	1	01	01	H5425_067_0	7		Y	Preferred Generic	4	11	3	2	1	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								7.00	14.00	14.00					0.00	0.00	0.00											7.00	14.00	14.00				0.00	0.00	0.00				7.00				7.00			0.23	0.00		0.23	0.00	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5425	067	0	1	01	01	H5425_067_0	7		Y	Preferred Generic	4	11	3	2	1	3		111	01		111	1				30	60	100	1	2				30	60	100	30		31								7.00	14.00	14.00					0.00	0.00	0.00											7.00	14.00	14.00				0.00	0.00	0.00				7.00				7.00			0.23	0.00		0.23	0.00	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H5425	067	0	1	01	01	H5425_067_0	7		Y	Generic	4	11	1	2	2	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								14.00	28.00	28.00					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	7		Y	Generic	4	11	1	2	2	3		111	01		111	1				30	60	100	1	2				30	60	100	30		31								14.00	28.00	28.00					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	7		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								47.00	94.00	121.00					25.00	50.00	55.00											47.00	94.00	121.00				25.00	50.00	55.00				47.00				47.00			1.57	0.83		1.57	0.83	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5425	067	0	1	01	01	H5425_067_0	7		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								100.00	200.00	280.00					95.00	190.00	265.00											100.00	200.00	280.00				95.00	190.00	265.00				100.00				100.00			3.33	3.17		3.33	3.17	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5425	067	0	1	01	01	H5425_067_0	7		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5425	068	0	1	01	01	H5425_068_0	7		Y	Preferred Generic	4	11	3	2	1	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								7.00	14.00	14.00					0.00	0.00	0.00											7.00	14.00	14.00				0.00	0.00	0.00				7.00				7.00			0.23	0.00		0.23	0.00	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5425	068	0	1	01	01	H5425_068_0	7		Y	Preferred Generic	4	11	3	2	1	3		111	01		111	1				30	60	100	1	2				30	60	100	30		31								7.00	14.00	14.00					0.00	0.00	0.00											7.00	14.00	14.00				0.00	0.00	0.00				7.00				7.00			0.23	0.00		0.23	0.00	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H5425	068	0	1	01	01	H5425_068_0	7		Y	Generic	4	11	1	2	2	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								14.00	28.00	28.00					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	7		Y	Generic	4	11	1	2	2	3		111	01		111	1				30	60	100	1	2				30	60	100	30		31								14.00	28.00	28.00					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	7		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								47.00	94.00	121.00					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	7		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								100.00	200.00	280.00					95.00	190.00	265.00											100.00	200.00	280.00				95.00	190.00	265.00				100.00				100.00			3.33	3.17		3.33	3.17	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5425	068	0	1	01	01	H5425_068_0	7		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5425	069	0	1	01	01	H5425_069_0	9		Y	Preferred Generic	4	11	1	2	1	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								5.00	10.00	10.00					0.00	0.00	0.00											5.00	10.00	10.00				0.00	0.00	0.00				5.00				5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5425	069	0	1	01	01	H5425_069_0	9		Y	Preferred Generic	4	11	1	2	1	3		111	01		111	1				30	60	100	1	2				30	60	100	30		31								5.00	10.00	10.00					0.00	0.00	0.00											5.00	10.00	10.00				0.00	0.00	0.00				5.00				5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5425	069	0	1	01	01	H5425_069_0	9		Y	Generic	4	11	1	2	2	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								15.00	30.00	30.00					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	9		Y	Generic	4	11	1	2	2	3		111	01		111	1				30	60	100	1	2				30	60	100	30		31								15.00	30.00	30.00					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	9		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								47.00	94.00	121.00					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	9		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								100.00	200.00	280.00					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	9		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5425	070	0	1	01	01	H5425_070_0	9		Y	Preferred Generic	4	11	1	2	1	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								5.00	10.00	10.00					0.00	0.00	0.00											5.00	10.00	10.00				0.00	0.00	0.00				5.00				5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5425	070	0	1	01	01	H5425_070_0	9		Y	Preferred Generic	4	11	1	2	1	3		111	01		111	1				30	60	100	1	2				30	60	100	30		31								5.00	10.00	10.00					0.00	0.00	0.00											5.00	10.00	10.00				0.00	0.00	0.00				5.00				5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5425	070	0	1	01	01	H5425_070_0	9		Y	Generic	4	11	1	2	2	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								15.00	30.00	30.00					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	9		Y	Generic	4	11	1	2	2	3		111	01		111	1				30	60	100	1	2				30	60	100	30		31								15.00	30.00	30.00					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	9		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								45.00	90.00	115.00					30.00	60.00	70.00											45.00	90.00	115.00				30.00	60.00	70.00				45.00				45.00			1.50	1.00		1.50	1.00	1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5425	070	0	1	01	01	H5425_070_0	9		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								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	9		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5425	073	0	1	01	01	H5425_073_0	9		Y	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	9		Y	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	9		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								45.00	90.00	115.00					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	9		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								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	9		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5425	074	0	1	01	01	H5425_074_0	8		Y	Preferred Generic	4	11	1	2	1	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								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	8		Y	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	8		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								47.00	94.00	121.00					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	8		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								100.00	200.00	280.00					95.00	190.00	265.00											100.00	200.00	280.00				95.00	190.00	265.00				100.00				100.00			3.33	3.17		3.33	3.17	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5425	074	0	1	01	01	H5425_074_0	8		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5425	075	0	1	01	01	H5425_075_0	8		Y	Preferred Generic	4	11	3	2	1	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								5.00	10.00	10.00					0.00	0.00	0.00											5.00	10.00	10.00				0.00	0.00	0.00				5.00				5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5425	075	0	1	01	01	H5425_075_0	8		Y	Preferred Generic	4	11	3	2	1	3		111	01		111	1				30	60	100	1	2				30	60	100	30		31								5.00	10.00	10.00					0.00	0.00	0.00											5.00	10.00	10.00				0.00	0.00	0.00				5.00				5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H5425	075	0	1	01	01	H5425_075_0	8		Y	Generic	4	11	1	2	2	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								10.00	20.00	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	8		Y	Generic	4	11	1	2	2	3		111	01		111	1				30	60	100	1	2				30	60	100	30		31								10.00	20.00	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	8		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								47.00	94.00	121.00					37.00	74.00	91.00											47.00	94.00	121.00				37.00	74.00	91.00				47.00				47.00			1.57	1.23		1.57	1.23	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5425	075	0	1	01	01	H5425_075_0	8		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								100.00	200.00	280.00					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	8		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5425	076	0	1	01	01	H5425_076_0	8		Y	Preferred Generic	4	11	1	2	1	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								5.00	10.00	10.00					0.00	0.00	0.00											5.00	10.00	10.00				0.00	0.00	0.00				5.00				5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5425	076	0	1	01	01	H5425_076_0	8		Y	Preferred Generic	4	11	1	2	1	3		111	01		111	1				30	60	100	1	2				30	60	100	30		31								5.00	10.00	10.00					0.00	0.00	0.00											5.00	10.00	10.00				0.00	0.00	0.00				5.00				5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5425	076	0	1	01	01	H5425_076_0	8		Y	Generic	4	11	1	2	2	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								10.00	20.00	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	8		Y	Generic	4	11	1	2	2	3		111	01		111	1				30	60	100	1	2				30	60	100	30		31								10.00	20.00	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	8		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								47.00	94.00	121.00					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	8		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								100.00	200.00	280.00					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	8		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5425	077	0	1	01	01	H5425_077_0	8		Y	Preferred Generic	4	11	1	2	1	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								5.00	10.00	10.00					0.00	0.00	0.00											5.00	10.00	10.00				0.00	0.00	0.00				5.00				5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5425	077	0	1	01	01	H5425_077_0	8		Y	Preferred Generic	4	11	1	2	1	3		111	01		111	1				30	60	100	1	2				30	60	100	30		31								5.00	10.00	10.00					0.00	0.00	0.00											5.00	10.00	10.00				0.00	0.00	0.00				5.00				5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5425	077	0	1	01	01	H5425_077_0	8		Y	Generic	4	11	1	2	2	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								10.00	20.00	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	8		Y	Generic	4	11	1	2	2	3		111	01		111	1				30	60	100	1	2				30	60	100	30		31								10.00	20.00	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	8		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								47.00	94.00	121.00					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	8		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								100.00	200.00	280.00					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	8		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5425	078	0	1	01	01	H5425_078_0	8		Y	Preferred Generic	4	11	3	2	1	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								5.00	10.00	10.00					0.00	0.00	0.00											5.00	10.00	10.00				0.00	0.00	0.00				5.00				5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5425	078	0	1	01	01	H5425_078_0	8		Y	Preferred Generic	4	11	3	2	1	3		111	01		111	1				30	60	100	1	2				30	60	100	30		31								5.00	10.00	10.00					0.00	0.00	0.00											5.00	10.00	10.00				0.00	0.00	0.00				5.00				5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H5425	078	0	1	01	01	H5425_078_0	8		Y	Generic	4	11	1	2	2	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								10.00	20.00	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	8		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								47.00	94.00	121.00					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	8		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								100.00	200.00	280.00					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	8		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5425	079	0	1	01	01	H5425_079_0	8		Y	Preferred Generic	4	11	1	2	1	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								5.00	10.00	10.00					0.00	0.00	0.00											5.00	10.00	10.00				0.00	0.00	0.00				5.00				5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5425	079	0	1	01	01	H5425_079_0	8		Y	Preferred Generic	4	11	1	2	1	3		111	01		111	1				30	60	100	1	2				30	60	100	30		31								5.00	10.00	10.00					0.00	0.00	0.00											5.00	10.00	10.00				0.00	0.00	0.00				5.00				5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5425	079	0	1	01	01	H5425_079_0	8		Y	Generic	4	11	1	2	2	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								10.00	20.00	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	8		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								47.00	94.00	121.00					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	8		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								100.00	200.00	280.00					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	8		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5425	080	0	1	01	01	H5425_080_0	8		Y	Preferred Generic	4	11	1	2	1	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								5.00	10.00	10.00					0.00	0.00	0.00											5.00	10.00	10.00				0.00	0.00	0.00				5.00				5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5425	080	0	1	01	01	H5425_080_0	8		Y	Preferred Generic	4	11	1	2	1	3		111	01		111	1				30	60	100	1	2				30	60	100	30		31								5.00	10.00	10.00					0.00	0.00	0.00											5.00	10.00	10.00				0.00	0.00	0.00				5.00				5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5425	080	0	1	01	01	H5425_080_0	8		Y	Generic	4	11	1	2	2	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								10.00	20.00	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	8		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								47.00	94.00	121.00					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	8		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								100.00	200.00	280.00					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	8		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5425	082	0	1	01	01	H5425_082_0	8		Y	Preferred Generic	4	11	3	2	1	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								7.00	14.00	14.00					0.00	0.00	0.00											7.00	14.00	14.00				0.00	0.00	0.00				7.00				7.00			0.23	0.00		0.23	0.00	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5425	082	0	1	01	01	H5425_082_0	8		Y	Preferred Generic	4	11	3	2	1	3		111	01		111	1				30	60	100	1	2				30	60	100	30		31								7.00	14.00	14.00					0.00	0.00	0.00											7.00	14.00	14.00				0.00	0.00	0.00				7.00				7.00			0.23	0.00		0.23	0.00	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H5425	082	0	1	01	01	H5425_082_0	8		Y	Generic	4	11	1	2	2	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								15.00	30.00	30.00					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	8		Y	Generic	4	11	1	2	2	3		111	01		111	1				30	60	100	1	2				30	60	100	30		31								15.00	30.00	30.00					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	8		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								47.00	94.00	121.00					25.00	50.00	55.00											47.00	94.00	121.00				25.00	50.00	55.00				47.00				47.00			1.57	0.83		1.57	0.83	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5425	082	0	1	01	01	H5425_082_0	8		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								100.00	200.00	280.00					95.00	190.00	265.00											100.00	200.00	280.00				95.00	190.00	265.00				100.00				100.00			3.33	3.17		3.33	3.17	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5425	082	0	1	01	01	H5425_082_0	8		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5425	083	0	1	01	01	H5425_083_0	7		Y	Preferred Generic	4	11	3	2	1	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								10.00	20.00	20.00					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	7		Y	Preferred Generic	4	11	3	2	1	3		111	01		111	1				30	60	100	1	2				30	60	100	30		31								10.00	20.00	20.00					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	7		Y	Generic	4	11	1	2	2	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								15.00	30.00	30.00					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	7		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								47.00	94.00	121.00					37.00	74.00	91.00											47.00	94.00	121.00				37.00	74.00	91.00				47.00				47.00			1.57	1.23		1.57	1.23	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5425	083	0	1	01	01	H5425_083_0	7		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								100.00	200.00	280.00					95.00	190.00	265.00											100.00	200.00	280.00				95.00	190.00	265.00				100.00				100.00			3.33	3.17		3.33	3.17	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5425	083	0	1	01	01	H5425_083_0	7		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5425	084	0	1	01	01	H5425_084_0	8		Y	Preferred Generic	4	11	3	2	1	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								7.00	14.00	14.00					0.00	0.00	0.00											7.00	14.00	14.00				0.00	0.00	0.00				7.00				7.00			0.23	0.00		0.23	0.00	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5425	084	0	1	01	01	H5425_084_0	8		Y	Preferred Generic	4	11	3	2	1	3		111	01		111	1				30	60	100	1	2				30	60	100	30		31								7.00	14.00	14.00					0.00	0.00	0.00											7.00	14.00	14.00				0.00	0.00	0.00				7.00				7.00			0.23	0.00		0.23	0.00	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H5425	084	0	1	01	01	H5425_084_0	8		Y	Generic	4	11	1	2	2	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								15.00	30.00	30.00					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	8		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								47.00	94.00	121.00					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	8		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								100.00	200.00	280.00					95.00	190.00	265.00											100.00	200.00	280.00				95.00	190.00	265.00				100.00				100.00			3.33	3.17		3.33	3.17	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5425	084	0	1	01	01	H5425_084_0	8		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5425	085	0	1	01	01	H5425_085_0	8		Y	Preferred Generic	4	11	3	2	1	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								7.00	14.00	14.00					0.00	0.00	0.00											7.00	14.00	14.00				0.00	0.00	0.00				7.00				7.00			0.23	0.00		0.23	0.00	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5425	085	0	1	01	01	H5425_085_0	8		Y	Preferred Generic	4	11	3	2	1	3		111	01		111	1				30	60	100	1	2				30	60	100	30		31								7.00	14.00	14.00					0.00	0.00	0.00											7.00	14.00	14.00				0.00	0.00	0.00				7.00				7.00			0.23	0.00		0.23	0.00	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H5425	085	0	1	01	01	H5425_085_0	8		Y	Generic	4	11	1	2	2	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								15.00	30.00	30.00					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	8		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								47.00	94.00	121.00					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	8		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								100.00	200.00	280.00					95.00	190.00	265.00											100.00	200.00	280.00				95.00	190.00	265.00				100.00				100.00			3.33	3.17		3.33	3.17	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5425	085	0	1	01	01	H5425_085_0	8		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5425	086	0	1	01	01	H5425_086_0	8		Y	Preferred Generic	4	11	1	2	1	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				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	8		Y	Preferred Generic	4	11	1	2	1	3		111	01		111	1				30	60	100	1	2				30	60	100	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				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	8		Y	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	8		Y	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	8		Y	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	8		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								100.00	200.00	280.00					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	8		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5425	087	0	1	01	01	H5425_087_0	8		Y	Preferred Generic	4	11	1	2	1	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				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	8		Y	Preferred Generic	4	11	1	2	1	3		111	01		111	1				30	60	100	1	2				30	60	100	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				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	8		Y	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	8		Y	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	8		Y	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	8		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								100.00	200.00	280.00					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	8		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5425	091	0	1	01	01	H5425_091_0	8		Y	Preferred Generic	4	11	1	2	1	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				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	091	0	1	01	01	H5425_091_0	8		Y	Preferred Generic	4	11	1	2	1	3		111	01		111	1				30	60	100	1	2				30	60	100	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5425	091	0	1	01	01	H5425_091_0	8		Y	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	091	0	1	01	01	H5425_091_0	8		Y	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	091	0	1	01	01	H5425_091_0	8		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								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	091	0	1	01	01	H5425_091_0	8		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								100.00	200.00	280.00					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	091	0	1	01	01	H5425_091_0	8		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5425	092	0	1	01	01	H5425_092_0	7		Y	Preferred Generic	4	11	3	2	1	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								7.00	14.00	14.00					0.00	0.00	0.00											7.00	14.00	14.00				0.00	0.00	0.00				7.00				7.00			0.23	0.00		0.23	0.00	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5425	092	0	1	01	01	H5425_092_0	7		Y	Preferred Generic	4	11	3	2	1	3		111	01		111	1				30	60	100	1	2				30	60	100	30		31								7.00	14.00	14.00					0.00	0.00	0.00											7.00	14.00	14.00				0.00	0.00	0.00				7.00				7.00			0.23	0.00		0.23	0.00	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H5425	092	0	1	01	01	H5425_092_0	7		Y	Generic	4	11	1	2	2	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								15.00	30.00	30.00					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	092	0	1	01	01	H5425_092_0	7		Y	Generic	4	11	1	2	2	3		111	01		111	1				30	60	100	1	2				30	60	100	30		31								15.00	30.00	30.00					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	092	0	1	01	01	H5425_092_0	7		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								47.00	94.00	121.00					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	092	0	1	01	01	H5425_092_0	7		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								100.00	200.00	280.00					95.00	190.00	265.00											100.00	200.00	280.00				95.00	190.00	265.00				100.00				100.00			3.33	3.17		3.33	3.17	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5425	092	0	1	01	01	H5425_092_0	7		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5425	093	0	1	01	01	H5425_093_0	7		Y	Preferred Generic	4	11	3	2	1	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								7.00	14.00	14.00					0.00	0.00	0.00											7.00	14.00	14.00				0.00	0.00	0.00				7.00				7.00			0.23	0.00		0.23	0.00	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5425	093	0	1	01	01	H5425_093_0	7		Y	Preferred Generic	4	11	3	2	1	3		111	01		111	1				30	60	100	1	2				30	60	100	30		31								7.00	14.00	14.00					0.00	0.00	0.00											7.00	14.00	14.00				0.00	0.00	0.00				7.00				7.00			0.23	0.00		0.23	0.00	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H5425	093	0	1	01	01	H5425_093_0	7		Y	Generic	4	11	1	2	2	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								15.00	30.00	30.00					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	093	0	1	01	01	H5425_093_0	7		Y	Generic	4	11	1	2	2	3		111	01		111	1				30	60	100	1	2				30	60	100	30		31								15.00	30.00	30.00					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	093	0	1	01	01	H5425_093_0	7		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								47.00	94.00	121.00					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	093	0	1	01	01	H5425_093_0	7		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								100.00	200.00	280.00					95.00	190.00	265.00											100.00	200.00	280.00				95.00	190.00	265.00				100.00				100.00			3.33	3.17		3.33	3.17	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5425	093	0	1	01	01	H5425_093_0	7		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5427	059	0	1	01	01	H5427_059_0	5		N	Preferred Generic	4	11	3	2	1	1	110		01	110		1	30		100				2	2	30		100				30		34	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5427	059	0	1	01	01	H5427_059_0	5		N	Preferred Generic	4	11	3	2	1	3	110		01	110		1	30		100				2	2	30		100				30		34	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H5427	059	0	1	01	01	H5427_059_0	5		N	Preferred Brand	4	11	3	2	2	1	110		01	110		1	30		90				2	2	30		90				30		34	35.00		105.00																			35.00		70.00																35.00				35.00		1.17			1.17			1.03	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5427	059	0	1	01	01	H5427_059_0	5		N	Non-Preferred Drug	4	11	3	2	3	1	110		01	110		1	30		90				2	2	30		90				30		34	85.00		255.00																			85.00		170.00																85.00				85.00		2.83			2.83			2.50	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5427	059	0	1	01	01	H5427_059_0	5		N	Specialty Tier	4	11	1	1	4	1	010		01	010		1	30								30						30		34					33																				33																	33			33								Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5427	060	0	1	01	01	H5427_060_0	5		N	Preferred Generic	4	11	3	2	1	1	110		01	110		1	30		100				2	2	30		100				30		34	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5427	060	0	1	01	01	H5427_060_0	5		N	Preferred Generic	4	11	3	2	1	3	110		01	110		1	30		100				2	2	30		100				30		34	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H5427	060	0	1	01	01	H5427_060_0	5		N	Preferred Brand	4	11	3	2	2	1	110		01	110		1	30		90				2	2	30		90				30		34	35.00		105.00																			35.00		70.00																35.00				35.00		1.17			1.17			1.03	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5427	060	0	1	01	01	H5427_060_0	5		N	Non-Preferred Drug	4	11	3	2	3	1	110		01	110		1	30		90				2	2	30		90				30		34	85.00		255.00																			85.00		170.00																85.00				85.00		2.83			2.83			2.50	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5427	060	0	1	01	01	H5427_060_0	5		N	Specialty Tier	4	11	1	1	4	1	010		01	010		1	30								30						30		34					33																				33																	33			33								Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5427	070	0	1	01	01	H5427_070_0	6		Y	Preferred Generic	4	11	3	2	1	1	110		01	110		1	30		100				2	2	30		100				30		34	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs												
H5427	070	0	1	01	01	H5427_070_0	6		Y	Preferred Generic	4	11	3	2	1	3	110		01	110		1	30		100				2	2	30		100				30		34	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs										1		3
H5427	070	0	1	01	01	H5427_070_0	6		Y	Preferred Brand	4	11	3	2	2	1	110		01	110		1	30		90				2	2	30		90				30		34	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												
H5427	070	0	1	01	01	H5427_070_0	6		Y	Non-Preferred Drug	4	11	3	2	3	1	110		01	110		1	30		90				2	2	30		90				30		34	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												
H5427	070	0	1	01	01	H5427_070_0	6		Y	Specialty Tier	4	11	1	1	4	1	010		01	010		1	30								30						30		34					33																				33																	33			33								Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs												
H5427	070	0	1	01	01	H5427_070_0	6		Y	Select Diabetic Drugs	4	10	1	2	5	1	110		01	110		1	30		90				1	2	30		90				30		34	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs												
H5427	070	0	1	01	01	H5427_070_0	6		Y	Select Diabetic Drugs	4	10	1	2	5	3	110		01	110		1	30		90				1	2	30		90				30		34	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs										1		
H5427	072	0	1	01	01	H5427_072_0	6		Y	Preferred Generic	4	11	3	2	1	1	110		01	110		1	30		100				2	2	30		100				30		34	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs												
H5427	072	0	1	01	01	H5427_072_0	6		Y	Preferred Generic	4	11	3	2	1	3	110		01	110		1	30		100				2	2	30		100				30		34	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs										1		3
H5427	072	0	1	01	01	H5427_072_0	6		Y	Preferred Brand	4	11	3	2	2	1	110		01	110		1	30		90				2	2	30		90				30		34	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	6		Y	Non-Preferred Drug	4	11	3	2	3	1	110		01	110		1	30		90				2	2	30		90				30		34	65.00		195.00																			65.00		130.00																65.00				65.00		2.17			2.17			1.91	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs												
H5427	072	0	1	01	01	H5427_072_0	6		Y	Specialty Tier	4	11	1	1	4	1	010		01	010		1	30								30						30		34					33																				33																	33			33								Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs												
H5427	072	0	1	01	01	H5427_072_0	6		Y	Select Diabetic Drugs	4	10	1	2	5	1	110		01	110		1	30		90				1	2	30		90				30		34	10.00		30.00																			10.00		20.00																10.00				10.00		0.33			0.33			0.29	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs												
H5427	072	0	1	01	01	H5427_072_0	6		Y	Select Diabetic Drugs	4	10	1	2	5	3	110		01	110		1	30		90				1	2	30		90				30		34	10.00		30.00																			10.00		20.00																10.00				10.00		0.33			0.33			0.29	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs										1		
H5427	077	0	1	01	01	H5427_077_0	5		N	Preferred Generic	4	11	3	2	1	1	110		01	110		1	30		100				2	2	30		100				30		34	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5427	077	0	1	01	01	H5427_077_0	5		N	Preferred Generic	4	11	3	2	1	3	110		01	110		1	30		100				2	2	30		100				30		34	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H5427	077	0	1	01	01	H5427_077_0	5		N	Preferred Brand	4	11	3	2	2	1	110		01	110		1	30		90				2	2	30		90				30		34	20.00		60.00																			20.00		40.00																20.00				20.00		0.67			0.67			0.59	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5427	077	0	1	01	01	H5427_077_0	5		N	Non-Preferred Drug	4	11	3	2	3	1	110		01	110		1	30		90				2	2	30		90				30		34	60.00		180.00																			60.00		120.00																60.00				60.00		2.00			2.00			1.76	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5427	077	0	1	01	01	H5427_077_0	5		N	Specialty Tier	4	11	1	1	4	1	010		01	010		1	30								30						30		34					33																				33																	33			33								Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5427	078	0	1	01	01	H5427_078_0	6		N	Preferred Generic	4	11	3	2	1	1	110		01	110		1	30		100				2	2	30		100				30		34	15.00		45.00																			15.00		45.00																15.00				15.00		0.50			0.50			0.44	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5427	078	0	1	01	01	H5427_078_0	6		N	Preferred Brand	4	11	3	2	2	1	110		01	110		1	30		90				2	2	30		90				30		34	45.00		135.00																			45.00		135.00																45.00				45.00		1.50			1.50			1.32	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5427	078	0	1	01	01	H5427_078_0	6		N	Non-Preferred Drug	4	11	3	2	3	1	110		01	110		1	30		90				2	2	30		90				30		34	95.00		285.00																			95.00		285.00																95.00				95.00		3.17			3.17			2.79	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5427	078	0	1	01	01	H5427_078_0	6		N	Specialty Tier	4	11	1	1	4	1	010		01	010		1	30								30						30		34					25																				25																	25			25								Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5427	082	0	1	01	01	H5427_082_0	6		N	Preferred Generic	4	11	3	2	1	1	110		01	110		1	30		100				2	2	30		100				30		34	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs												
H5427	082	0	1	01	01	H5427_082_0	6		N	Preferred Generic	4	11	3	2	1	3	110		01	110		1	30		100				2	2	30		100				30		34	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs										1		3
H5427	082	0	1	01	01	H5427_082_0	6		N	Preferred Brand	4	11	3	2	2	1	110		01	110		1	30		90				2	2	30		90				30		34	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	082	0	1	01	01	H5427_082_0	6		N	Non-Preferred Drug	4	11	3	2	3	1	110		01	110		1	30		90				2	2	30		90				30		34	80.00		240.00																			80.00		160.00																80.00				80.00		2.67			2.67			2.35	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs												
H5427	082	0	1	01	01	H5427_082_0	6		N	Specialty Tier	4	11	1	1	4	1	010		01	010		1	30								30						30		34					33																				33																	33			33								Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs												
H5427	082	0	1	01	01	H5427_082_0	6		N	Select Diabetic Drugs	4	10	1	2	5	1	110		01	110		1	30		90				1	2	30		90				30		34	10.00		30.00																			10.00		20.00																10.00				10.00		0.33			0.33			0.29	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs												
H5427	083	0	1	01	01	H5427_083_0	6		N	Preferred Generic	4	11	3	2	1	1	110		01	110		1	30		100				2	2	30		100				30		34	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5427	083	0	1	01	01	H5427_083_0	6		N	Preferred Generic	4	11	3	2	1	3	110		01	110		1	30		100				2	2	30		100				30		34	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H5427	083	0	1	01	01	H5427_083_0	6		N	Preferred Brand	4	11	3	2	2	1	110		01	110		1	30		90				2	2	30		90				30		34	30.00		90.00																			30.00		60.00																30.00				30.00		1.00			1.00			0.88	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5427	083	0	1	01	01	H5427_083_0	6		N	Non-Preferred Drug	4	11	3	2	3	1	110		01	110		1	30		90				2	2	30		90				30		34	80.00		240.00																			80.00		160.00																80.00				80.00		2.67			2.67			2.35	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5427	083	0	1	01	01	H5427_083_0	6		N	Specialty Tier	4	11	1	1	4	1	010		01	010		1	30								30						30		34					33																				33																	33			33								Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5427	087	0	1	01	01	H5427_087_0	5		N	Preferred Generic	4	11	3	2	1	1	110		01	110		1	30		100				2	2	30		100				30		34	15.00		45.00																			15.00		45.00																15.00				15.00		0.50			0.50			0.44	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5427	087	0	1	01	01	H5427_087_0	5		N	Preferred Brand	4	11	3	2	2	1	110		01	110		1	30		90				2	2	30		90				30		34	45.00		135.00																			45.00		135.00																45.00				45.00		1.50			1.50			1.32	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5427	087	0	1	01	01	H5427_087_0	5		N	Non-Preferred Drug	4	11	3	2	3	1	110		01	110		1	30		90				2	2	30		90				30		34	95.00		285.00																			95.00		285.00																95.00				95.00		3.17			3.17			2.79	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5427	087	0	1	01	01	H5427_087_0	5		N	Specialty Tier	4	11	1	1	4	1	010		01	010		1	30								30						30		34					25																				25																	25			25								Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5427	088	0	1	01	01	H5427_088_0	5		N	Preferred Generic	4	11	3	2	1	1	110		01	110		1	30		100				2	2	30		100				30		34	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5427	088	0	1	01	01	H5427_088_0	5		N	Preferred Generic	4	11	3	2	1	3	110		01	110		1	30		100				2	2	30		100				30		34	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H5427	088	0	1	01	01	H5427_088_0	5		N	Preferred Brand	4	11	3	2	2	1	110		01	110		1	30		90				2	2	30		90				30		34	30.00		90.00																			30.00		60.00																30.00				30.00		1.00			1.00			0.88	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5427	088	0	1	01	01	H5427_088_0	5		N	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	5		N	Specialty Tier	4	11	1	1	4	1	010		01	010		1	30								30						30		34					33																				33																	33			33								Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5427	089	0	1	01	01	H5427_089_0	5		N	Preferred Generic	4	11	3	2	1	1	110		01	110		1	30		100				2	2	30		100				30		34	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5427	089	0	1	01	01	H5427_089_0	5		N	Preferred Generic	4	11	3	2	1	3	110		01	110		1	30		100				2	2	30		100				30		34	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H5427	089	0	1	01	01	H5427_089_0	5		N	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	089	0	1	01	01	H5427_089_0	5		N	Non-Preferred Drug	4	11	3	2	3	1	110		01	110		1	30		90				2	2	30		90				30		34	65.00		195.00																			65.00		130.00																65.00				65.00		2.17			2.17			1.91	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5427	089	0	1	01	01	H5427_089_0	5		N	Specialty Tier	4	11	1	1	4	1	010		01	010		1	30								30						30		34					33																				33																	33			33								Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5427	091	0	1	01	01	H5427_091_0	5		N	Preferred Generic	4	11	3	2	1	1	110		01	110		1	30		100				2	2	30		100				30		34	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5427	091	0	1	01	01	H5427_091_0	5		N	Preferred Generic	4	11	3	2	1	3	110		01	110		1	30		100				2	2	30		100				30		34	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H5427	091	0	1	01	01	H5427_091_0	5		N	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	091	0	1	01	01	H5427_091_0	5		N	Non-Preferred Drug	4	11	3	2	3	1	110		01	110		1	30		90				2	2	30		90				30		34	70.00		210.00																			70.00		140.00																70.00				70.00		2.33			2.33			2.06	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5427	091	0	1	01	01	H5427_091_0	5		N	Specialty Tier	4	11	1	1	4	1	010		01	010		1	30								30						30		34					33																				33																	33			33								Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5427	092	0	1	01	01	H5427_092_0	5		N	Preferred Generic	4	11	3	2	1	1	110		01	110		1	30		100				2	2	30		100				30		34	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5427	092	0	1	01	01	H5427_092_0	5		N	Preferred Generic	4	11	3	2	1	3	110		01	110		1	30		100				2	2	30		100				30		34	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H5427	092	0	1	01	01	H5427_092_0	5		N	Preferred Brand	4	11	3	2	2	1	110		01	110		1	30		90				2	2	30		90				30		34	10.00		30.00																			10.00		20.00																10.00				10.00		0.33			0.33			0.29	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5427	092	0	1	01	01	H5427_092_0	5		N	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	5		N	Specialty Tier	4	11	1	1	4	1	010		01	010		1	30								30						30		34					33																				33																	33			33								Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5427	093	0	1	01	01	H5427_093_0	5		N	Preferred Generic	4	11	3	2	1	1	110		01	110		1	30		100				2	2	30		100				30		34	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5427	093	0	1	01	01	H5427_093_0	5		N	Preferred Generic	4	11	3	2	1	3	110		01	110		1	30		100				2	2	30		100				30		34	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H5427	093	0	1	01	01	H5427_093_0	5		N	Preferred Brand	4	11	3	2	2	1	110		01	110		1	30		90				2	2	30		90				30		34	30.00		90.00																			30.00		60.00																30.00				30.00		1.00			1.00			0.88	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5427	093	0	1	01	01	H5427_093_0	5		N	Non-Preferred Drug	4	11	3	2	3	1	110		01	110		1	30		90				2	2	30		90				30		34	70.00		210.00																			70.00		140.00																70.00				70.00		2.33			2.33			2.06	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5427	093	0	1	01	01	H5427_093_0	5		N	Specialty Tier	4	11	1	1	4	1	010		01	010		1	30								30						30		34					33																				33																	33			33								Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5427	094	0	1	01	01	H5427_094_0	5		N	Preferred Generic	4	11	3	2	1	1	110		01	110		1	30		100				2	2	30		100				30		34	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5427	094	0	1	01	01	H5427_094_0	5		N	Preferred Generic	4	11	3	2	1	3	110		01	110		1	30		100				2	2	30		100				30		34	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H5427	094	0	1	01	01	H5427_094_0	5		N	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	5		N	Non-Preferred Drug	4	11	3	2	3	1	110		01	110		1	30		90				2	2	30		90				30		34	70.00		210.00																			70.00		140.00																70.00				70.00		2.33			2.33			2.06	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5427	094	0	1	01	01	H5427_094_0	5		N	Specialty Tier	4	11	1	1	4	1	010		01	010		1	30								30						30		34					33																				33																	33			33								Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5427	096	0	1	01	01	H5427_096_0	5		N	Preferred Generic	4	11	3	2	1	1	110		01	110		1	30		100				2	2	30		100				30		34	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5427	096	0	1	01	01	H5427_096_0	5		N	Preferred Brand	4	11	3	2	2	1	110		01	110		1	30		90				2	2	30		90				30		34	35.00		105.00																			35.00		70.00																35.00				35.00		1.17			1.17			1.03	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5427	096	0	1	01	01	H5427_096_0	5		N	Non-Preferred Drug	4	11	3	2	3	1	110		01	110		1	30		90				2	2	30		90				30		34	85.00		255.00																			85.00		170.00																85.00				85.00		2.83			2.83			2.50	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5427	096	0	1	01	01	H5427_096_0	5		N	Specialty Tier	4	11	1	1	4	1	010		01	010		1	30								30						30		34					33																				33																	33			33								Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5427	098	0	1	01	01	H5427_098_0	5		N	Preferred Generic	4	11	3	2	1	1	110		01	110		1	30		100				2	2	30		100				30		34	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5427	098	0	1	01	01	H5427_098_0	5		N	Preferred Generic	4	11	3	2	1	3	110		01	110		1	30		100				2	2	30		100				30		34	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H5427	098	0	1	01	01	H5427_098_0	5		N	Preferred Brand	4	11	3	2	2	1	110		01	110		1	30		90				2	2	30		90				30		34	30.00		90.00																			30.00		60.00																30.00				30.00		1.00			1.00			0.88	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5427	098	0	1	01	01	H5427_098_0	5		N	Non-Preferred Drug	4	11	3	2	3	1	110		01	110		1	30		90				2	2	30		90				30		34	70.00		210.00																			70.00		140.00																70.00				70.00		2.33			2.33			2.06	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5427	098	0	1	01	01	H5427_098_0	5		N	Specialty Tier	4	11	1	1	4	1	010		01	010		1	30								30						30		34					33																				33																	33			33								Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5427	099	0	1	01	01	H5427_099_0	6		Y	Preferred Generic	4	11	3	2	1	1	110		01	110		1	30		100				2	2	30		100				30		34	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs												
H5427	099	0	1	01	01	H5427_099_0	6		Y	Preferred Generic	4	11	3	2	1	3	110		01	110		1	30		100				2	2	30		100				30		34	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs										1		3
H5427	099	0	1	01	01	H5427_099_0	6		Y	Preferred Brand	4	11	3	2	2	1	110		01	110		1	30		90				2	2	30		90				30		34	30.00		90.00																			30.00		60.00																30.00				30.00		1.00			1.00			0.88	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs												
H5427	099	0	1	01	01	H5427_099_0	6		Y	Non-Preferred Drug	4	11	3	2	3	1	110		01	110		1	30		90				2	2	30		90				30		34	60.00		180.00																			60.00		120.00																60.00				60.00		2.00			2.00			1.76	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs												
H5427	099	0	1	01	01	H5427_099_0	6		Y	Specialty Tier	4	11	1	1	4	1	010		01	010		1	30								30						30		34					33																				33																	33			33								Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs												
H5427	099	0	1	01	01	H5427_099_0	6		Y	Select Diabetic Drugs	4	10	1	2	5	1	110		01	110		1	30		90				1	2	30		90				30		34	10.00		30.00																			10.00		20.00																10.00				10.00		0.33			0.33			0.29	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs												
H5427	099	0	1	01	01	H5427_099_0	6		Y	Select Diabetic Drugs	4	10	1	2	5	3	110		01	110		1	30		90				1	2	30		90				30		34	10.00		30.00																			10.00		20.00																10.00				10.00		0.33			0.33			0.29	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs										1		
H5427	102	0	1	01	01	H5427_102_0	5		N	Preferred Generic	4	11	3	2	1	1	110		01	110		1	30		100				2	2	30		100				30		34	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5427	102	0	1	01	01	H5427_102_0	5		N	Preferred Brand	4	11	3	2	2	1	110		01	110		1	30		90				2	2	30		90				30		34	35.00		105.00																			35.00		70.00																35.00				35.00		1.17			1.17			1.03	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5427	102	0	1	01	01	H5427_102_0	5		N	Non-Preferred Drug	4	11	3	2	3	1	110		01	110		1	30		90				2	2	30		90				30		34	85.00		255.00																			85.00		170.00																85.00				85.00		2.83			2.83			2.50	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5427	102	0	1	01	01	H5427_102_0	5		N	Specialty Tier	4	11	1	1	4	1	010		01	010		1	30								30						30		34					33																				33																	33			33								Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5427	103	0	1	01	01	H5427_103_0	5		N	Preferred Generic	4	11	3	2	1	1	110		01	110		1	30		100				2	2	30		100				30		34	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5427	103	0	1	01	01	H5427_103_0	5		N	Preferred Brand	4	11	3	2	2	1	110		01	110		1	30		90				2	2	30		90				30		34	35.00		105.00																			35.00		70.00																35.00				35.00		1.17			1.17			1.03	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5427	103	0	1	01	01	H5427_103_0	5		N	Non-Preferred Drug	4	11	3	2	3	1	110		01	110		1	30		90				2	2	30		90				30		34	85.00		255.00																			85.00		170.00																85.00				85.00		2.83			2.83			2.50	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5427	103	0	1	01	01	H5427_103_0	5		N	Specialty Tier	4	11	1	1	4	1	010		01	010		1	30								30						30		34					33																				33																	33			33								Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5427	104	0	1	01	01	H5427_104_0	5		N	Preferred Generic	4	11	3	2	1	1	110		01	110		1	30		100				2	2	30		100				30		34	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5427	104	0	1	01	01	H5427_104_0	5		N	Preferred Generic	4	11	3	2	1	3	110		01	110		1	30		100				2	2	30		100				30		34	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H5427	104	0	1	01	01	H5427_104_0	5		N	Preferred Brand	4	11	3	2	2	1	110		01	110		1	30		90				2	2	30		90				30		34	20.00		60.00																			20.00		40.00																20.00				20.00		0.67			0.67			0.59	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5427	104	0	1	01	01	H5427_104_0	5		N	Non-Preferred Drug	4	11	3	2	3	1	110		01	110		1	30		90				2	2	30		90				30		34	60.00		180.00																			60.00		120.00																60.00				60.00		2.00			2.00			1.76	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5427	104	0	1	01	01	H5427_104_0	5		N	Specialty Tier	4	11	1	1	4	1	010		01	010		1	30								30						30		34					33																				33																	33			33								Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5427	105	0	1	01	01	H5427_105_0	5		N	Preferred Generic	4	11	3	2	1	1	110		01	110		1	30		100				2	2	30		100				30		34	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5427	105	0	1	01	01	H5427_105_0	5		N	Preferred Brand	4	11	3	2	2	1	110		01	110		1	30		90				2	2	30		90				30		34	35.00		105.00																			35.00		70.00																35.00				35.00		1.17			1.17			1.03	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5427	105	0	1	01	01	H5427_105_0	5		N	Non-Preferred Drug	4	11	3	2	3	1	110		01	110		1	30		90				2	2	30		90				30		34	85.00		255.00																			85.00		170.00																85.00				85.00		2.83			2.83			2.50	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5427	105	0	1	01	01	H5427_105_0	5		N	Specialty Tier	4	11	1	1	4	1	010		01	010		1	30								30						30		34					33																				33																	33			33								Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5427	106	0	1	01	01	H5427_106_0	5		N	Preferred Generic	4	11	3	2	1	1	110		01	110		1	30		100				2	2	30		100				30		34	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5427	106	0	1	01	01	H5427_106_0	5		N	Preferred Brand	4	11	3	2	2	1	110		01	110		1	30		90				2	2	30		90				30		34	30.00		90.00																			30.00		60.00																30.00				30.00		1.00			1.00			0.88	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5427	106	0	1	01	01	H5427_106_0	5		N	Non-Preferred Drug	4	11	3	2	3	1	110		01	110		1	30		90				2	2	30		90				30		34	80.00		240.00																			80.00		160.00																80.00				80.00		2.67			2.67			2.35	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5427	106	0	1	01	01	H5427_106_0	5		N	Specialty Tier	4	11	1	1	4	1	010		01	010		1	30								30						30		34					33																				33																	33			33								Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5427	107	0	1	01	01	H5427_107_0	5		N	Preferred Generic	4	11	3	2	1	1	110		01	110		1	30		100				2	2	30		100				30		34	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5427	107	0	1	01	01	H5427_107_0	5		N	Preferred Brand	4	11	3	2	2	1	110		01	110		1	30		90				2	2	30		90				30		34	30.00		90.00																			30.00		60.00																30.00				30.00		1.00			1.00			0.88	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5427	107	0	1	01	01	H5427_107_0	5		N	Non-Preferred Drug	4	11	3	2	3	1	110		01	110		1	30		90				2	2	30		90				30		34	60.00		180.00																			60.00		120.00																60.00				60.00		2.00			2.00			1.76	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5427	107	0	1	01	01	H5427_107_0	5		N	Specialty Tier	4	11	1	1	4	1	010		01	010		1	30								30						30		34					33																				33																	33			33								Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5427	108	0	1	01	01	H5427_108_0	6		N	Preferred Generic	4	11	3	2	1	1	110		01	110		1	30		100				2	2	30		100				30		34	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs												
H5427	108	0	1	01	01	H5427_108_0	6		N	Preferred Generic	4	11	3	2	1	3	110		01	110		1	30		100				2	2	30		100				30		34	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs										1		3
H5427	108	0	1	01	01	H5427_108_0	6		N	Preferred Brand	4	11	3	2	2	1	110		01	110		1	30		90				2	2	30		90				30		34	30.00		90.00																			30.00		60.00																30.00				30.00		1.00			1.00			0.88	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs												
H5427	108	0	1	01	01	H5427_108_0	6		N	Non-Preferred Drug	4	11	3	2	3	1	110		01	110		1	30		90				2	2	30		90				30		34	80.00		240.00																			80.00		160.00																80.00				80.00		2.67			2.67			2.35	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs												
H5427	108	0	1	01	01	H5427_108_0	6		N	Specialty Tier	4	11	1	1	4	1	010		01	010		1	30								30						30		34					33																				33																	33			33								Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs												
H5427	108	0	1	01	01	H5427_108_0	6		N	Select Diabetic Drugs	4	10	1	2	5	1	110		01	110		1	30		90				1	2	30		90				30		34	10.00		30.00																			10.00		20.00																10.00				10.00		0.33			0.33			0.29	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs												
H5427	109	0	1	01	01	H5427_109_0	5		N	Preferred Generic	4	11	3	2	1	1	110		01	110		1	30		100				2	2	30		100				30		34	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5427	109	0	1	01	01	H5427_109_0	5		N	Preferred Generic	4	11	3	2	1	3	110		01	110		1	30		100				2	2	30		100				30		34	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H5427	109	0	1	01	01	H5427_109_0	5		N	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	109	0	1	01	01	H5427_109_0	5		N	Non-Preferred Drug	4	11	3	2	3	1	110		01	110		1	30		90				2	2	30		90				30		34	70.00		210.00																			70.00		140.00																70.00				70.00		2.33			2.33			2.06	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5427	109	0	1	01	01	H5427_109_0	5		N	Specialty Tier	4	11	1	1	4	1	010		01	010		1	30								30						30		34					33																				33																	33			33								Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5427	110	0	1	01	01	H5427_110_0	5		N	Preferred Generic	4	11	3	2	1	1	110		01	110		1	30		100				2	2	30		100				30		34	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5427	110	0	1	01	01	H5427_110_0	5		N	Preferred Generic	4	11	3	2	1	3	110		01	110		1	30		100				2	2	30		100				30		34	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H5427	110	0	1	01	01	H5427_110_0	5		N	Preferred Brand	4	11	3	2	2	1	110		01	110		1	30		90				2	2	30		90				30		34	20.00		60.00																			20.00		40.00																20.00				20.00		0.67			0.67			0.59	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5427	110	0	1	01	01	H5427_110_0	5		N	Non-Preferred Drug	4	11	3	2	3	1	110		01	110		1	30		90				2	2	30		90				30		34	60.00		180.00																			60.00		120.00																60.00				60.00		2.00			2.00			1.76	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5427	110	0	1	01	01	H5427_110_0	5		N	Specialty Tier	4	11	1	1	4	1	010		01	010		1	30								30						30		34					33																				33																	33			33								Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5427	111	0	1	01	01	H5427_111_0	5		N	Preferred Generic	4	11	3	2	1	1	110		01	110		1	30		100				2	2	30		100				30		34	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5427	111	0	1	01	01	H5427_111_0	5		N	Preferred Generic	4	11	3	2	1	3	110		01	110		1	30		100				2	2	30		100				30		34	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H5427	111	0	1	01	01	H5427_111_0	5		N	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	111	0	1	01	01	H5427_111_0	5		N	Non-Preferred Drug	4	11	3	2	3	1	110		01	110		1	30		90				2	2	30		90				30		34	65.00		195.00																			65.00		130.00																65.00				65.00		2.17			2.17			1.91	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5427	111	0	1	01	01	H5427_111_0	5		N	Specialty Tier	4	11	1	1	4	1	010		01	010		1	30								30						30		34					33																				33																	33			33								Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5431	001	0	1	01	01	H5431_001_0	6			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	6			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	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 Brand, Specialty Tier, Supplemental Drugs												
H5431	001	0	1	01	01	H5431_001_0	6			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	6			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	6			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	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 Brand, Specialty Tier, Supplemental Drugs												
H5431	001	0	1	01	01	H5431_001_0	6			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	6			Preferred Generic	4	01	1	1	1	1	111		01	111		1	30	60	90				2	2	30	60	90				30		34				1.67	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	6			Generic	4	01	1	1	2	1	111		01	111		1	30	60	90				2	2	30	60	90				30		34				6.35	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	6			Preferred Brand	4	10	1	1	3	1	010		01	010		1	30								30						30		34				43.90	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	6			Non-Preferred Brand	4	10	1	1	4	1	010		01	010		1	30								30						30		34				70.98	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	6			Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		34					26																				26																	26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs												
H5431	006	0	1	01	01	H5431_006_0	6			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	6			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	6			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	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 Brand, Specialty Tier, Supplemental Drugs												
H5431	012	0	1	01	01	H5431_012_0	6			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	6			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	6			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	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 Brand, Specialty Tier, Supplemental Drugs												
H5431	012	0	1	01	01	H5431_012_0	6			Supplemental Drugs	4	11	2	2	6	1		010	01	010		1				30					30						30		34								0.00							0.00							0.00																		0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs												
H5431	013	0	1	01	01	H5431_013_0	6			Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs												
H5431	013	0	1	01	01	H5431_013_0	6			Preferred Generic	4	01	1	2	1	3		111	01	111		1				30	60	90	2	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs										1		
H5431	013	0	1	01	01	H5431_013_0	6			Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs												
H5431	013	0	1	01	01	H5431_013_0	6			Generic	4	01	1	2	2	3		111	01	111		1				30	60	90	2	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs										1		
H5431	013	0	1	01	01	H5431_013_0	6			Preferred Brand	4	10	1	2	3	1		010	01	010		1				30					30						30		34								20.00							15.00							15.00																		20.00				20.00			0.67	0.50	0.50			0.59	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs												
H5431	013	0	1	01	01	H5431_013_0	6			Non-Preferred Brand	4	10	1	2	4	1		010	01	010		1				30					30						30		34								35.00							30.00							30.00																		35.00				35.00			1.17	1.00	1.00			1.03	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs												
H5431	013	0	1	01	01	H5431_013_0	6			Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs												
H5431	013	0	1	01	01	H5431_013_0	6			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	016	0	1	01	01	H5431_016_0	6		N	Preferred Generic	4	01	1	1	1	1	111		01	111		1	30	60	90				2	2	30	60	90				30		34				1.71	25	25	25																		25	25	25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs												
H5431	016	0	1	01	01	H5431_016_0	6		N	Generic	4	01	1	1	2	1	111		01	111		1	30	60	90				2	2	30	60	90				30		34				6.36	25	25	25																		25	25	25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs												
H5431	016	0	1	01	01	H5431_016_0	6		N	Preferred Brand	4	10	1	1	3	1	010		01	010		1	30								30						30		34				44.04	25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs												
H5431	016	0	1	01	01	H5431_016_0	6		N	Non-Preferred Brand	4	10	1	1	4	1	010		01	010		1	30								30						30		34				79.58	25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs												
H5431	016	0	1	01	01	H5431_016_0	6		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		34					25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs												
H5431	016	0	1	01	01	H5431_016_0	6		N	Supplemental Drugs	4	11	2	2	6	1	010		01	010		1	30								30						30		34	0.00																					0.00																		0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs												
H5431	017	0	1	01	01	H5431_017_0	6			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	6			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	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 Brand, Specialty Tier, Supplemental Drugs												
H5431	017	0	1	01	01	H5431_017_0	6			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	6			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	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, Supplemental Drugs												
H5431	017	0	1	01	01	H5431_017_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 Brand, Specialty Tier, Supplemental Drugs												
H5431	017	0	1	01	01	H5431_017_0	6			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	6			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	6			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	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 Brand, Specialty Tier, Supplemental Drugs												
H5431	018	0	1	01	01	H5431_018_0	6			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	6			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	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, Supplemental Drugs												
H5431	018	0	1	01	01	H5431_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 Brand, Specialty Tier, Supplemental Drugs												
H5431	018	0	1	01	01	H5431_018_0	6			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	8		N	Preferred Generic	4	01	1	1	1	1	111		01	111		1	30	60	90				2	2	30	60	90				30		34				1.65	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	8		N	Generic	4	01	1	1	2	1	111		01	111		1	30	60	90				2	2	30	60	90				30		34				6.25	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	8		N	Preferred Brand	4	10	1	1	3	1	010		01	010		1	30								30						30		34				43.06	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	8		N	Non-Preferred Brand	4	10	1	1	4	1	010		01	010		1	30								30						30		34				72.10	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	8		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		34					25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs												
H5431	019	0	1	01	01	H5431_019_0	8		N	Supplemental Drugs	4	11	2	2	6	1	010		01	010		1	30								30						30		34	0.00																					0.00																		0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs												
H5431	020	0	1	01	01	H5431_020_0	6			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	020	0	1	01	01	H5431_020_0	6			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	020	0	1	01	01	H5431_020_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 Brand, Specialty Tier, Supplemental Drugs												
H5431	020	0	1	01	01	H5431_020_0	6			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	020	0	1	01	01	H5431_020_0	6			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	020	0	1	01	01	H5431_020_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, Supplemental Drugs												
H5431	020	0	1	01	01	H5431_020_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 Brand, Specialty Tier, Supplemental Drugs												
H5431	020	0	1	01	01	H5431_020_0	6			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												
H5433	001	0	1	01	01	H5433_001_0	5		N	Generic	4	11	3	2	1	1	111		01			1	30	60	90				2	2							30		31	0.00	0.00	0.00																																					0.00				0.00									Generic, Brand												
H5433	001	0	1	01	01	H5433_001_0	5		N	Generic	4	11	3	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		3
H5433	001	0	1	01	01	H5433_001_0	5		N	Brand	4	11	1	2	2	1	111		01			1	30	60	90				2	2							30		31	0.00	0.00	0.00																																					0.00				0.00									Generic, Brand												
H5434	002	0	1	04	01	H5434_002_0	6		Y	Preferred Generic	4	01	1	2	1	1	110		01	110		1	31		100				1	2	31		100				31		31	3.00		9.00																			3.00		9.00																3.00				3.00		0.10			0.10			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5434	002	0	1	04	01	H5434_002_0	6		Y	Preferred Generic	4	01	1	2	1	3	110		01	110		1	31		100				1	2	31		100				31		31	3.00		9.00																			3.00		9.00																3.00				3.00		0.00			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		Y	Generic	4	01	1	2	2	1	110		01	110		1	31		100				1	2	31		100				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	002	0	1	04	01	H5434_002_0	6		Y	Preferred Brand	4	11	1	2	3	1	110		01	110		1	31		90				1	2	31		90				31		31	40.00		120.00																			40.00		120.00																40.00				40.00		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		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01	110		1	31		90				1	2	31		90				31		31	93.00		279.00																			93.00		279.00																93.00				93.00		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		Y	Specialty Tier	4	11	1	1	5	1	010		01	010		1	31								31						31		31				1117.98	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		Y	Select Care Drugs	4	01	1	2	6	1	110		01	110		1	31		100				1	2	31		100				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	002	0	1	04	01	H5434_002_0	6		Y	Select Care Drugs	4	01	1	2	6	3	110		01	110		1	31		100				1	2	31		100				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	6		Y	Preferred Generic	4	01	1	2	1	1	110		01	110		1	31		100				1	2	31		100				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	6		Y	Preferred Generic	4	01	1	2	1	3	110		01	110		1	31		100				1	2	31		100				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	6		Y	Generic	4	01	1	2	2	1	110		01	110		1	31		100				1	2	31		100				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	6		Y	Preferred Brand	4	11	1	2	3	1	110		01	110		1	31		90				1	2	31		90				31		31	47.00		141.00																			47.00		141.00																47.00				47.00		1.52			1.52			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5434	023	0	1	04	01	H5434_023_0	6		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01	110		1	31		90				1	2	31		90				31		31	100.00		300.00																			100.00		300.00																100.00				100.00		3.23			3.23			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5434	023	0	1	04	01	H5434_023_0	6		Y	Specialty Tier	4	11	1	1	5	1	010		01	010		1	31								31						31		31				1233.64	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	6		Y	Select Care Drugs	4	01	1	2	6	1	110		01	110		1	31		100				1	2	31		100				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	6		Y	Select Care Drugs	4	01	1	2	6	3	110		01	110		1	31		100				1	2	31		100				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		Y	Preferred Generic	4	01	1	2	1	1	110		01	110		1	31		100				1	2	31		100				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		Y	Preferred Generic	4	01	1	2	1	3	110		01	110		1	31		100				1	2	31		100				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		Y	Generic	4	01	1	2	2	1	110		01	110		1	31		100				1	2	31		100				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		Y	Preferred Brand	4	11	1	2	3	1	110		01	110		1	31		90				1	2	31		90				31		31	47.00		141.00																			47.00		141.00																47.00				47.00		1.52			1.52			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5434	024	0	1	04	01	H5434_024_0	6		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01	110		1	31		90				1	2	31		90				31		31	100.00		300.00																			100.00		300.00																100.00				100.00		3.23			3.23			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5434	024	0	1	04	01	H5434_024_0	6		Y	Specialty Tier	4	11	1	1	5	1	010		01	010		1	31								31						31		31				1154.17	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		Y	Select Care Drugs	4	01	1	2	6	1	110		01	110		1	31		100				1	2	31		100				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		Y	Select Care Drugs	4	01	1	2	6	3	110		01	110		1	31		100				1	2	31		100				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		Y	Preferred Generic	4	01	1	2	1	1	110		01	110		1	31		100				1	2	31		100				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		Y	Preferred Generic	4	01	1	2	1	3	110		01	110		1	31		100				1	2	31		100				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		Y	Generic	4	01	1	2	2	1	110		01	110		1	31		100				1	2	31		100				31		31	5.00		15.00																			5.00		15.00																5.00				5.00		0.16			0.16			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5434	025	0	1	04	01	H5434_025_0	6		Y	Preferred Brand	4	11	1	2	3	1	110		01	110		1	31		90				1	2	31		90				31		31	47.00		141.00																			47.00		141.00																47.00				47.00		1.52			1.52			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5434	025	0	1	04	01	H5434_025_0	6		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01	110		1	31		90				1	2	31		90				31		31	100.00		300.00																			100.00		300.00																100.00				100.00		3.23			3.23			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5434	025	0	1	04	01	H5434_025_0	6		Y	Specialty Tier	4	11	1	1	5	1	010		01	010		1	31								31						31		31				1278.21	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		Y	Select Care Drugs	4	01	1	2	6	1	110		01	110		1	31		100				1	2	31		100				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		Y	Select Care Drugs	4	01	1	2	6	3	110		01	110		1	31		100				1	2	31		100				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		Y	Preferred Generic	4	01	1	2	1	1	110		01	110		1	31		100				1	2	31		100				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		Y	Generic	4	01	1	2	2	1	110		01	110		1	31		100				1	2	31		100				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		Y	Preferred Brand	4	11	1	2	3	1	110		01	110		1	31		90				1	2	31		90				31		31	47.00		141.00																			47.00		141.00																47.00				47.00		1.52			1.52			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5434	026	0	1	04	01	H5434_026_0	6		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01	110		1	31		90				1	2	31		90				31		31	100.00		300.00																			100.00		300.00																100.00				100.00		3.23			3.23			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5434	026	0	1	04	01	H5434_026_0	6		Y	Specialty Tier	4	11	1	1	5	1	010		01	010		1	31								31						31		31				1114.33	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		Y	Select Care Drugs	4	01	1	2	6	1	110		01	110		1	31		100				1	2	31		100				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		Y	Select Care Drugs	4	01	1	2	6	3	110		01	110		1	31		100				1	2	31		100				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		Y	Preferred Generic	4	01	1	2	1	1	110		01	110		1	31		100				1	2	31		100				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		Y	Generic	4	01	1	2	2	1	110		01	110		1	31		100				1	2	31		100				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		Y	Preferred Brand	4	11	1	2	3	1	110		01	110		1	31		90				1	2	31		90				31		31	47.00		141.00																			47.00		141.00																47.00				47.00		1.52			1.52			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5434	030	0	1	04	01	H5434_030_0	6		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01	110		1	31		90				1	2	31		90				31		31	100.00		300.00																			100.00		300.00																100.00				100.00		3.23			3.23			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5434	030	0	1	04	01	H5434_030_0	6		Y	Specialty Tier	4	11	1	1	5	1	010		01	010		1	31								31						31		31				1092.06	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		Y	Select Care Drugs	4	01	1	2	6	1	110		01	110		1	31		100				1	2	31		100				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		Y	Select Care Drugs	4	01	1	2	6	3	110		01	110		1	31		100				1	2	31		100				31		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H5434	031	0	1	04	01	H5434_031_0	7		Y	Preferred Generic	4	01	1	2	1	1	110		01	110		1	31		100				1	2	31		100				31		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5434	031	0	1	04	01	H5434_031_0	7		Y	Generic	4	01	1	2	2	1	110		01	110		1	31		100				1	2	31		100				31		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, Select Care Drugs												
H5434	031	0	1	04	01	H5434_031_0	7		Y	Preferred Brand	4	11	1	2	3	1	110		01	110		1	31		90				1	2	31		90				31		31	47.00		141.00																			47.00		141.00																47.00				47.00		1.52			1.52			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5434	031	0	1	04	01	H5434_031_0	7		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01	110		1	31		90				1	2	31		90				31		31	100.00		300.00																			100.00		300.00																100.00				100.00		3.23			3.23			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5434	031	0	1	04	01	H5434_031_0	7		Y	Specialty Tier	4	11	1	1	5	1	010		01	010		1	31								31						31		31				1276.22	30																				30																	30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5434	031	0	1	04	01	H5434_031_0	7		Y	Select Care Drugs	4	01	1	2	6	1	110		01	110		1	31		100				1	2	31		100				31		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5434	031	0	1	04	01	H5434_031_0	7		Y	Select Care Drugs	4	01	1	2	6	3	110		01	110		1	31		100				1	2	31		100				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		Y	Preferred Generic	4	01	1	2	1	1	110		01	110		1	31		100				1	2	31		100				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		Y	Generic	4	01	1	2	2	1	110		01	110		1	31		100				1	2	31		100				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		Y	Preferred Brand	4	11	1	2	3	1	110		01	110		1	31		90				1	2	31		90				31		31	47.00		141.00																			47.00		141.00																47.00				47.00		1.52			1.52			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5434	032	0	1	04	01	H5434_032_0	6		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01	110		1	31		90				1	2	31		90				31		31	100.00		300.00																			100.00		300.00																100.00				100.00		3.23			3.23			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5434	032	0	1	04	01	H5434_032_0	6		Y	Specialty Tier	4	11	1	1	5	1	010		01	010		1	31								31						31		31				1234.63	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		Y	Select Care Drugs	4	01	1	2	6	1	110		01	110		1	31		100				1	2	31		100				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		Y	Select Care Drugs	4	01	1	2	6	3	110		01	110		1	31		100				1	2	31		100				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		Y	Preferred Generic	4	01	1	2	1	1	110		01	110		1	31		100				1	2	31		100				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		Y	Generic	4	01	1	2	2	1	110		01	110		1	31		100				1	2	31		100				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		Y	Preferred Brand	4	11	1	2	3	1	110		01	110		1	31		90				1	2	31		90				31		31	47.00		141.00																			47.00		141.00																47.00				47.00		1.52			1.52			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5434	033	0	1	04	01	H5434_033_0	6		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01	110		1	31		90				1	2	31		90				31		31	100.00		300.00																			100.00		300.00																100.00				100.00		3.23			3.23			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5434	033	0	1	04	01	H5434_033_0	6		Y	Specialty Tier	4	11	1	1	5	1	010		01	010		1	31								31						31		31				1113.08	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		Y	Select Care Drugs	4	01	1	2	6	1	110		01	110		1	31		100				1	2	31		100				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		Y	Select Care Drugs	4	01	1	2	6	3	110		01	110		1	31		100				1	2	31		100				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		Y	Preferred Generic	4	01	1	2	1	1	110		01	110		1	31		100				1	2	31		100				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		Y	Generic	4	01	1	2	2	1	110		01	110		1	31		100				1	2	31		100				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		Y	Preferred Brand	4	11	1	2	3	1	110		01	110		1	31		90				1	2	31		90				31		31	47.00		141.00																			47.00		141.00																47.00				47.00		1.52			1.52			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5434	034	0	1	04	01	H5434_034_0	6		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01	110		1	31		90				1	2	31		90				31		31	100.00		300.00																			100.00		300.00																100.00				100.00		3.23			3.23			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5434	034	0	1	04	01	H5434_034_0	6		Y	Specialty Tier	4	11	1	1	5	1	010		01	010		1	31								31						31		31				1366.53	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		Y	Select Care Drugs	4	01	1	2	6	1	110		01	110		1	31		100				1	2	31		100				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		Y	Select Care Drugs	4	01	1	2	6	3	110		01	110		1	31		100				1	2	31		100				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	5		Y	Preferred Generic	4	01	1	2	1	1	110		01	110		1	31		100				1	2	31		100				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	5		Y	Generic	4	01	1	2	2	1	110		01	110		1	31		100				1	2	31		100				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	035	0	1	04	01	H5434_035_0	5		Y	Preferred Brand	4	11	1	2	3	1	110		01	110		1	31		90				1	2	31		90				31		31	47.00		141.00																			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	5		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01	110		1	31		90				1	2	31		90				31		31	100.00		300.00																			100.00		300.00																100.00				100.00		3.23			3.23			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5434	035	0	1	04	01	H5434_035_0	5		Y	Specialty Tier	4	11	1	1	5	1	010		01	010		1	31								31						31		31				1285.09	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	5		Y	Select Care Drugs	4	01	1	2	6	1	110		01	110		1	31		100				1	2	31		100				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	5		Y	Select Care Drugs	4	01	1	2	6	3	110		01	110		1	31		100				1	2	31		100				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	5		Y	Preferred Generic	4	01	1	2	1	1	110		01	110		1	31		100				1	2	31		100				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	5		Y	Generic	4	01	1	2	2	1	110		01	110		1	31		100				1	2	31		100				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	5		Y	Preferred Brand	4	11	1	2	3	1	110		01	110		1	31		90				1	2	31		90				31		31	47.00		141.00																			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	5		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01	110		1	31		90				1	2	31		90				31		31	100.00		300.00																			100.00		300.00																100.00				100.00		3.23			3.23			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5434	036	0	1	04	01	H5434_036_0	5		Y	Specialty Tier	4	11	1	1	5	1	010		01	010		1	31								31						31		31				1382.96	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	5		Y	Select Care Drugs	4	01	1	2	6	1	110		01	110		1	31		100				1	2	31		100				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	5		Y	Select Care Drugs	4	01	1	2	6	3	110		01	110		1	31		100				1	2	31		100				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	4		Y	Preferred Generic	4	01	1	2	1	1	110		01	110		1	31		100				1	2	31		100				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	4		Y	Preferred Generic	4	01	1	2	1	3	110		01	110		1	31		100				1	2	31		100				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	4		Y	Generic	4	01	1	2	2	1	110		01	110		1	31		100				1	2	31		100				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	4		Y	Preferred Brand	4	11	1	2	3	1	110		01	110		1	31		90				1	2	31		90				31		31	47.00		141.00																			47.00		141.00																47.00				47.00		1.52			1.52			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5434	039	0	1	04	01	H5434_039_0	4		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01	110		1	31		90				1	2	31		90				31		31	100.00		300.00																			100.00		300.00																100.00				100.00		3.23			3.23			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5434	039	0	1	04	01	H5434_039_0	4		Y	Specialty Tier	4	11	1	1	5	1	010		01	010		1	31								31						31		31				1211.56	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	4		Y	Select Care Drugs	4	01	1	2	6	1	110		01	110		1	31		100				1	2	31		100				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	4		Y	Select Care Drugs	4	01	1	2	6	3	110		01	110		1	31		100				1	2	31		100				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		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												
H5435	024	0	1	09	04	H5435_024_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												
H5435	024	0	1	09	04	H5435_024_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
H5435	024	0	1	09	04	H5435_024_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												
H5435	024	0	1	09	04	H5435_024_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												
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				259.00	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								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												
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	4			Preferred Generic	4	11	3	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	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												
H5439	015	0	1	04	01	H5439_015_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	015	0	1	04	01	H5439_015_0	4			Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											47.00	94.00	141.00				37.00	74.00	74.00				47.00				47.00			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	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	015	0	1	04	01	H5439_015_0	4			Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												29							29												29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5439	015	0	1	04	01	H5439_015_0	4			Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	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	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	017	0	1	04	01	H5439_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								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00				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												
H5439	017	0	1	04	01	H5439_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								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00				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
H5439	017	0	1	04	01	H5439_017_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												
H5439	017	0	1	04	01	H5439_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												
H5439	017	0	1	04	01	H5439_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												
H5439	017	0	1	04	01	H5439_017_0	4			Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												29							29												29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5439	017	0	1	04	01	H5439_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												
H5439	017	0	1	04	01	H5439_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	
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								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00				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												
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								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00				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										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	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												
H5439	019	0	1	04	01	H5439_019_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
H5439	019	0	1	04	01	H5439_019_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												
H5439	019	0	1	04	01	H5439_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												
H5439	019	0	1	04	01	H5439_019_0	5			Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	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	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												
H5439	019	0	1	04	01	H5439_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												
H5439	019	0	1	04	01	H5439_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	
H5447	001	0	1	01	01	H5447_001_0	4		Y	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	4		Y	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	4		Y	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	4		Y	Non-Preferred Brand	4	10	1	1	4	1	111		10	111		1	30	60	90				1	2	30	60	90					29	31				99.60	29	29	29																		29	29	29																29		29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5447	001	0	1	01	01	H5447_001_0	4		Y	Specialty Tier	4	11	1	1	5	1	010		10	010		1	30								30							29	31				1174.20	29																				29																		29		29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5447	002	0	1	01	01	H5447_002_0	5		N	Preferred Generic	3	01	1	1	1	1	111		10	111		1	30	60	90				1	2	30	60	90					29	31				4.23	25	25	25																		25	25	25																25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5447	002	0	1	01	01	H5447_002_0	5		N	Generic	3	01	1	1	2	1	111		10	111		1	30	60	90				1	2	30	60	90					29	31				14.90	25	25	25																		25	25	25																25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5447	002	0	1	01	01	H5447_002_0	5		N	Preferred Brand	3	10	1	1	3	1	111		10	111		1	30	60	90				1	2	30	60	90					29	31				112.85	25	25	25																		25	25	25																25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5447	002	0	1	01	01	H5447_002_0	5		N	Non-Preferred Brand	3	10	1	1	4	1	111		10	111		1	30	60	90				1	2	30	60	90					29	31				63.71	25	25	25																		25	25	25																25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5447	002	0	1	01	01	H5447_002_0	5		N	Specialty Tier	3	11	1	1	5	1	010		10	010		1	30								30							29	31				946.55	25																				25																		25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5454	001	0	1	01	01	H5454_001_0	5		Y	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		Y	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		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5454	001	0	1	01	01	H5454_001_0	5		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								100.00	200.00	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		Y	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	5		Y	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	5		Y	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	5		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5454	002	0	1	01	01	H5454_002_0	5		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								100.00	200.00	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	5		Y	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		N	Preferred Generic	4	01	3	2	1	1		111	01	111		1				30	60	100	2	2	30	60	100				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 Brand, Specialty Tier												
H5471	064	0	1	01	01	H5471_064_0	6		N	Generic	4	11	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								20.00	40.00	60.00					20.00	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		N	Preferred Brand	4	10	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								47.00	94.00	141.00					47.00	94.00	141.00					47.00	141.00	141.00																47.00				47.00			1.57	1.57	1.57			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	064	0	1	01	01	H5471_064_0	6		N	Non-Preferred Brand	4	10	1	2	4	1		010	01	010		1				30					30						30		34								100.00							95.00							95.00																		100.00				100.00			3.33	3.17	3.17			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	064	0	1	01	01	H5471_064_0	6		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												25							25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	065	0	1	01	01	H5471_065_0	6		N	Preferred Generic	4	01	3	2	1	1	111		01	111		1	30	60	100				2	2	30	60	100				30		34	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	065	0	1	01	01	H5471_065_0	6		N	Preferred Generic	4	01	3	2	1	3	111		01	111		1	30	60	100				2	2	30	60	100				30		34	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		3
H5471	065	0	1	01	01	H5471_065_0	6		N	Generic	4	11	1	2	2	1	111		01	111		1	30	60	90				2	2	30	60	90				30		34	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	065	0	1	01	01	H5471_065_0	6		N	Generic	4	11	1	2	2	3	111		01	111		1	30	60	90				2	2	30	60	90				30		34	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5471	065	0	1	01	01	H5471_065_0	6		N	Preferred Brand	4	10	1	2	3	1	111		01	111		1	30	60	90				2	2	30	60	90				30		34	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	065	0	1	01	01	H5471_065_0	6		N	Non-Preferred Brand	4	10	1	2	4	1	010		01	010		1	30								30						30		34	5.00																					5.00																		5.00				5.00		0.17			0.17			0.15	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	065	0	1	01	01	H5471_065_0	6		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		34					33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	066	0	1	01	01	H5471_066_0	6		N	Preferred Generic	4	01	3	2	1	1		111	01	111		1				30	60	100	2	2	30	60	100				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 Brand, Specialty Tier												
H5471	066	0	1	01	01	H5471_066_0	6		N	Generic	4	11	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								20.00	40.00	60.00					20.00	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		N	Preferred Brand	4	10	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								47.00	94.00	141.00					47.00	94.00	141.00					47.00	141.00	141.00																47.00				47.00			1.57	1.57	1.57			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	066	0	1	01	01	H5471_066_0	6		N	Non-Preferred Brand	4	10	1	2	4	1		010	01	010		1				30					30						30		34								100.00							95.00							95.00																		100.00				100.00			3.33	3.17	3.17			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	066	0	1	01	01	H5471_066_0	6		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												25							25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	067	0	1	01	01	H5471_067_0	6		N	Preferred Generic	4	01	1	2	1	1	111		01			1	30	60	100				2	2							30		34	4.00	8.00	12.00																																					4.00				4.00		0.13						0.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	067	0	1	01	01	H5471_067_0	6		N	Generic	4	11	1	2	2	1	111		01			1	30	60	90				2	2							30		34	5.00	10.00	15.00																																					5.00				5.00		0.17						0.15	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	067	0	1	01	01	H5471_067_0	6		N	Preferred Brand	4	10	1	1	3	1	111		01			1	30	60	90				2	2							30		34				93.59	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		N	Non-Preferred Brand	4	10	1	1	4	1	010		01			1	30														30		34				86.17	25																																					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	067	0	1	01	01	H5471_067_0	6		N	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		34					25																																					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	068	0	1	01	01	H5471_068_0	6		N	Preferred Generic	4	01	1	2	1	1	111		01			1	30	60	100				2	2							30		34	0.00	0.00	0.00																																					0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	068	0	1	01	01	H5471_068_0	6		N	Preferred Generic	4	01	1	2	1	3	111		01			1	30	60	100				2	2							30		34	0.00	0.00	0.00																																					0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5471	068	0	1	01	01	H5471_068_0	6		N	Generic	4	11	1	2	2	1	111		01			1	30	60	90				2	2							30		34	5.00	10.00	15.00																																					5.00				5.00		0.17						0.15	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	068	0	1	01	01	H5471_068_0	6		N	Preferred Brand	4	10	1	1	3	1	111		01			1	30	60	90				2	2							30		34				91.00	25	25	25																																			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	068	0	1	01	01	H5471_068_0	6		N	Non-Preferred Brand	4	10	1	1	4	1	010		01			1	30														30		34				88.26	25																																					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	068	0	1	01	01	H5471_068_0	6		N	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		34					25																																					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	069	0	1	01	01	H5471_069_0	6		Y	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		Y	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		Y	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		Y	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		Y	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		Y	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		Y	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		Y	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		Y	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		Y	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		Y	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		Y	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		Y	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		Y	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		Y	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		Y	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		Y	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		Y	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		N	Preferred Generic	4	01	3	2	1	1	111		01	111		1	30	60	100				2	2	30	60	100				30		34	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	071	0	1	01	01	H5471_071_0	6		N	Preferred Generic	4	01	3	2	1	3	111		01	111		1	30	60	100				2	2	30	60	100				30		34	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		3
H5471	071	0	1	01	01	H5471_071_0	6		N	Generic	4	11	1	2	2	1	111		01	111		1	30	60	90				2	2	30	60	90				30		34	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	071	0	1	01	01	H5471_071_0	6		N	Generic	4	11	1	2	2	3	111		01	111		1	30	60	90				2	2	30	60	90				30		34	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5471	071	0	1	01	01	H5471_071_0	6		N	Preferred Brand	4	10	1	2	3	1	111		01	111		1	30	60	90				2	2	30	60	90				30		34	10.00	20.00	30.00																			10.00	30.00	30.00																10.00				10.00		0.33			0.33			0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	071	0	1	01	01	H5471_071_0	6		N	Non-Preferred Brand	4	10	1	2	4	1	010		01	010		1	30								30						30		34	55.00																					55.00																		55.00				55.00		1.83			1.83			1.62	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	071	0	1	01	01	H5471_071_0	6		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		34					33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	072	0	1	01	01	H5471_072_0	6		N	Preferred Generic	4	01	3	2	1	1		111	01	111		1				30	60	100	2	2	30	60	100				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 Brand, Specialty Tier												
H5471	072	0	1	01	01	H5471_072_0	6		N	Generic	4	11	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								20.00	40.00	60.00					20.00	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		N	Preferred Brand	4	10	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								47.00	94.00	141.00					47.00	94.00	141.00					47.00	141.00	141.00																47.00				47.00			1.57	1.57	1.57			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	072	0	1	01	01	H5471_072_0	6		N	Non-Preferred Brand	4	10	1	2	4	1		010	01	010		1				30					30						30		34								100.00							95.00							95.00																		100.00				100.00			3.33	3.17	3.17			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	072	0	1	01	01	H5471_072_0	6		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												25							25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	073	0	1	01	01	H5471_073_0	6		Y	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		Y	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		Y	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		Y	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		Y	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	50.00	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		Y	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	50.00	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		Y	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		Y	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		Y	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		N	Preferred Generic	4	01	3	2	1	1	111		01	111		1	30	60	100				2	2	30	60	100				30		34	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	074	0	1	01	01	H5471_074_0	6		N	Preferred Generic	4	01	3	2	1	3	111		01	111		1	30	60	100				2	2	30	60	100				30		34	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		3
H5471	074	0	1	01	01	H5471_074_0	6		N	Generic	4	11	1	2	2	1	111		01	111		1	30	60	90				2	2	30	60	90				30		34	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	074	0	1	01	01	H5471_074_0	6		N	Generic	4	11	1	2	2	3	111		01	111		1	30	60	90				2	2	30	60	90				30		34	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5471	074	0	1	01	01	H5471_074_0	6		N	Preferred Brand	4	10	1	2	3	1	111		01	111		1	30	60	90				2	2	30	60	90				30		34	25.00	50.00	75.00																			25.00	75.00	75.00																25.00				25.00		0.83			0.83			0.74	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	074	0	1	01	01	H5471_074_0	6		N	Non-Preferred Brand	4	10	1	2	4	1	010		01	010		1	30								30						30		34	75.00																					75.00																		75.00				75.00		2.50			2.50			2.21	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	074	0	1	01	01	H5471_074_0	6		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		34					33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	075	0	1	01	01	H5471_075_0	8		Y	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		Y	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		Y	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		Y	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		Y	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	60.00	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		Y	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	60.00	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		Y	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		Y	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		Y	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		N	Preferred Generic	4	01	3	2	1	1		111	01	111		1				30	60	100	2	2	30	60	100				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 Brand, Specialty Tier												
H5471	076	0	1	01	01	H5471_076_0	6		N	Generic	4	11	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								20.00	40.00	60.00					20.00	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		N	Preferred Brand	4	10	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								47.00	94.00	141.00					47.00	94.00	141.00					47.00	141.00	141.00																47.00				47.00			1.57	1.57	1.57			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	076	0	1	01	01	H5471_076_0	6		N	Non-Preferred Brand	4	10	1	2	4	1		010	01	010		1				30					30						30		34								100.00							95.00							95.00																		100.00				100.00			3.33	3.17	3.17			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	076	0	1	01	01	H5471_076_0	6		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												25							25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	077	0	1	01	01	H5471_077_0	6		N	Preferred Generic	4	01	3	2	1	1	111		01	111		1	30	60	100				2	2	30	60	100				30		34	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	077	0	1	01	01	H5471_077_0	6		N	Preferred Generic	4	01	3	2	1	3	111		01	111		1	30	60	100				2	2	30	60	100				30		34	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		3
H5471	077	0	1	01	01	H5471_077_0	6		N	Generic	4	11	1	2	2	1	111		01	111		1	30	60	90				2	2	30	60	90				30		34	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	077	0	1	01	01	H5471_077_0	6		N	Generic	4	11	1	2	2	3	111		01	111		1	30	60	90				2	2	30	60	90				30		34	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5471	077	0	1	01	01	H5471_077_0	6		N	Preferred Brand	4	10	1	2	3	1	111		01	111		1	30	60	90				2	2	30	60	90				30		34	15.00	30.00	45.00																			15.00	45.00	45.00																15.00				15.00		0.50			0.50			0.44	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	077	0	1	01	01	H5471_077_0	6		N	Non-Preferred Brand	4	10	1	2	4	1	010		01	010		1	30								30						30		34	75.00																					75.00																		75.00				75.00		2.50			2.50			2.21	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	077	0	1	01	01	H5471_077_0	6		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		34					33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	078	0	1	01	01	H5471_078_0	6		N	Preferred Generic	4	01	3	2	1	1	111		01	111		1	30	60	100				2	2	30	60	100				30		34	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	078	0	1	01	01	H5471_078_0	6		N	Preferred Generic	4	01	3	2	1	3	111		01	111		1	30	60	100				2	2	30	60	100				30		34	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		3
H5471	078	0	1	01	01	H5471_078_0	6		N	Generic	4	11	1	2	2	1	111		01	111		1	30	60	90				2	2	30	60	90				30		34	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	078	0	1	01	01	H5471_078_0	6		N	Generic	4	11	1	2	2	3	111		01	111		1	30	60	90				2	2	30	60	90				30		34	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5471	078	0	1	01	01	H5471_078_0	6		N	Preferred Brand	4	10	1	2	3	1	111		01	111		1	30	60	90				2	2	30	60	90				30		34	35.00	70.00	105.00																			35.00	105.00	105.00																35.00				35.00		1.17			1.17			1.03	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	078	0	1	01	01	H5471_078_0	6		N	Non-Preferred Brand	4	10	1	2	4	1	010		01	010		1	30								30						30		34	75.00																					75.00																		75.00				75.00		2.50			2.50			2.21	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	078	0	1	01	01	H5471_078_0	6		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		34					33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	080	0	1	01	01	H5471_080_0	6		Y	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		Y	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		Y	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		Y	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		Y	Preferred Brand	4	10	1	2	3	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				15.00		0.50			0.50			0.44	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	080	0	1	01	01	H5471_080_0	6		Y	Preferred Brand	4	10	1	2	3	3	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				15.00		0.50			0.50			0.44	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2		
H5471	080	0	1	01	01	H5471_080_0	6		Y	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		Y	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		Y	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		N	Preferred Generic	4	01	3	2	1	1		111	01	111		1				30	60	100	2	2	30	60	100				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 Brand, Specialty Tier												
H5471	082	0	1	01	01	H5471_082_0	6		N	Generic	4	11	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								20.00	40.00	60.00					20.00	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		N	Preferred Brand	4	10	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								47.00	94.00	141.00					47.00	94.00	141.00					47.00	141.00	141.00																47.00				47.00			1.57	1.57	1.57			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	082	0	1	01	01	H5471_082_0	6		N	Non-Preferred Brand	4	10	1	2	4	1		010	01	010		1				30					30						30		34								100.00							95.00							95.00																		100.00				100.00			3.33	3.17	3.17			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	082	0	1	01	01	H5471_082_0	6		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												25							25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	083	0	1	01	01	H5471_083_0	6		N	Preferred Generic	4	01	3	2	1	1	111		01	111		1	30	60	100				2	2	30	60	100				30		34	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	083	0	1	01	01	H5471_083_0	6		N	Preferred Generic	4	01	3	2	1	3	111		01	111		1	30	60	100				2	2	30	60	100				30		34	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		3
H5471	083	0	1	01	01	H5471_083_0	6		N	Generic	4	11	1	2	2	1	111		01	111		1	30	60	90				2	2	30	60	90				30		34	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	083	0	1	01	01	H5471_083_0	6		N	Generic	4	11	1	2	2	3	111		01	111		1	30	60	90				2	2	30	60	90				30		34	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5471	083	0	1	01	01	H5471_083_0	6		N	Preferred Brand	4	10	1	2	3	1	111		01	111		1	30	60	90				2	2	30	60	90				30		34	15.00	30.00	45.00																			15.00	45.00	45.00																15.00				15.00		0.50			0.50			0.44	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	083	0	1	01	01	H5471_083_0	6		N	Non-Preferred Brand	4	10	1	2	4	1	010		01	010		1	30								30						30		34	75.00																					75.00																		75.00				75.00		2.50			2.50			2.21	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	083	0	1	01	01	H5471_083_0	6		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		34					33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	084	0	1	01	01	H5471_084_0	6		N	Preferred Generic	4	01	3	2	1	1		111	01	111		1				30	60	100	2	2	30	60	100				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 Brand, Specialty Tier												
H5471	084	0	1	01	01	H5471_084_0	6		N	Generic	4	11	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								20.00	40.00	60.00					20.00	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		N	Preferred Brand	4	10	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								47.00	94.00	141.00					47.00	94.00	141.00					47.00	141.00	141.00																47.00				47.00			1.57	1.57	1.57			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	084	0	1	01	01	H5471_084_0	6		N	Non-Preferred Brand	4	10	1	2	4	1		010	01	010		1				30					30						30		34								100.00							95.00							95.00																		100.00				100.00			3.33	3.17	3.17			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	084	0	1	01	01	H5471_084_0	6		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												25							25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	085	0	1	01	01	H5471_085_0	6		Y	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		Y	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		Y	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		Y	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		Y	Preferred Brand	4	10	1	2	3	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				15.00		0.50			0.50			0.44	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	085	0	1	01	01	H5471_085_0	6		Y	Preferred Brand	4	10	1	2	3	3	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				15.00		0.50			0.50			0.44	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2		
H5471	085	0	1	01	01	H5471_085_0	6		Y	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		Y	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		Y	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		N	Preferred Generic	4	01	1	2	1	1	111		01			1	30	60	100				2	2							30		34	4.00	8.00	12.00																																					4.00				4.00		0.13						0.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	092	0	1	01	01	H5471_092_0	6		N	Generic	4	11	1	2	2	1	111		01			1	30	60	90				2	2							30		34	5.00	10.00	15.00																																					5.00				5.00		0.17						0.15	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	092	0	1	01	01	H5471_092_0	6		N	Preferred Brand	4	10	1	1	3	1	111		01			1	30	60	90				2	2							30		34				89.19	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		N	Non-Preferred Brand	4	10	1	1	4	1	010		01			1	30														30		34				82.26	25																																					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	092	0	1	01	01	H5471_092_0	6		N	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		34					25																																					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	093	0	1	01	01	H5471_093_0	8		N	Preferred Generic	4	01	1	2	1	1	111		01			1	30	60	100				2	2							30		34	0.00	0.00	0.00																																					0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	093	0	1	01	01	H5471_093_0	8		N	Preferred Generic	4	01	1	2	1	3	111		01			1	30	60	100				2	2							30		34	0.00	0.00	0.00																																					0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5471	093	0	1	01	01	H5471_093_0	8		N	Generic	4	11	1	2	2	1	111		01			1	30	60	90				2	2							30		34	5.00	10.00	15.00																																					5.00				5.00		0.17						0.15	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	093	0	1	01	01	H5471_093_0	8		N	Preferred Brand	4	10	1	1	3	1	111		01			1	30	60	90				2	2							30		34				91.08	25	25	25																																			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	093	0	1	01	01	H5471_093_0	8		N	Non-Preferred Brand	4	10	1	1	4	1	010		01			1	30														30		34				84.12	25																																					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	093	0	1	01	01	H5471_093_0	8		N	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		34					25																																					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	103	0	1	01	01	H5471_103_0	6		N	Preferred Generic	4	01	3	2	1	1	111		01	111		1	30	60	100				2	2	30	60	100				30		34	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	103	0	1	01	01	H5471_103_0	6		N	Preferred Generic	4	01	3	2	1	3	111		01	111		1	30	60	100				2	2	30	60	100				30		34	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		3
H5471	103	0	1	01	01	H5471_103_0	6		N	Generic	4	11	1	2	2	1	111		01	111		1	30	60	90				2	2	30	60	90				30		34	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	103	0	1	01	01	H5471_103_0	6		N	Generic	4	11	1	2	2	3	111		01	111		1	30	60	90				2	2	30	60	90				30		34	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5471	103	0	1	01	01	H5471_103_0	6		N	Preferred Brand	4	10	1	2	3	1	111		01	111		1	30	60	90				2	2	30	60	90				30		34	47.00	94.00	141.00																			47.00	141.00	141.00																47.00				47.00		1.57			1.57			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	103	0	1	01	01	H5471_103_0	6		N	Non-Preferred Brand	4	10	1	2	4	1	010		01	010		1	30								30						30		34	100.00																					100.00																		100.00				100.00		3.33			3.33			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	103	0	1	01	01	H5471_103_0	6		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		34					33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	104	0	1	01	01	H5471_104_0	6		N	Preferred Generic	4	01	3	2	1	1	111		01	111		1	30	60	100				2	2	30	60	100				30		34	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	104	0	1	01	01	H5471_104_0	6		N	Preferred Generic	4	01	3	2	1	3	111		01	111		1	30	60	100				2	2	30	60	100				30		34	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		3
H5471	104	0	1	01	01	H5471_104_0	6		N	Generic	4	11	1	2	2	1	111		01	111		1	30	60	90				2	2	30	60	90				30		34	10.00	20.00	30.00																			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		N	Generic	4	11	1	2	2	3	111		01	111		1	30	60	90				2	2	30	60	90				30		34	10.00	20.00	30.00																			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		N	Preferred Brand	4	10	1	2	3	1	111		01	111		1	30	60	90				2	2	30	60	90				30		34	47.00	94.00	141.00																			47.00	141.00	141.00																47.00				47.00		1.57			1.57			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	104	0	1	01	01	H5471_104_0	6		N	Non-Preferred Brand	4	10	1	2	4	1	010		01	010		1	30								30						30		34	100.00																					100.00																		100.00				100.00		3.33			3.33			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	104	0	1	01	01	H5471_104_0	6		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		34					33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	105	0	1	01	01	H5471_105_0	6		N	Preferred Generic	4	01	3	2	1	1	111		01	111		1	30	60	100				2	2	30	60	100				30		34	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	105	0	1	01	01	H5471_105_0	6		N	Preferred Generic	4	01	3	2	1	3	111		01	111		1	30	60	100				2	2	30	60	100				30		34	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		3
H5471	105	0	1	01	01	H5471_105_0	6		N	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		N	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		N	Preferred Brand	4	10	1	2	3	1	111		01	111		1	30	60	90				2	2	30	60	90				30		34	47.00	94.00	141.00																			47.00	141.00	141.00																47.00				47.00		1.57			1.57			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	105	0	1	01	01	H5471_105_0	6		N	Non-Preferred Brand	4	10	1	2	4	1	010		01	010		1	30								30						30		34	100.00																					100.00																		100.00				100.00		3.33			3.33			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	105	0	1	01	01	H5471_105_0	6		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		34					31																				31																	31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	106	0	1	01	01	H5471_106_0	7		N	Preferred Generic	4	01	3	2	1	1	111		01	111		1	30	60	100				2	2	30	60	100				30		34	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	106	0	1	01	01	H5471_106_0	7		N	Preferred Generic	4	01	3	2	1	3	111		01	111		1	30	60	100				2	2	30	60	100				30		34	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		3
H5471	106	0	1	01	01	H5471_106_0	7		N	Generic	4	11	1	2	2	1	111		01	111		1	30	60	90				2	2	30	60	90				30		34	20.00	40.00	60.00																			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	7		N	Generic	4	11	1	2	2	3	111		01	111		1	30	60	90				2	2	30	60	90				30		34	20.00	40.00	60.00																			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	7		N	Preferred Brand	4	10	1	2	3	1	111		01	111		1	30	60	90				2	2	30	60	90				30		34	47.00	94.00	141.00																			47.00	141.00	141.00																47.00				47.00		1.57			1.57			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	106	0	1	01	01	H5471_106_0	7		N	Non-Preferred Brand	4	10	1	2	4	1	010		01	010		1	30								30						30		34	100.00																					100.00																		100.00				100.00		3.33			3.33			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	106	0	1	01	01	H5471_106_0	7		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		34					33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	107	0	1	01	01	H5471_107_0	6		N	Preferred Generic	4	01	3	2	1	1	111		01	111		1	30	60	100				2	2	30	60	100				30		34	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	107	0	1	01	01	H5471_107_0	6		N	Preferred Generic	4	01	3	2	1	3	111		01	111		1	30	60	100				2	2	30	60	100				30		34	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		3
H5471	107	0	1	01	01	H5471_107_0	6		N	Generic	4	11	1	2	2	1	111		01	111		1	30	60	90				2	2	30	60	90				30		34	10.00	20.00	30.00																			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		N	Generic	4	11	1	2	2	3	111		01	111		1	30	60	90				2	2	30	60	90				30		34	10.00	20.00	30.00																			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		N	Preferred Brand	4	10	1	2	3	1	111		01	111		1	30	60	90				2	2	30	60	90				30		34	47.00	94.00	141.00																			47.00	141.00	141.00																47.00				47.00		1.57			1.57			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	107	0	1	01	01	H5471_107_0	6		N	Non-Preferred Brand	4	10	1	2	4	1	010		01	010		1	30								30						30		34	100.00																					100.00																		100.00				100.00		3.33			3.33			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	107	0	1	01	01	H5471_107_0	6		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		34					33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	108	0	1	01	01	H5471_108_0	6		N	Preferred Generic	4	01	3	2	1	1	111		01	111		1	30	60	100				2	2	30	60	100				30		34	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	108	0	1	01	01	H5471_108_0	6		N	Preferred Generic	4	01	3	2	1	3	111		01	111		1	30	60	100				2	2	30	60	100				30		34	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		3
H5471	108	0	1	01	01	H5471_108_0	6		N	Generic	4	11	1	2	2	1	111		01	111		1	30	60	90				2	2	30	60	90				30		34	20.00	40.00	60.00																			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	108	0	1	01	01	H5471_108_0	6		N	Generic	4	11	1	2	2	3	111		01	111		1	30	60	90				2	2	30	60	90				30		34	20.00	40.00	60.00																			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	108	0	1	01	01	H5471_108_0	6		N	Preferred Brand	4	10	1	2	3	1	111		01	111		1	30	60	90				2	2	30	60	90				30		34	47.00	94.00	141.00																			47.00	141.00	141.00																47.00				47.00		1.57			1.57			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	108	0	1	01	01	H5471_108_0	6		N	Non-Preferred Brand	4	10	1	2	4	1	010		01	010		1	30								30						30		34	100.00																					100.00																		100.00				100.00		3.33			3.33			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	108	0	1	01	01	H5471_108_0	6		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		34					33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	110	0	1	01	01	H5471_110_0	6		N	Preferred Generic	4	01	3	2	1	1	111		01	111		1	30	60	100				2	2	30	60	100				30		34	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	110	0	1	01	01	H5471_110_0	6		N	Preferred Generic	4	01	3	2	1	3	111		01	111		1	30	60	100				2	2	30	60	100				30		34	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		3
H5471	110	0	1	01	01	H5471_110_0	6		N	Generic	4	11	1	2	2	1	111		01	111		1	30	60	90				2	2	30	60	90				30		34	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	110	0	1	01	01	H5471_110_0	6		N	Generic	4	11	1	2	2	3	111		01	111		1	30	60	90				2	2	30	60	90				30		34	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5471	110	0	1	01	01	H5471_110_0	6		N	Preferred Brand	4	10	1	2	3	1	111		01	111		1	30	60	90				2	2	30	60	90				30		34	35.00	70.00	105.00																			35.00	105.00	105.00																35.00				35.00		1.17			1.17			1.03	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	110	0	1	01	01	H5471_110_0	6		N	Non-Preferred Brand	4	10	1	2	4	1	010		01	010		1	30								30						30		34	75.00																					75.00																		75.00				75.00		2.50			2.50			2.21	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	110	0	1	01	01	H5471_110_0	6		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		34					33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	111	0	1	01	01	H5471_111_0	6		N	Preferred Generic	4	01	3	2	1	1		111	01	111		1				30	60	100	2	2	30	60	100				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 Brand, Specialty Tier												
H5471	111	0	1	01	01	H5471_111_0	6		N	Generic	4	11	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								20.00	40.00	60.00					20.00	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	111	0	1	01	01	H5471_111_0	6		N	Preferred Brand	4	10	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								47.00	94.00	141.00					47.00	94.00	141.00					47.00	141.00	141.00																47.00				47.00			1.57	1.57	1.57			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	111	0	1	01	01	H5471_111_0	6		N	Non-Preferred Brand	4	10	1	2	4	1		010	01	010		1				30					30						30		34								100.00							95.00							95.00																		100.00				100.00			3.33	3.17	3.17			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	111	0	1	01	01	H5471_111_0	6		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												25							25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	112	0	1	01	01	H5471_112_0	6		N	Preferred Generic	4	01	3	2	1	1	111		01	111		1	30	60	100				2	2	30	60	100				30		34	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	112	0	1	01	01	H5471_112_0	6		N	Preferred Generic	4	01	3	2	1	3	111		01	111		1	30	60	100				2	2	30	60	100				30		34	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		3
H5471	112	0	1	01	01	H5471_112_0	6		N	Generic	4	11	1	2	2	1	111		01	111		1	30	60	90				2	2	30	60	90				30		34	10.00	20.00	30.00																			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	112	0	1	01	01	H5471_112_0	6		N	Generic	4	11	1	2	2	3	111		01	111		1	30	60	90				2	2	30	60	90				30		34	10.00	20.00	30.00																			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	112	0	1	01	01	H5471_112_0	6		N	Preferred Brand	4	10	1	2	3	1	111		01	111		1	30	60	90				2	2	30	60	90				30		34	47.00	94.00	141.00																			47.00	141.00	141.00																47.00				47.00		1.57			1.57			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	112	0	1	01	01	H5471_112_0	6		N	Non-Preferred Brand	4	10	1	2	4	1	010		01	010		1	30								30						30		34	100.00																					100.00																		100.00				100.00		3.33			3.33			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	112	0	1	01	01	H5471_112_0	6		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		34					33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5472	001	0	1	01	01	H5472_001_0	5		N	Preferred Generic	4	11	1	2	1	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5472	001	0	1	01	01	H5472_001_0	5		N	Preferred Generic	4	11	1	2	1	3	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H5472	001	0	1	01	01	H5472_001_0	5		N	Generic	4	01	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5472	001	0	1	01	01	H5472_001_0	5		N	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	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												
H5472	001	0	1	01	01	H5472_001_0	5		N	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	300.00																			100.00	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												
H5472	001	0	1	01	01	H5472_001_0	5		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				842.86	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5472	001	0	1	01	01	H5472_001_0	5		N	Select Care Drugs	4	01	1	2	6	1	111		01	111		1	30	60	100				1	2	30	60	100				30		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												
H5472	001	0	1	01	01	H5472_001_0	5		N	Select Care Drugs	4	01	1	2	6	3	111		01	111		1	30	60	100				1	2	30	60	100				30		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		
H5472	002	0	1	01	01	H5472_002_0	5		N	Preferred Generic	4	11	1	2	1	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5472	002	0	1	01	01	H5472_002_0	5		N	Preferred Generic	4	11	1	2	1	3	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H5472	002	0	1	01	01	H5472_002_0	5		N	Generic	4	01	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5472	002	0	1	01	01	H5472_002_0	5		N	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	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												
H5472	002	0	1	01	01	H5472_002_0	5		N	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	300.00																			100.00	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												
H5472	002	0	1	01	01	H5472_002_0	5		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				850.24	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5472	002	0	1	01	01	H5472_002_0	5		N	Select Care Drugs	4	01	1	2	6	1	111		01	111		1	30	60	100				1	2	30	60	100				30		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												
H5472	002	0	1	01	01	H5472_002_0	5		N	Select Care Drugs	4	01	1	2	6	3	111		01	111		1	30	60	100				1	2	30	60	100				30		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		
H5475	011	0	1	02	01	H5475_011_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												
H5475	011	0	1	02	01	H5475_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	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	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												
H5475	011	0	1	02	01	H5475_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					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	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												
H5475	011	0	1	02	01	H5475_011_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												
H5475	022	0	1	02	01	H5475_022_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												
H5475	022	0	1	02	01	H5475_022_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												
H5475	022	0	1	02	01	H5475_022_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												
H5475	022	0	1	02	01	H5475_022_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												
H5475	022	0	1	02	01	H5475_022_0	6			Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5475	022	0	1	02	01	H5475_022_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												
H5475	024	0	1	02	01	H5475_024_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												
H5475	024	0	1	02	01	H5475_024_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												
H5475	024	0	1	02	01	H5475_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								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	6			Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											76.74	50	50	50				73.67	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	024	0	1	02	01	H5475_024_0	6			Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5475	024	0	1	02	01	H5475_024_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												
H5475	026	0	1	02	01	H5475_026_0	6			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												
H5475	026	0	1	02	01	H5475_026_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												
H5475	026	0	1	02	01	H5475_026_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												
H5475	026	0	1	02	01	H5475_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		31											77.34	50	50	50				74.25	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	026	0	1	02	01	H5475_026_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												
H5475	026	0	1	02	01	H5475_026_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												
H5475	031	0	1	01	01	H5475_031_0	6			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												
H5475	031	0	1	01	01	H5475_031_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					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	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												
H5475	031	0	1	01	01	H5475_031_0	6			Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											87.70	50	50	50				84.19	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	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												
H5475	031	0	1	01	01	H5475_031_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												
H5475	032	0	1	01	01	H5475_032_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												
H5475	032	0	1	01	01	H5475_032_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					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	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												
H5475	032	0	1	01	01	H5475_032_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											83.76	50	50	50				80.41	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	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												
H5475	032	0	1	01	01	H5475_032_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												
H5475	038	0	1	01	01	H5475_038_0	7			Preferred Generic	4	11	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								19.00	38.00	57.00					0.00	0.00	0.00											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												
H5475	038	0	1	01	01	H5475_038_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					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												
H5475	038	0	1	01	01	H5475_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					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, Select Care Drugs												
H5475	038	0	1	01	01	H5475_038_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											98.81	43	43	43				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												
H5475	038	0	1	01	01	H5475_038_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, Select Care Drugs												
H5475	038	0	1	01	01	H5475_038_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												
H5496	005	0	1	01	01	H5496_005_0	8		Y	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												
H5496	005	0	1	01	01	H5496_005_0	8		Y	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		
H5496	005	0	1	01	01	H5496_005_0	8		Y	Generic	4	11	3	2	2	1	110		01	100		1	30		100				1	2			100				30		31	5.00		12.00																					10.00																5.00				5.00		0.17						0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5496	005	0	1	01	01	H5496_005_0	8		Y	Generic	4	11	3	2	2	3	110		01	100		1	30		100				1	2			100				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										1		3
H5496	005	0	1	01	01	H5496_005_0	8		Y	Preferred Brand	4	11	1	2	3	1	110		01	100		1	30		100				1	2			100				30		31	45.00		110.00																					90.00																45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5496	005	0	1	01	01	H5496_005_0	8		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01	100		1	30		100				1	2			100				30		31	90.00		225.00																					180.00																90.00				90.00		3.00						2.90	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5496	005	0	1	01	01	H5496_005_0	8		Y	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31				838.15	33																																					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5496	005	0	1	01	01	H5496_005_0	8		Y	Select Care Drugs	4	10	1	2	6	1	110		01	100		1	30		100				1	2			100				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		Y	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												
H5496	007	0	1	01	01	H5496_007_0	8		Y	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										1		
H5496	007	0	1	01	01	H5496_007_0	8		Y	Generic	4	11	3	2	2	1	110		01	100		1	30		100				1	2			100				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		Y	Generic	4	11	3	2	2	3	110		01	100		1	30		100				1	2			100				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										1		3
H5496	007	0	1	01	01	H5496_007_0	8		Y	Preferred Brand	4	11	1	2	3	1	110		01	100		1	30		100				1	2			100				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		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01	100		1	30		100				1	2			100				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		Y	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31				1139.88	33																																					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5496	011	0	1	01	01	H5496_011_0	9		N	Preferred Generic	4	11	1	1	1	1	110		01	100		1	30		100				1	2			100				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	9		N	Preferred Generic	4	11	1	1	1	3	110		01	100		1	30		100				1	2			100				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	9		N	Generic	4	11	3	1	2	1	110		01	100		1	30		100				1	2			100				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	9		N	Generic	4	11	3	1	2	3	110		01	100		1	30		100				1	2			100				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	9		N	Preferred Brand	4	11	1	1	3	1	110		01	100		1	30		100				1	2			100				30		31				141.64	25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5496	011	0	1	01	01	H5496_011_0	9		N	Non-Preferred Drug	4	11	1	1	4	1	110		01	100		1	30		100				1	2			100				30		31				112.74	25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5496	011	0	1	01	01	H5496_011_0	9		N	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31				674.54	25																																					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5496	012	0	1	01	01	H5496_012_0	8		Y	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												
H5496	012	0	1	01	01	H5496_012_0	8		Y	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										1		
H5496	012	0	1	01	01	H5496_012_0	8		Y	Generic	4	11	3	2	2	1	110		01	100		1	30		100				1	2			100				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		Y	Generic	4	11	3	2	2	3	110		01	100		1	30		100				1	2			100				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										1		3
H5496	012	0	1	01	01	H5496_012_0	8		Y	Preferred Brand	4	11	1	2	3	1	110		01	100		1	30		100				1	2			100				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		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01	100		1	30		100				1	2			100				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		Y	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31				939.08	33																																					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	013	0	1	04	01	H5521_013_0	3		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					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		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	013	0	1	04	01	H5521_013_0	3		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	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		N	Generic	4	01	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		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			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		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			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		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											954.38	29						354.14	29												29						29						29		29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	015	0	1	04	01	H5521_015_0	5		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					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	5		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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	5		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					10.00	20.00	20.00											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												
H5521	015	0	1	04	01	H5521_015_0	5		N	Generic	4	01	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	20.00											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										1		
H5521	015	0	1	04	01	H5521_015_0	5		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			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	5		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			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	5		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											733.51	28						609.84	28												28						28						28		28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	016	0	1	04	01	H5521_016_0	3		N	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	3		N	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	3		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								12.00	24.00	36.00					10.00	20.00	20.00											12.00	24.00	36.00				10.00	20.00	20.00					12.00			12.00			0.40	0.33		0.40	0.33	0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	016	0	1	04	01	H5521_016_0	3		N	Generic	4	01	1	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								12.00	24.00	36.00					10.00	20.00	20.00											12.00	24.00	36.00				10.00	20.00	20.00					12.00			12.00			0.40	0.33		0.40	0.33	0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	016	0	1	04	01	H5521_016_0	3		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	016	0	1	04	01	H5521_016_0	3		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	016	0	1	04	01	H5521_016_0	3		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											959.91	33						585.80	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	020	0	1	04	01	H5521_020_0	5		N	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	020	0	1	04	01	H5521_020_0	5		N	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	020	0	1	04	01	H5521_020_0	5		N	Generic	4	01	3	2	2	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					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	020	0	1	04	01	H5521_020_0	5		N	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	020	0	1	04	01	H5521_020_0	5		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00					47.00			47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	020	0	1	04	01	H5521_020_0	5		N	Non-Preferred Drug	4	11	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	020	0	1	04	01	H5521_020_0	5		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1133.74	33						383.70	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	022	0	1	04	01	H5521_022_0	4		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					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	4		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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	4		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					10.00	20.00	20.00											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												
H5521	022	0	1	04	01	H5521_022_0	4		N	Generic	4	01	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	20.00											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										1		
H5521	022	0	1	04	01	H5521_022_0	4		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			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	4		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			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	4		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											952.68	33						630.51	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	027	0	1	04	01	H5521_027_0	6		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					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	6		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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	6		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					10.00	20.00	20.00											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												
H5521	027	0	1	04	01	H5521_027_0	6		N	Generic	4	01	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	20.00											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										1		
H5521	027	0	1	04	01	H5521_027_0	6		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			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	6		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			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	6		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											695.84	28						397.74	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		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					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		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	033	0	1	04	01	H5521_033_0	3		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					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		N	Generic	4	01	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		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			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		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			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		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1009.39	28						561.58	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		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					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		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	037	0	1	04	01	H5521_037_0	2		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	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	037	0	1	04	01	H5521_037_0	2		N	Generic	4	01	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	037	0	1	04	01	H5521_037_0	2		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			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		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			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		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											789.41	29						389.50	29												29						29						29		29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	040	0	1	04	01	H5521_040_0	3		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					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	3		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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	3		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					10.00	20.00	20.00											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												
H5521	040	0	1	04	01	H5521_040_0	3		N	Generic	4	01	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	20.00											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										1		
H5521	040	0	1	04	01	H5521_040_0	3		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	040	0	1	04	01	H5521_040_0	3		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	040	0	1	04	01	H5521_040_0	3		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1041.09	29						521.35	29												29						29						29		29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	053	0	1	04	01	H5521_053_0	5		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					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	5		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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	5		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					10.00	20.00	20.00											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												
H5521	053	0	1	04	01	H5521_053_0	5		N	Generic	4	01	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	20.00											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										1		
H5521	053	0	1	04	01	H5521_053_0	5		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			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	5		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			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	5		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											943.38	33						723.99	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	055	0	1	04	01	H5521_055_0	3		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	055	0	1	04	01	H5521_055_0	3		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	055	0	1	04	01	H5521_055_0	3		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					10.00	20.00	20.00											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												
H5521	055	0	1	04	01	H5521_055_0	3		N	Generic	4	01	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	20.00											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										1		
H5521	055	0	1	04	01	H5521_055_0	3		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	055	0	1	04	01	H5521_055_0	3		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	055	0	1	04	01	H5521_055_0	3		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1061.09	33						478.01	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	056	0	1	04	01	H5521_056_0	5		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					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	5		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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	5		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					10.00	20.00	20.00											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												
H5521	056	0	1	04	01	H5521_056_0	5		N	Generic	4	01	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	20.00											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										1		
H5521	056	0	1	04	01	H5521_056_0	5		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			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	5		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	056	0	1	04	01	H5521_056_0	5		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											930.88	33						574.88	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	076	0	1	04	01	H5521_076_0	2		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					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	2		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	076	0	1	04	01	H5521_076_0	2		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					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	2		N	Generic	4	01	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	2		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			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	2		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			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	2		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											605.02	30						550.74	30												30						30						30		30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	077	0	1	04	01	H5521_077_0	2		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					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	2		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	077	0	1	04	01	H5521_077_0	2		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					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	2		N	Generic	4	01	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	2		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			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	2		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			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	2		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1031.19	30						584.36	30												30						30						30		30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	081	0	1	04	01	H5521_081_0	3		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					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		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					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		N	Generic	4	01	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		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			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		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			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		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											892.66	30						591.85	30												30						30						30		30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	082	0	1	04	01	H5521_082_0	5		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					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	5		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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	5		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					10.00	20.00	20.00											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												
H5521	082	0	1	04	01	H5521_082_0	5		N	Generic	4	01	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	20.00											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										1		
H5521	082	0	1	04	01	H5521_082_0	5		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			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	5		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			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	5		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											709.54	28						489.36	28												28						28						28		28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	083	0	1	04	01	H5521_083_0	5		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					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	5		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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	5		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					10.00	20.00	25.00											20.00	40.00	60.00				10.00	20.00	25.00					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	083	0	1	04	01	H5521_083_0	5		N	Generic	4	01	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	083	0	1	04	01	H5521_083_0	5		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			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	5		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			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	5		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											827.64	29						485.53	29												29						29						29		29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	084	0	1	04	01	H5521_084_0	5		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					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	5		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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	5		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					10.00	20.00	20.00											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												
H5521	084	0	1	04	01	H5521_084_0	5		N	Generic	4	01	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	20.00											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										1		
H5521	084	0	1	04	01	H5521_084_0	5		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			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	5		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			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	5		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											842.78	28						517.42	28												28						28						28		28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	085	0	1	04	01	H5521_085_0	4		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					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	4		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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	4		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					10.00	20.00	20.00											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												
H5521	085	0	1	04	01	H5521_085_0	4		N	Generic	4	01	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	20.00											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										1		
H5521	085	0	1	04	01	H5521_085_0	4		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			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	4		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			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	4		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											922.15	33						411.14	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	086	0	1	04	01	H5521_086_0	3		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	086	0	1	04	01	H5521_086_0	3		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	086	0	1	04	01	H5521_086_0	3		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					10.00	20.00	20.00											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												
H5521	086	0	1	04	01	H5521_086_0	3		N	Generic	4	01	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	20.00											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										1		
H5521	086	0	1	04	01	H5521_086_0	3		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	086	0	1	04	01	H5521_086_0	3		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	086	0	1	04	01	H5521_086_0	3		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											949.77	33						621.05	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	087	0	1	04	01	H5521_087_0	4		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					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	4		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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	4		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					10.00	20.00	20.00											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												
H5521	087	0	1	04	01	H5521_087_0	4		N	Generic	4	01	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	20.00											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										1		
H5521	087	0	1	04	01	H5521_087_0	4		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			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	4		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	087	0	1	04	01	H5521_087_0	4		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1089.63	33						703.59	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	088	0	1	04	01	H5521_088_0	4		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					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	4		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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	4		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					10.00	20.00	20.00											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												
H5521	088	0	1	04	01	H5521_088_0	4		N	Generic	4	01	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	20.00											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										1		
H5521	088	0	1	04	01	H5521_088_0	4		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			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	4		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	088	0	1	04	01	H5521_088_0	4		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											921.70	33						603.62	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	089	0	1	04	01	H5521_089_0	4		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					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	4		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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	4		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					10.00	20.00	20.00											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												
H5521	089	0	1	04	01	H5521_089_0	4		N	Generic	4	01	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	20.00											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										1		
H5521	089	0	1	04	01	H5521_089_0	4		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			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	4		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	089	0	1	04	01	H5521_089_0	4		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1090.87	33						495.80	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	090	0	1	04	01	H5521_090_0	4		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					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	4		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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	4		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					10.00	20.00	20.00											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												
H5521	090	0	1	04	01	H5521_090_0	4		N	Generic	4	01	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	20.00											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										1		
H5521	090	0	1	04	01	H5521_090_0	4		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			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	4		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	090	0	1	04	01	H5521_090_0	4		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											900.84	33						703.31	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	091	0	1	04	01	H5521_091_0	2		Y	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					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	2		Y	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	091	0	1	04	01	H5521_091_0	2		Y	Generic	4	01	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	2		Y	Generic	4	01	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	2		Y	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			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	2		Y	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			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	2		Y	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1132.12	30						641.00	30												30						30						30		30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	095	0	1	04	01	H5521_095_0	2		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					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	2		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	095	0	1	04	01	H5521_095_0	2		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					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	2		N	Generic	4	01	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	2		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			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	2		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			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	2		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1287.93	33						560.74	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	099	0	1	04	01	H5521_099_0	3		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	099	0	1	04	01	H5521_099_0	3		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	099	0	1	04	01	H5521_099_0	3		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					10.00	20.00	20.00											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												
H5521	099	0	1	04	01	H5521_099_0	3		N	Generic	4	01	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	20.00											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										1		
H5521	099	0	1	04	01	H5521_099_0	3		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	099	0	1	04	01	H5521_099_0	3		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	099	0	1	04	01	H5521_099_0	3		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											950.03	33						685.07	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	100	0	1	04	01	H5521_100_0	3		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	100	0	1	04	01	H5521_100_0	3		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	100	0	1	04	01	H5521_100_0	3		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					10.00	20.00	20.00											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												
H5521	100	0	1	04	01	H5521_100_0	3		N	Generic	4	01	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	20.00											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										1		
H5521	100	0	1	04	01	H5521_100_0	3		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	100	0	1	04	01	H5521_100_0	3		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	100	0	1	04	01	H5521_100_0	3		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											738.61	33						475.62	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	101	0	1	04	01	H5521_101_0	3		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	101	0	1	04	01	H5521_101_0	3		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	101	0	1	04	01	H5521_101_0	3		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					10.00	20.00	20.00											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												
H5521	101	0	1	04	01	H5521_101_0	3		N	Generic	4	01	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	20.00											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										1		
H5521	101	0	1	04	01	H5521_101_0	3		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	101	0	1	04	01	H5521_101_0	3		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	101	0	1	04	01	H5521_101_0	3		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											872.86	33						573.95	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	102	0	1	04	01	H5521_102_0	5		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					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	102	0	1	04	01	H5521_102_0	5		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	102	0	1	04	01	H5521_102_0	5		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					10.00	20.00	20.00											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												
H5521	102	0	1	04	01	H5521_102_0	5		N	Generic	4	01	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	20.00											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										1		
H5521	102	0	1	04	01	H5521_102_0	5		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			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	5		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			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	5		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											906.92	29						501.70	29												29						29						29		29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	110	0	1	04	01	H5521_110_0	4		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					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		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					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		N	Generic	4	01	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		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			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		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			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		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											907.16	30						468.29	30												30						30						30		30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	116	0	1	04	01	H5521_116_0	3		Y	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	116	0	1	04	01	H5521_116_0	3		Y	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	116	0	1	04	01	H5521_116_0	3		Y	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												
H5521	116	0	1	04	01	H5521_116_0	3		Y	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		
H5521	116	0	1	04	01	H5521_116_0	3		Y	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	116	0	1	04	01	H5521_116_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	116	0	1	04	01	H5521_116_0	3		Y	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											942.34	33						571.97	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	117	0	1	04	01	H5521_117_0	2		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					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	2		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	117	0	1	04	01	H5521_117_0	2		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					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	2		N	Generic	4	01	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	2		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			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	2		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			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	2		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1119.95	28						416.63	28												28						28						28		28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	118	0	1	04	01	H5521_118_0	3		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					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	3		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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	3		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					10.00	20.00	20.00											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												
H5521	118	0	1	04	01	H5521_118_0	3		N	Generic	4	01	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	20.00											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										1		
H5521	118	0	1	04	01	H5521_118_0	3		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	118	0	1	04	01	H5521_118_0	3		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	118	0	1	04	01	H5521_118_0	3		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											890.76	29						747.57	29												29						29						29		29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	119	0	1	04	01	H5521_119_0	2		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					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	2		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	119	0	1	04	01	H5521_119_0	2		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					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	2		N	Generic	4	01	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	2		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			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	2		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			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	2		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											939.26	30						467.87	30												30						30						30		30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	120	0	1	04	01	H5521_120_0	2		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					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	2		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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	2		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					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	2		N	Generic	4	01	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	2		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			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	2		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			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	2		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											800.50	28						530.48	28												28						28						28		28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	121	0	1	04	01	H5521_121_0	2		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					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	2		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	121	0	1	04	01	H5521_121_0	2		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	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	121	0	1	04	01	H5521_121_0	2		N	Generic	4	01	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	121	0	1	04	01	H5521_121_0	2		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			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	2		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			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	2		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											838.57	29						744.55	29												29						29						29		29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	122	0	1	04	01	H5521_122_0	2		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	122	0	1	04	01	H5521_122_0	2		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	122	0	1	04	01	H5521_122_0	2		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					5.00	10.00	10.00											20.00	40.00	60.00				5.00	10.00	10.00					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		N	Generic	4	01	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		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			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		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			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		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1161.75	33						467.25	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		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					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		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	123	0	1	04	01	H5521_123_0	2		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	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	123	0	1	04	01	H5521_123_0	2		N	Generic	4	01	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	123	0	1	04	01	H5521_123_0	2		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			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		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			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		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											857.77	29						492.73	29												29						29						29		29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	124	0	1	04	01	H5521_124_0	2		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					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		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	124	0	1	04	01	H5521_124_0	2		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					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		N	Generic	4	01	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		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			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		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			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		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1003.68	30						541.90	30												30						30						30		30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	125	0	1	04	01	H5521_125_0	5		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					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	5		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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	5		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					10.00	20.00	20.00											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												
H5521	125	0	1	04	01	H5521_125_0	5		N	Generic	4	01	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	20.00											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										1		
H5521	125	0	1	04	01	H5521_125_0	5		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			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	5		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	125	0	1	04	01	H5521_125_0	5		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											821.10	33						712.96	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	127	0	1	04	01	H5521_127_0	3		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	127	0	1	04	01	H5521_127_0	3		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	127	0	1	04	01	H5521_127_0	3		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					10.00	20.00	20.00											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												
H5521	127	0	1	04	01	H5521_127_0	3		N	Generic	4	01	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	20.00											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										1		
H5521	127	0	1	04	01	H5521_127_0	3		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	127	0	1	04	01	H5521_127_0	3		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	127	0	1	04	01	H5521_127_0	3		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											871.83	33						641.59	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	128	0	1	04	01	H5521_128_0	3		N	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	128	0	1	04	01	H5521_128_0	3		N	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	128	0	1	04	01	H5521_128_0	3		N	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	128	0	1	04	01	H5521_128_0	3		N	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	128	0	1	04	01	H5521_128_0	3		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	128	0	1	04	01	H5521_128_0	3		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	128	0	1	04	01	H5521_128_0	3		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1081.97	33						511.28	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	134	0	1	04	01	H5521_134_0	5		N	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	134	0	1	04	01	H5521_134_0	5		N	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	134	0	1	04	01	H5521_134_0	5		N	Generic	4	01	3	2	2	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					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	134	0	1	04	01	H5521_134_0	5		N	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	134	0	1	04	01	H5521_134_0	5		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00					47.00			47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	134	0	1	04	01	H5521_134_0	5		N	Non-Preferred Drug	4	11	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	134	0	1	04	01	H5521_134_0	5		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											785.68	33						419.61	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	139	0	1	04	01	H5521_139_0	3		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					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		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					5.00	10.00	10.00											20.00	40.00	60.00				5.00	10.00	10.00					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		N	Generic	4	01	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		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			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		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			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		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1009.92	30						582.80	30												30						30						30		30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	140	0	1	04	01	H5521_140_0	2		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					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	2		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	140	0	1	04	01	H5521_140_0	2		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					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	2		N	Generic	4	01	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	2		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			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	2		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			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	2		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1069.62	30						657.10	30												30						30						30		30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	141	0	1	04	01	H5521_141_0	3		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	141	0	1	04	01	H5521_141_0	3		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	141	0	1	04	01	H5521_141_0	3		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					5.00	10.00	10.00											20.00	40.00	60.00				5.00	10.00	10.00					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	3		N	Generic	4	01	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	3		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	141	0	1	04	01	H5521_141_0	3		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	141	0	1	04	01	H5521_141_0	3		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											875.25	33						860.45	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	144	0	1	04	01	H5521_144_0	2		Y	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					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	2		Y	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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	2		Y	Generic	4	01	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	20.00											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												
H5521	144	0	1	04	01	H5521_144_0	2		Y	Generic	4	01	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	20.00											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										1		
H5521	144	0	1	04	01	H5521_144_0	2		Y	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			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	2		Y	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			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	2		Y	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											837.18	29						741.74	29												29						29						29		29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	150	0	1	04	01	H5521_150_0	3		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	150	0	1	04	01	H5521_150_0	3		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	150	0	1	04	01	H5521_150_0	3		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					10.00	20.00	20.00											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												
H5521	150	0	1	04	01	H5521_150_0	3		N	Generic	4	01	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	20.00											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										1		
H5521	150	0	1	04	01	H5521_150_0	3		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	150	0	1	04	01	H5521_150_0	3		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	150	0	1	04	01	H5521_150_0	3		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											678.47	29						433.08	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		N	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		N	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		N	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		N	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		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			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		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			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		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1064.13	33						708.03	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	156	0	1	04	01	H5521_156_0	4		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					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	4		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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	4		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					10.00	20.00	20.00											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												
H5521	156	0	1	04	01	H5521_156_0	4		N	Generic	4	01	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	20.00											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										1		
H5521	156	0	1	04	01	H5521_156_0	4		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			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	4		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	156	0	1	04	01	H5521_156_0	4		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											717.14	33						506.75	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		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					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		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	157	0	1	04	01	H5521_157_0	3		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					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		N	Generic	4	01	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		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			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		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			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		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1010.06	33						487.79	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	159	0	1	04	01	H5521_159_0	2		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					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	2		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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	2		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					5.00	10.00	10.00											20.00	40.00	60.00				5.00	10.00	10.00					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	2		N	Generic	4	01	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	2		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			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	2		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			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	2		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											796.22	33						499.42	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	160	0	1	04	01	H5521_160_0	2		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					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	2		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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	2		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					5.00	10.00	10.00											20.00	40.00	60.00				5.00	10.00	10.00					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	2		N	Generic	4	01	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	2		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			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	2		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			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	2		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											723.77	33						544.87	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		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					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		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					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		N	Generic	4	01	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		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			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		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			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		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1105.60	30						606.34	30												30						30						30		30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	169	0	1	04	01	H5521_169_0	2		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					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	2		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	169	0	1	04	01	H5521_169_0	2		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					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	2		N	Generic	4	01	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	2		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			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	2		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			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	2		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1111.78	30						589.23	30												30						30						30		30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	170	0	1	04	01	H5521_170_0	2		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	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	2		N	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	2		N	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	2		N	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	2		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			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	2		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			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	2		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1054.36	33						684.55	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	171	0	1	04	01	H5521_171_0	3		Y	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	171	0	1	04	01	H5521_171_0	3		Y	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	171	0	1	04	01	H5521_171_0	3		Y	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												
H5521	171	0	1	04	01	H5521_171_0	3		Y	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		
H5521	171	0	1	04	01	H5521_171_0	3		Y	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	171	0	1	04	01	H5521_171_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	171	0	1	04	01	H5521_171_0	3		Y	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											865.65	33						655.11	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	177	0	1	04	01	H5521_177_0	2		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					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	2		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	177	0	1	04	01	H5521_177_0	2		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					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	2		N	Generic	4	01	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	2		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			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	2		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			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	2		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1284.22	30						651.57	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		Y	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					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		Y	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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		Y	Generic	4	01	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		Y	Generic	4	01	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		Y	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			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		Y	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			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		Y	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											875.38	30						549.11	30												30						30						30		30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	184	0	1	04	01	H5521_184_0	3		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	184	0	1	04	01	H5521_184_0	3		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	184	0	1	04	01	H5521_184_0	3		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					10.00	20.00	20.00											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												
H5521	184	0	1	04	01	H5521_184_0	3		N	Generic	4	01	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	20.00											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										1		
H5521	184	0	1	04	01	H5521_184_0	3		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	184	0	1	04	01	H5521_184_0	3		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	184	0	1	04	01	H5521_184_0	3		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1117.52	30						604.69	30												30						30						30		30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	190	0	1	04	01	H5521_190_0	3		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	190	0	1	04	01	H5521_190_0	3		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	190	0	1	04	01	H5521_190_0	3		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					10.00	20.00	20.00											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												
H5521	190	0	1	04	01	H5521_190_0	3		N	Generic	4	01	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	20.00											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										1		
H5521	190	0	1	04	01	H5521_190_0	3		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	190	0	1	04	01	H5521_190_0	3		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	190	0	1	04	01	H5521_190_0	3		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											789.62	33						381.43	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	194	0	1	04	01	H5521_194_0	4		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					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	4		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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	4		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					10.00	20.00	20.00											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												
H5521	194	0	1	04	01	H5521_194_0	4		N	Generic	4	01	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	20.00											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										1		
H5521	194	0	1	04	01	H5521_194_0	4		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			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	4		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			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	4		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											813.33	33						634.00	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	195	0	1	04	01	H5521_195_0	3		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	195	0	1	04	01	H5521_195_0	3		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	195	0	1	04	01	H5521_195_0	3		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					10.00	20.00	20.00											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												
H5521	195	0	1	04	01	H5521_195_0	3		N	Generic	4	01	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	20.00											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										1		
H5521	195	0	1	04	01	H5521_195_0	3		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	195	0	1	04	01	H5521_195_0	3		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	195	0	1	04	01	H5521_195_0	3		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											658.88	29						854.46	29												29						29						29		29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	196	0	1	04	01	H5521_196_0	3		N	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	196	0	1	04	01	H5521_196_0	3		N	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	196	0	1	04	01	H5521_196_0	3		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								12.00	24.00	36.00					10.00	20.00	20.00											12.00	24.00	36.00				10.00	20.00	20.00					12.00			12.00			0.40	0.33		0.40	0.33	0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	196	0	1	04	01	H5521_196_0	3		N	Generic	4	01	1	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								12.00	24.00	36.00					10.00	20.00	20.00											12.00	24.00	36.00				10.00	20.00	20.00					12.00			12.00			0.40	0.33		0.40	0.33	0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	196	0	1	04	01	H5521_196_0	3		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	196	0	1	04	01	H5521_196_0	3		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	196	0	1	04	01	H5521_196_0	3		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											997.52	33						704.29	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		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					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		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	197	0	1	04	01	H5521_197_0	2		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					10.00	20.00	20.00											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												
H5521	197	0	1	04	01	H5521_197_0	2		N	Generic	4	01	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	20.00											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										1		
H5521	197	0	1	04	01	H5521_197_0	2		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			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		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			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		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											955.60	33						760.15	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	200	0	1	04	01	H5521_200_0	3		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					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	3		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	200	0	1	04	01	H5521_200_0	3		N	Generic	4	01	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	20.00											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												
H5521	200	0	1	04	01	H5521_200_0	3		N	Generic	4	01	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	20.00											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										1		
H5521	200	0	1	04	01	H5521_200_0	3		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	200	0	1	04	01	H5521_200_0	3		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	200	0	1	04	01	H5521_200_0	3		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											923.67	30						638.06	30												30						30						30		30								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					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					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	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					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	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											1120.71	33						676.19	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	211	0	1	04	01	H5521_211_0	3		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	211	0	1	04	01	H5521_211_0	3		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	211	0	1	04	01	H5521_211_0	3		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					10.00	20.00	20.00											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												
H5521	211	0	1	04	01	H5521_211_0	3		N	Generic	4	01	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	20.00											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										1		
H5521	211	0	1	04	01	H5521_211_0	3		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	211	0	1	04	01	H5521_211_0	3		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	211	0	1	04	01	H5521_211_0	3		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											815.44	33						590.58	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	214	0	1	04	01	H5521_214_0	3		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					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	3		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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	3		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					10.00	20.00	20.00											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												
H5521	214	0	1	04	01	H5521_214_0	3		N	Generic	4	01	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	20.00											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										1		
H5521	214	0	1	04	01	H5521_214_0	3		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	214	0	1	04	01	H5521_214_0	3		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	214	0	1	04	01	H5521_214_0	3		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											836.78	33						520.03	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	215	0	1	04	01	H5521_215_0	2		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					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	2		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	215	0	1	04	01	H5521_215_0	2		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					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	2		N	Generic	4	01	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	2		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			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	2		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			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	2		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											681.66	30						534.23	30												30						30						30		30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	216	0	1	04	01	H5521_216_0	3		Y	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	216	0	1	04	01	H5521_216_0	3		Y	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	216	0	1	04	01	H5521_216_0	3		Y	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												
H5521	216	0	1	04	01	H5521_216_0	3		Y	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		
H5521	216	0	1	04	01	H5521_216_0	3		Y	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	216	0	1	04	01	H5521_216_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	216	0	1	04	01	H5521_216_0	3		Y	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											691.76	33						465.74	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	217	0	1	04	01	H5521_217_0	3		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	217	0	1	04	01	H5521_217_0	3		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	217	0	1	04	01	H5521_217_0	3		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					10.00	20.00	20.00											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												
H5521	217	0	1	04	01	H5521_217_0	3		N	Generic	4	01	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	20.00											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										1		
H5521	217	0	1	04	01	H5521_217_0	3		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	217	0	1	04	01	H5521_217_0	3		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	217	0	1	04	01	H5521_217_0	3		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1240.42	33						659.11	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		Y	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	218	0	1	04	01	H5521_218_0	4		Y	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	218	0	1	04	01	H5521_218_0	4		Y	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												
H5521	218	0	1	04	01	H5521_218_0	4		Y	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		
H5521	218	0	1	04	01	H5521_218_0	4		Y	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			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		Y	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			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		Y	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											890.68	33						704.27	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	219	0	1	04	01	H5521_219_0	3		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	219	0	1	04	01	H5521_219_0	3		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	219	0	1	04	01	H5521_219_0	3		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					10.00	20.00	20.00											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												
H5521	219	0	1	04	01	H5521_219_0	3		N	Generic	4	01	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	20.00											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										1		
H5521	219	0	1	04	01	H5521_219_0	3		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	219	0	1	04	01	H5521_219_0	3		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	219	0	1	04	01	H5521_219_0	3		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											879.46	33						542.46	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	220	0	1	04	01	H5521_220_0	3		Y	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	220	0	1	04	01	H5521_220_0	3		Y	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	220	0	1	04	01	H5521_220_0	3		Y	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												
H5521	220	0	1	04	01	H5521_220_0	3		Y	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		
H5521	220	0	1	04	01	H5521_220_0	3		Y	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	220	0	1	04	01	H5521_220_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	220	0	1	04	01	H5521_220_0	3		Y	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											878.58	33						492.37	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	222	0	1	04	01	H5521_222_0	3		Y	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	222	0	1	04	01	H5521_222_0	3		Y	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	222	0	1	04	01	H5521_222_0	3		Y	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												
H5521	222	0	1	04	01	H5521_222_0	3		Y	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		
H5521	222	0	1	04	01	H5521_222_0	3		Y	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	222	0	1	04	01	H5521_222_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	222	0	1	04	01	H5521_222_0	3		Y	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											818.50	33						516.88	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	223	0	1	04	01	H5521_223_0	3		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					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	3		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	223	0	1	04	01	H5521_223_0	3		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					10.00	20.00	20.00											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												
H5521	223	0	1	04	01	H5521_223_0	3		N	Generic	4	01	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	20.00											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										1		
H5521	223	0	1	04	01	H5521_223_0	3		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	223	0	1	04	01	H5521_223_0	3		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	223	0	1	04	01	H5521_223_0	3		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											878.84	33						676.62	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	224	0	1	04	01	H5521_224_0	3		Y	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	224	0	1	04	01	H5521_224_0	3		Y	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	224	0	1	04	01	H5521_224_0	3		Y	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												
H5521	224	0	1	04	01	H5521_224_0	3		Y	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		
H5521	224	0	1	04	01	H5521_224_0	3		Y	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	224	0	1	04	01	H5521_224_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	224	0	1	04	01	H5521_224_0	3		Y	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											803.06	33						466.54	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	226	0	1	04	01	H5521_226_0	3		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	226	0	1	04	01	H5521_226_0	3		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	226	0	1	04	01	H5521_226_0	3		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					10.00	20.00	20.00											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												
H5521	226	0	1	04	01	H5521_226_0	3		N	Generic	4	01	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	20.00											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										1		
H5521	226	0	1	04	01	H5521_226_0	3		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	226	0	1	04	01	H5521_226_0	3		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	226	0	1	04	01	H5521_226_0	3		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											834.85	33						675.71	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	227	0	1	04	01	H5521_227_0	3		Y	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	227	0	1	04	01	H5521_227_0	3		Y	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	227	0	1	04	01	H5521_227_0	3		Y	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												
H5521	227	0	1	04	01	H5521_227_0	3		Y	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		
H5521	227	0	1	04	01	H5521_227_0	3		Y	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	227	0	1	04	01	H5521_227_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	227	0	1	04	01	H5521_227_0	3		Y	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											989.55	33						566.01	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	230	0	1	04	01	H5521_230_0	3		Y	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	230	0	1	04	01	H5521_230_0	3		Y	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	230	0	1	04	01	H5521_230_0	3		Y	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												
H5521	230	0	1	04	01	H5521_230_0	3		Y	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		
H5521	230	0	1	04	01	H5521_230_0	3		Y	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	230	0	1	04	01	H5521_230_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	230	0	1	04	01	H5521_230_0	3		Y	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											888.48	33						671.76	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	231	0	1	04	01	H5521_231_0	3		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					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		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					10.00	20.00	20.00											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												
H5521	231	0	1	04	01	H5521_231_0	3		N	Generic	4	01	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	20.00											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										1		
H5521	231	0	1	04	01	H5521_231_0	3		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			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		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			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		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1399.58	33						471.02	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	232	0	1	04	01	H5521_232_0	3		Y	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	232	0	1	04	01	H5521_232_0	3		Y	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	232	0	1	04	01	H5521_232_0	3		Y	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												
H5521	232	0	1	04	01	H5521_232_0	3		Y	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		
H5521	232	0	1	04	01	H5521_232_0	3		Y	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	232	0	1	04	01	H5521_232_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	232	0	1	04	01	H5521_232_0	3		Y	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											694.42	33						489.59	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	233	0	1	04	01	H5521_233_0	3		Y	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					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	3		Y	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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	3		Y	Generic	4	01	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	3		Y	Generic	4	01	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	3		Y	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	233	0	1	04	01	H5521_233_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	233	0	1	04	01	H5521_233_0	3		Y	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											781.56	30						512.82	30												30						30						30		30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	234	0	1	04	01	H5521_234_0	3		Y	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	234	0	1	04	01	H5521_234_0	3		Y	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	234	0	1	04	01	H5521_234_0	3		Y	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												
H5521	234	0	1	04	01	H5521_234_0	3		Y	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		
H5521	234	0	1	04	01	H5521_234_0	3		Y	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	234	0	1	04	01	H5521_234_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	234	0	1	04	01	H5521_234_0	3		Y	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											860.70	33						624.96	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	236	0	1	04	01	H5521_236_0	2		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					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	2		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	236	0	1	04	01	H5521_236_0	2		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					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	2		N	Generic	4	01	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	2		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			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	2		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			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	2		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1189.32	30						497.09	30												30						30						30		30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	243	0	1	04	01	H5521_243_0	2		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	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	243	0	1	04	01	H5521_243_0	2		N	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	243	0	1	04	01	H5521_243_0	2		N	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	243	0	1	04	01	H5521_243_0	2		N	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	243	0	1	04	01	H5521_243_0	2		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			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	2		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			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	2		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											814.17	33						576.42	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	245	0	1	04	01	H5521_245_0	3		N	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		N	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		N	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		N	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		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			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		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			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		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											970.71	33						631.18	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	246	0	1	04	01	H5521_246_0	3		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	246	0	1	04	01	H5521_246_0	3		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	246	0	1	04	01	H5521_246_0	3		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					5.00	10.00	10.00											20.00	40.00	60.00				5.00	10.00	10.00					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	246	0	1	04	01	H5521_246_0	3		N	Generic	4	01	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	246	0	1	04	01	H5521_246_0	3		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	246	0	1	04	01	H5521_246_0	3		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	246	0	1	04	01	H5521_246_0	3		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											973.63	33						768.58	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	247	0	1	04	01	H5521_247_0	2		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	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	2		N	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	2		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								12.00	24.00	36.00					10.00	20.00	20.00											12.00	24.00	36.00				10.00	20.00	20.00					12.00			12.00			0.40	0.33		0.40	0.33	0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	247	0	1	04	01	H5521_247_0	2		N	Generic	4	01	1	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								12.00	24.00	36.00					10.00	20.00	20.00											12.00	24.00	36.00				10.00	20.00	20.00					12.00			12.00			0.40	0.33		0.40	0.33	0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	247	0	1	04	01	H5521_247_0	2		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			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	2		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			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	2		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											849.29	33						593.66	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		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					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		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					10.00	20.00	20.00											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												
H5521	249	0	1	04	01	H5521_249_0	3		N	Generic	4	01	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	20.00											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										1		
H5521	249	0	1	04	01	H5521_249_0	3		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			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		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			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		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1179.60	30						672.76	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					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					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	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					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	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											867.74	33						626.40	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		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					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		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					5.00	10.00	10.00											20.00	40.00	60.00				5.00	10.00	10.00					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		N	Generic	4	01	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		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			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		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			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		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1092.67	30						688.75	30												30						30						30		30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	254	0	1	04	01	H5521_254_0	2		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					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	2		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	254	0	1	04	01	H5521_254_0	2		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					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	254	0	1	04	01	H5521_254_0	2		N	Generic	4	01	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	254	0	1	04	01	H5521_254_0	2		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			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	2		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			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	2		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1047.49	33						527.61	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	259	0	1	04	01	H5521_259_0	4		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					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	4		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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	4		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					10.00	20.00	20.00											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												
H5521	259	0	1	04	01	H5521_259_0	4		N	Generic	4	01	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	20.00											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										1		
H5521	259	0	1	04	01	H5521_259_0	4		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			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	4		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			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	4		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											630.90	33						514.77	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	260	0	1	04	01	H5521_260_0	4		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					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	4		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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	4		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					10.00	20.00	20.00											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												
H5521	260	0	1	04	01	H5521_260_0	4		N	Generic	4	01	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	20.00											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										1		
H5521	260	0	1	04	01	H5521_260_0	4		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			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	4		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			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	4		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											905.04	33						537.92	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		N	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		N	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		N	Generic	4	01	3	2	2	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					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		N	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		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			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		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			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		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1030.61	33						415.07	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	262	0	1	04	01	H5521_262_0	3		N	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	262	0	1	04	01	H5521_262_0	3		N	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	262	0	1	04	01	H5521_262_0	3		N	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												
H5521	262	0	1	04	01	H5521_262_0	3		N	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		
H5521	262	0	1	04	01	H5521_262_0	3		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			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	3		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			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	3		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											961.57	33						693.03	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	263	0	1	04	01	H5521_263_0	2		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					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	263	0	1	04	01	H5521_263_0	2		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	263	0	1	04	01	H5521_263_0	2		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	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		N	Generic	4	01	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		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			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		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			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		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1142.85	33						744.67	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	266	0	1	04	01	H5521_266_0	4		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					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	4		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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	4		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					10.00	20.00	20.00											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												
H5521	266	0	1	04	01	H5521_266_0	4		N	Generic	4	01	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	20.00											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										1		
H5521	266	0	1	04	01	H5521_266_0	4		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			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	4		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			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	4		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											905.63	33						538.37	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	267	0	1	04	01	H5521_267_0	4		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					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	4		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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	4		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					10.00	20.00	20.00											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												
H5521	267	0	1	04	01	H5521_267_0	4		N	Generic	4	01	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	20.00											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										1		
H5521	267	0	1	04	01	H5521_267_0	4		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			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	4		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			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	4		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											867.91	33						547.07	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		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					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		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	268	0	1	04	01	H5521_268_0	3		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					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		N	Generic	4	01	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		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			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		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			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		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1103.74	30						440.61	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		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					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		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	269	0	1	04	01	H5521_269_0	3		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					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		N	Generic	4	01	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		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			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		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			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		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1152.20	30						535.50	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		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					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		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	270	0	1	04	01	H5521_270_0	3		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					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		N	Generic	4	01	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		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			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		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			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		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1074.93	30						564.33	30												30						30						30		30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	271	0	1	04	01	H5521_271_0	2		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					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	2		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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	2		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					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	2		N	Generic	4	01	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	2		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			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	2		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			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	2		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											829.90	30						554.39	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		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					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		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	272	0	1	04	01	H5521_272_0	3		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					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		N	Generic	4	01	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		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			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		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			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		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1087.54	30						584.01	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		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					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		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	273	0	1	04	01	H5521_273_0	3		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					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		N	Generic	4	01	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		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			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		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			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		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											977.39	30						545.14	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		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					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		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	275	0	1	04	01	H5521_275_0	2		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					10.00	20.00	20.00											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												
H5521	275	0	1	04	01	H5521_275_0	2		N	Generic	4	01	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	20.00											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										1		
H5521	275	0	1	04	01	H5521_275_0	2		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			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		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			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		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											663.46	27						380.86	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		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					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		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	277	0	1	04	01	H5521_277_0	2		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					10.00	20.00	20.00											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												
H5521	277	0	1	04	01	H5521_277_0	2		N	Generic	4	01	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	20.00											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										1		
H5521	277	0	1	04	01	H5521_277_0	2		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			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		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			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		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											862.20	27						594.78	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		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					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		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	278	0	1	04	01	H5521_278_0	2		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					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		N	Generic	4	01	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		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			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		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			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		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											945.61	28						466.95	28												28						28						28		28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	280	0	1	04	01	H5521_280_0	4		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					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	280	0	1	04	01	H5521_280_0	4		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	280	0	1	04	01	H5521_280_0	4		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					5.00	10.00	10.00											20.00	40.00	60.00				5.00	10.00	10.00					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	4		N	Generic	4	01	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	4		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			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	4		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			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	4		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											995.27	33						573.79	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	281	0	1	04	01	H5521_281_0	4		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					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	4		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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	4		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					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	4		N	Generic	4	01	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	4		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			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	4		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			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	4		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											946.76	33						506.55	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	283	0	1	04	01	H5521_283_0	3		N	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	3		N	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	3		N	Generic	4	01	3	2	2	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					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	3		N	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	3		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			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	3		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			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	3		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											733.80	33						497.14	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		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					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		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					10.00	20.00	20.00											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												
H5521	284	0	1	04	01	H5521_284_0	3		N	Generic	4	01	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	20.00											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										1		
H5521	284	0	1	04	01	H5521_284_0	3		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			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		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			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		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											709.65	33						490.10	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		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					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		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					10.00	20.00	20.00											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												
H5521	285	0	1	04	01	H5521_285_0	3		N	Generic	4	01	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	20.00											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										1		
H5521	285	0	1	04	01	H5521_285_0	3		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			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		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			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		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1087.00	33						555.08	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		N	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		N	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		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								12.00	24.00	36.00					10.00	20.00	20.00											12.00	24.00	36.00				10.00	20.00	20.00					12.00			12.00			0.40	0.33		0.40	0.33	0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	288	0	1	04	01	H5521_288_0	3		N	Generic	4	01	1	2	2	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								12.00	24.00	36.00					10.00	20.00	20.00											12.00	24.00	36.00				10.00	20.00	20.00					12.00			12.00			0.40	0.33		0.40	0.33	0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	288	0	1	04	01	H5521_288_0	3		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			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		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			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		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											748.01	33						475.89	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		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					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		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					10.00	20.00	20.00											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												
H5521	289	0	1	04	01	H5521_289_0	3		N	Generic	4	01	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	20.00											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										1		
H5521	289	0	1	04	01	H5521_289_0	3		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			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		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			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		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											950.29	29						501.62	29												29						29						29		29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	290	0	1	04	01	H5521_290_0	3		N	Preferred Generic	4	01	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	290	0	1	04	01	H5521_290_0	3		N	Preferred Generic	4	01	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	290	0	1	04	01	H5521_290_0	3		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					5.00	10.00	10.00											20.00	40.00	60.00				5.00	10.00	10.00					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	290	0	1	04	01	H5521_290_0	3		N	Generic	4	01	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	290	0	1	04	01	H5521_290_0	3		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			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	3		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			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	3		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											883.28	33						469.90	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	292	0	1	04	01	H5521_292_0	5		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					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	5		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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	5		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					10.00	20.00	20.00											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												
H5521	292	0	1	04	01	H5521_292_0	5		N	Generic	4	01	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	20.00											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										1		
H5521	292	0	1	04	01	H5521_292_0	5		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			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	5		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			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	5		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1098.24	33						572.34	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	293	0	1	04	01	H5521_293_0	5		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					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	5		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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	5		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					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	5		N	Generic	4	01	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	5		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			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	5		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			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	5		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											688.53	33						626.95	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	294	0	1	04	01	H5521_294_0	2		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					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	2		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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	2		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					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	2		N	Generic	4	01	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	2		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			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	2		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			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	2		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											809.45	33						498.24	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		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					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		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	295	0	1	04	01	H5521_295_0	2		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					10.00	20.00	20.00											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												
H5521	295	0	1	04	01	H5521_295_0	2		N	Generic	4	01	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	20.00											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										1		
H5521	295	0	1	04	01	H5521_295_0	2		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			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		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			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		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											931.91	28						523.31	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		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					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		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	298	0	1	04	01	H5521_298_0	2		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					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		N	Generic	4	01	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		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			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		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			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		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											739.45	28						657.81	28												28						28						28		28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	299	0	1	04	01	H5521_299_0	2		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					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	2		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	299	0	1	04	01	H5521_299_0	2		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	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	299	0	1	04	01	H5521_299_0	2		N	Generic	4	01	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	299	0	1	04	01	H5521_299_0	2		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			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	2		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			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	2		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											881.81	33						552.38	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	300	0	1	04	01	H5521_300_0	3		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					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	3		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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	3		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					5.00	10.00	10.00											20.00	40.00	60.00				5.00	10.00	10.00					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	300	0	1	04	01	H5521_300_0	3		N	Generic	4	01	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	300	0	1	04	01	H5521_300_0	3		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			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	3		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			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	3		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1100.40	33						645.06	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	301	0	1	04	01	H5521_301_0	3		N	Preferred Generic	4	01	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	301	0	1	04	01	H5521_301_0	3		N	Preferred Generic	4	01	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	301	0	1	04	01	H5521_301_0	3		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					5.00	10.00	10.00											20.00	40.00	60.00				5.00	10.00	10.00					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	301	0	1	04	01	H5521_301_0	3		N	Generic	4	01	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	301	0	1	04	01	H5521_301_0	3		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			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	3		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			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	3		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											939.54	33						512.08	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		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					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		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					10.00	20.00	20.00											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												
H5521	302	0	1	04	01	H5521_302_0	3		N	Generic	4	01	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	20.00											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										1		
H5521	302	0	1	04	01	H5521_302_0	3		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			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		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			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		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											922.61	33						424.65	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	303	0	1	04	01	H5521_303_0	3		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					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	3		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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	3		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					5.00	10.00	10.00											20.00	40.00	60.00				5.00	10.00	10.00					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	303	0	1	04	01	H5521_303_0	3		N	Generic	4	01	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	303	0	1	04	01	H5521_303_0	3		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			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	3		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			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	3		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1095.95	33						572.99	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		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					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		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	305	0	1	04	01	H5521_305_0	3		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					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		N	Generic	4	01	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		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			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		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			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		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											967.70	30						680.59	30												30						30						30		30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	307	0	1	04	01	H5521_307_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	307	0	1	04	01	H5521_307_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	307	0	1	04	01	H5521_307_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	307	0	1	04	01	H5521_307_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	307	0	1	04	01	H5521_307_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	307	0	1	04	01	H5521_307_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	307	0	1	04	01	H5521_307_0	2			Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											966.91	33						568.07	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	310	0	1	04	01	H5521_310_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	310	0	1	04	01	H5521_310_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	310	0	1	04	01	H5521_310_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	20.00											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												
H5521	310	0	1	04	01	H5521_310_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	20.00											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										1		
H5521	310	0	1	04	01	H5521_310_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	310	0	1	04	01	H5521_310_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	310	0	1	04	01	H5521_310_0	2			Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1100.68	28						526.71	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		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					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		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					10.00	20.00	20.00											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												
H5521	311	0	1	04	01	H5521_311_0	3		N	Generic	4	01	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	20.00											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										1		
H5521	311	0	1	04	01	H5521_311_0	3		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			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		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			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		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											782.02	33						793.71	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	312	0	1	04	01	H5521_312_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	312	0	1	04	01	H5521_312_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	312	0	1	04	01	H5521_312_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	20.00											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												
H5521	312	0	1	04	01	H5521_312_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	20.00											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										1		
H5521	312	0	1	04	01	H5521_312_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	312	0	1	04	01	H5521_312_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	312	0	1	04	01	H5521_312_0	2			Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											761.50	28						443.44	28												28						28						28		28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	313	0	1	04	01	H5521_313_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	313	0	1	04	01	H5521_313_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	313	0	1	04	01	H5521_313_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	20.00											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												
H5521	313	0	1	04	01	H5521_313_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	20.00											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										1		
H5521	313	0	1	04	01	H5521_313_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	313	0	1	04	01	H5521_313_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	313	0	1	04	01	H5521_313_0	3			Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											914.27	27						311.96	27												27						27						27		27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	314	0	1	04	01	H5521_314_0	3		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					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	3		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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	3		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					10.00	20.00	20.00											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												
H5521	314	0	1	04	01	H5521_314_0	3		N	Generic	4	01	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	20.00											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										1		
H5521	314	0	1	04	01	H5521_314_0	3		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			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	3		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			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	3		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											996.87	33						681.05	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	318	0	1	04	01	H5521_318_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	318	0	1	04	01	H5521_318_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	318	0	1	04	01	H5521_318_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	20.00											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												
H5521	318	0	1	04	01	H5521_318_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	20.00											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										1		
H5521	318	0	1	04	01	H5521_318_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	318	0	1	04	01	H5521_318_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	318	0	1	04	01	H5521_318_0	2			Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											736.87	28						403.42	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		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					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		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					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		N	Generic	4	01	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		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			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		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			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		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1686.80	33						694.33	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		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					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		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					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		N	Generic	4	01	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		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			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		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			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		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1118.92	33						612.10	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	326	0	1	04	01	H5521_326_0	2		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					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	2		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	326	0	1	04	01	H5521_326_0	2		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					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	2		N	Generic	4	01	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	2		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			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	2		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			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	2		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											742.14	30						596.13	30												30						30						30		30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	328	0	1	04	01	H5521_328_0	2		Y	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	2		Y	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	2		Y	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	2		Y	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	2		Y	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			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	2		Y	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			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	2		Y	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											829.78	33						579.85	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		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					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		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					10.00	20.00	20.00											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												
H5521	331	0	1	04	01	H5521_331_0	3		N	Generic	4	01	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	20.00											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										1		
H5521	331	0	1	04	01	H5521_331_0	3		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			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		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			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		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1008.97	33						563.84	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	332	0	1	04	01	H5521_332_0	5		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					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	5		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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	5		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					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	5		N	Generic	4	01	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	5		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			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	5		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			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	5		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											878.32	33						525.51	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	333	0	1	04	01	H5521_333_0	5		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					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	5		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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	5		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					10.00	20.00	20.00											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												
H5521	333	0	1	04	01	H5521_333_0	5		N	Generic	4	01	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	20.00											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										1		
H5521	333	0	1	04	01	H5521_333_0	5		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			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	5		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			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	5		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											993.93	33						577.12	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	340	0	1	04	01	H5521_340_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	340	0	1	04	01	H5521_340_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	340	0	1	04	01	H5521_340_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	20.00											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												
H5521	340	0	1	04	01	H5521_340_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	20.00											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										1		
H5521	340	0	1	04	01	H5521_340_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	340	0	1	04	01	H5521_340_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	340	0	1	04	01	H5521_340_0	2			Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											942.60	29						533.58	29												29						29						29		29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	341	0	1	04	01	H5521_341_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	341	0	1	04	01	H5521_341_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	341	0	1	04	01	H5521_341_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	20.00											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												
H5521	341	0	1	04	01	H5521_341_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	20.00											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										1		
H5521	341	0	1	04	01	H5521_341_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	341	0	1	04	01	H5521_341_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	341	0	1	04	01	H5521_341_0	3			Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											900.97	27						501.54	27												27						27						27		27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	344	0	1	04	01	H5521_344_0	4		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					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	344	0	1	04	01	H5521_344_0	4		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	344	0	1	04	01	H5521_344_0	4		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					10.00	20.00	20.00											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												
H5521	344	0	1	04	01	H5521_344_0	4		N	Generic	4	01	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	20.00											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										1		
H5521	344	0	1	04	01	H5521_344_0	4		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			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	4		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			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	4		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											911.84	30						537.33	30												30						30						30		30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	345	0	1	04	01	H5521_345_0	4		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					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		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					10.00	20.00	20.00											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												
H5521	345	0	1	04	01	H5521_345_0	4		N	Generic	4	01	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	20.00											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										1		
H5521	345	0	1	04	01	H5521_345_0	4		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			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		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			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		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											911.84	30						537.33	30												30						30						30		30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	348	0	1	04	01	H5521_348_0	2		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					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	2		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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	2		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					10.00	20.00	25.00											20.00	40.00	60.00				10.00	20.00	25.00					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	2		N	Generic	4	01	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	2		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			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	2		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			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	2		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											911.42	29						521.87	29												29						29						29		29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	352	0	1	04	01	H5521_352_0	2		Y	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					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	2		Y	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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	2		Y	Generic	4	01	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	2		Y	Generic	4	01	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	2		Y	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			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	2		Y	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			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	2		Y	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1053.25	33						573.10	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	354	0	1	04	01	H5521_354_0	2		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					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	2		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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	2		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					10.00	20.00	25.00											20.00	40.00	60.00				10.00	20.00	25.00					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	2		N	Generic	4	01	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	2		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			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	2		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			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	2		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											911.42	29						521.87	29												29						29						29		29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	360	0	1	04	01	H5521_360_0	3		Y	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	360	0	1	04	01	H5521_360_0	3		Y	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	360	0	1	04	01	H5521_360_0	3		Y	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												
H5521	360	0	1	04	01	H5521_360_0	3		Y	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		
H5521	360	0	1	04	01	H5521_360_0	3		Y	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	360	0	1	04	01	H5521_360_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	360	0	1	04	01	H5521_360_0	3		Y	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											983.15	33						565.70	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	363	0	1	04	01	H5521_363_0	3		N	Preferred Generic	4	01	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	363	0	1	04	01	H5521_363_0	3		N	Preferred Generic	4	01	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	363	0	1	04	01	H5521_363_0	3		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					5.00	10.00	10.00											20.00	40.00	60.00				5.00	10.00	10.00					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	363	0	1	04	01	H5521_363_0	3		N	Generic	4	01	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	363	0	1	04	01	H5521_363_0	3		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	363	0	1	04	01	H5521_363_0	3		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	363	0	1	04	01	H5521_363_0	3		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1008.99	33						563.84	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	364	0	1	04	01	H5521_364_0	2		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					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	364	0	1	04	01	H5521_364_0	2		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					10.00	20.00	0.00											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												
H5521	364	0	1	04	01	H5521_364_0	2		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	364	0	1	04	01	H5521_364_0	2		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	364	0	1	04	01	H5521_364_0	2		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											766.73	25						446.56	25												25						25						25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	365	0	1	04	01	H5521_365_0	3		Y	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	365	0	1	04	01	H5521_365_0	3		Y	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	365	0	1	04	01	H5521_365_0	3		Y	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												
H5521	365	0	1	04	01	H5521_365_0	3		Y	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		
H5521	365	0	1	04	01	H5521_365_0	3		Y	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	365	0	1	04	01	H5521_365_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	365	0	1	04	01	H5521_365_0	3		Y	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											902.93	33						532.71	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	366	0	1	04	01	H5521_366_0	3		Y	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	366	0	1	04	01	H5521_366_0	3		Y	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	366	0	1	04	01	H5521_366_0	3		Y	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												
H5521	366	0	1	04	01	H5521_366_0	3		Y	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		
H5521	366	0	1	04	01	H5521_366_0	3		Y	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	366	0	1	04	01	H5521_366_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	366	0	1	04	01	H5521_366_0	3		Y	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											902.93	33						532.71	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	370	0	1	04	01	H5521_370_0	5		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					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	370	0	1	04	01	H5521_370_0	5		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	370	0	1	04	01	H5521_370_0	5		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					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	370	0	1	04	01	H5521_370_0	5		N	Generic	4	01	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	370	0	1	04	01	H5521_370_0	5		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	370	0	1	04	01	H5521_370_0	5		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	370	0	1	04	01	H5521_370_0	5		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											919.49	33						544.88	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	371	0	1	04	01	H5521_371_0	5		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					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	371	0	1	04	01	H5521_371_0	5		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	371	0	1	04	01	H5521_371_0	5		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					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	371	0	1	04	01	H5521_371_0	5		N	Generic	4	01	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	371	0	1	04	01	H5521_371_0	5		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	371	0	1	04	01	H5521_371_0	5		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	371	0	1	04	01	H5521_371_0	5		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											919.49	33						544.88	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	372	0	1	04	01	H5521_372_0	5		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					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	372	0	1	04	01	H5521_372_0	5		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	372	0	1	04	01	H5521_372_0	5		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					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	372	0	1	04	01	H5521_372_0	5		N	Generic	4	01	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	372	0	1	04	01	H5521_372_0	5		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	372	0	1	04	01	H5521_372_0	5		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	372	0	1	04	01	H5521_372_0	5		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											919.49	33						544.88	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	373	0	1	04	01	H5521_373_0	2		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					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	373	0	1	04	01	H5521_373_0	2		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	373	0	1	04	01	H5521_373_0	2		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					10.00	20.00	25.00											20.00	40.00	60.00				10.00	20.00	25.00					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	373	0	1	04	01	H5521_373_0	2		N	Generic	4	01	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	373	0	1	04	01	H5521_373_0	2		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	373	0	1	04	01	H5521_373_0	2		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	373	0	1	04	01	H5521_373_0	2		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											894.31	29						518.67	29												29						29						29		29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	374	0	1	04	01	H5521_374_0	2		Y	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					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	374	0	1	04	01	H5521_374_0	2		Y	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	374	0	1	04	01	H5521_374_0	2		Y	Generic	4	01	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	374	0	1	04	01	H5521_374_0	2		Y	Generic	4	01	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	374	0	1	04	01	H5521_374_0	2		Y	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	374	0	1	04	01	H5521_374_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	374	0	1	04	01	H5521_374_0	2		Y	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1066.63	33						587.88	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	375	0	1	04	01	H5521_375_0	2		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					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	375	0	1	04	01	H5521_375_0	2		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	375	0	1	04	01	H5521_375_0	2		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					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	375	0	1	04	01	H5521_375_0	2		N	Generic	4	01	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	375	0	1	04	01	H5521_375_0	2		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	375	0	1	04	01	H5521_375_0	2		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	375	0	1	04	01	H5521_375_0	2		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1011.29	33						571.81	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	376	0	1	04	01	H5521_376_0	3		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					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	376	0	1	04	01	H5521_376_0	3		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	376	0	1	04	01	H5521_376_0	3		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					10.00	20.00	25.00											20.00	40.00	60.00				10.00	20.00	25.00					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	376	0	1	04	01	H5521_376_0	3		N	Generic	4	01	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	376	0	1	04	01	H5521_376_0	3		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	376	0	1	04	01	H5521_376_0	3		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	376	0	1	04	01	H5521_376_0	3		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											794.12	25						471.04	25												25						25						25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	377	0	1	04	01	H5521_377_0	4		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					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	377	0	1	04	01	H5521_377_0	4		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	377	0	1	04	01	H5521_377_0	4		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					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	377	0	1	04	01	H5521_377_0	4		N	Generic	4	01	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	377	0	1	04	01	H5521_377_0	4		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	377	0	1	04	01	H5521_377_0	4		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	377	0	1	04	01	H5521_377_0	4		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											967.90	30						528.68	30												30						30						30		30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	379	0	1	04	01	H5521_379_0	2		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					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	379	0	1	04	01	H5521_379_0	2		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	379	0	1	04	01	H5521_379_0	2		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					10.00	20.00	20.00											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												
H5521	379	0	1	04	01	H5521_379_0	2		N	Generic	4	01	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	20.00											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										1		
H5521	379	0	1	04	01	H5521_379_0	2		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	379	0	1	04	01	H5521_379_0	2		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	379	0	1	04	01	H5521_379_0	2		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1029.25	33						565.11	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	380	0	1	04	01	H5521_380_0	2		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					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	380	0	1	04	01	H5521_380_0	2		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	380	0	1	04	01	H5521_380_0	2		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					10.00	20.00	20.00											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												
H5521	380	0	1	04	01	H5521_380_0	2		N	Generic	4	01	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	20.00											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										1		
H5521	380	0	1	04	01	H5521_380_0	2		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	380	0	1	04	01	H5521_380_0	2		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	380	0	1	04	01	H5521_380_0	2		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											924.07	29						531.10	29												29						29						29		29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	381	0	1	04	01	H5521_381_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	381	0	1	04	01	H5521_381_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	381	0	1	04	01	H5521_381_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	381	0	1	04	01	H5521_381_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	381	0	1	04	01	H5521_381_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	381	0	1	04	01	H5521_381_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	381	0	1	04	01	H5521_381_0	2			Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											942.60	29						533.58	29												29						29						29		29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	382	0	1	04	01	H5521_382_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	382	0	1	04	01	H5521_382_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	382	0	1	04	01	H5521_382_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	20.00											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												
H5521	382	0	1	04	01	H5521_382_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	20.00											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										1		
H5521	382	0	1	04	01	H5521_382_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	382	0	1	04	01	H5521_382_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	382	0	1	04	01	H5521_382_0	2			Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											942.60	29						533.58	29												29						29						29		29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	383	0	1	04	01	H5521_383_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	383	0	1	04	01	H5521_383_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	383	0	1	04	01	H5521_383_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	20.00											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												
H5521	383	0	1	04	01	H5521_383_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	20.00											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										1		
H5521	383	0	1	04	01	H5521_383_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	383	0	1	04	01	H5521_383_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	383	0	1	04	01	H5521_383_0	2			Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											960.10	29						535.91	29												29						29						29		29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	384	0	1	04	01	H5521_384_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	384	0	1	04	01	H5521_384_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	384	0	1	04	01	H5521_384_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	20.00											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												
H5521	384	0	1	04	01	H5521_384_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	20.00											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										1		
H5521	384	0	1	04	01	H5521_384_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	384	0	1	04	01	H5521_384_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	384	0	1	04	01	H5521_384_0	2			Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											922.71	29						530.89	29												29						29						29		29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	386	0	1	04	01	H5521_386_0	3		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					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	386	0	1	04	01	H5521_386_0	3		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	386	0	1	04	01	H5521_386_0	3		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					10.00	20.00	20.00											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												
H5521	386	0	1	04	01	H5521_386_0	3		N	Generic	4	01	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	20.00											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										1		
H5521	386	0	1	04	01	H5521_386_0	3		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	386	0	1	04	01	H5521_386_0	3		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	386	0	1	04	01	H5521_386_0	3		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											991.04	33						549.88	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	387	0	1	04	01	H5521_387_0	3		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					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	387	0	1	04	01	H5521_387_0	3		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	387	0	1	04	01	H5521_387_0	3		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					10.00	20.00	20.00											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												
H5521	387	0	1	04	01	H5521_387_0	3		N	Generic	4	01	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	20.00											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										1		
H5521	387	0	1	04	01	H5521_387_0	3		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	387	0	1	04	01	H5521_387_0	3		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	387	0	1	04	01	H5521_387_0	3		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											873.45	29						513.04	29												29						29						29		29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	388	0	1	04	01	H5521_388_0	3		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					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	388	0	1	04	01	H5521_388_0	3		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	388	0	1	04	01	H5521_388_0	3		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					10.00	20.00	20.00											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												
H5521	388	0	1	04	01	H5521_388_0	3		N	Generic	4	01	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	20.00											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										1		
H5521	388	0	1	04	01	H5521_388_0	3		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	388	0	1	04	01	H5521_388_0	3		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	388	0	1	04	01	H5521_388_0	3		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											895.09	29						516.01	29												29						29						29		29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	389	0	1	04	01	H5521_389_0	3		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					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	389	0	1	04	01	H5521_389_0	3		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	389	0	1	04	01	H5521_389_0	3		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					10.00	20.00	20.00											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												
H5521	389	0	1	04	01	H5521_389_0	3		N	Generic	4	01	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	20.00											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										1		
H5521	389	0	1	04	01	H5521_389_0	3		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	389	0	1	04	01	H5521_389_0	3		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	389	0	1	04	01	H5521_389_0	3		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											895.09	29						516.01	29												29						29						29		29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	390	0	1	04	01	H5521_390_0	2		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					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	390	0	1	04	01	H5521_390_0	2		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	390	0	1	04	01	H5521_390_0	2		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					10.00	20.00	20.00											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												
H5521	390	0	1	04	01	H5521_390_0	2		N	Generic	4	01	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	20.00											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										1		
H5521	390	0	1	04	01	H5521_390_0	2		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	390	0	1	04	01	H5521_390_0	2		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	390	0	1	04	01	H5521_390_0	2		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											916.50	28						519.50	28												28						28						28		28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	391	0	1	04	01	H5521_391_0	2		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					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	391	0	1	04	01	H5521_391_0	2		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	391	0	1	04	01	H5521_391_0	2		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					10.00	20.00	20.00											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												
H5521	391	0	1	04	01	H5521_391_0	2		N	Generic	4	01	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	20.00											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										1		
H5521	391	0	1	04	01	H5521_391_0	2		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	391	0	1	04	01	H5521_391_0	2		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	391	0	1	04	01	H5521_391_0	2		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											916.50	28						519.50	28												28						28						28		28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	392	0	1	04	01	H5521_392_0	3		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					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	392	0	1	04	01	H5521_392_0	3		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	392	0	1	04	01	H5521_392_0	3		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					10.00	20.00	20.00											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												
H5521	392	0	1	04	01	H5521_392_0	3		N	Generic	4	01	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	20.00											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										1		
H5521	392	0	1	04	01	H5521_392_0	3		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	392	0	1	04	01	H5521_392_0	3		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	392	0	1	04	01	H5521_392_0	3		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											956.20	29						538.67	29												29						29						29		29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	393	0	1	04	01	H5521_393_0	3		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					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	393	0	1	04	01	H5521_393_0	3		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	393	0	1	04	01	H5521_393_0	3		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					10.00	20.00	20.00											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												
H5521	393	0	1	04	01	H5521_393_0	3		N	Generic	4	01	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	20.00											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										1		
H5521	393	0	1	04	01	H5521_393_0	3		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	393	0	1	04	01	H5521_393_0	3		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	393	0	1	04	01	H5521_393_0	3		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1029.25	33						565.11	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5522	001	0	1	04	01	H5522_001_0	2		Y	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	2		Y	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	2		Y	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	2		Y	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	2		Y	Preferred Brand	4	11	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	2		Y	Non-Preferred Drug	4	11	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	2		Y	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1387.30	33						732.49	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5522	002	0	1	04	01	H5522_002_0	2		Y	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	2		Y	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	2		Y	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	2		Y	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	2		Y	Preferred Brand	4	11	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	2		Y	Non-Preferred Drug	4	11	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	2		Y	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1198.35	33						688.58	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		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					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		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5522	004	0	1	04	01	H5522_004_0	2		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					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		N	Generic	4	01	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		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					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		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					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		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											988.86	33						596.98	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		Y	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		Y	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		Y	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		Y	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		Y	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					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		Y	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					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		Y	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1261.31	33						515.62	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5522	013	0	1	04	01	H5522_013_0	2		Y	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	2		Y	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	2		Y	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	2		Y	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	2		Y	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5522	013	0	1	04	01	H5522_013_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5522	013	0	1	04	01	H5522_013_0	2		Y	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											847.97	33						507.68	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5522	014	0	1	04	01	H5522_014_0	2		Y	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	2		Y	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	2		Y	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	2		Y	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	2		Y	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5522	014	0	1	04	01	H5522_014_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5522	014	0	1	04	01	H5522_014_0	2		Y	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1218.14	33						568.29	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		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5522	017	0	1	04	01	H5522_017_0	2		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5522	017	0	1	04	01	H5522_017_0	2		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					5.00	10.00	10.00											20.00	40.00	60.00				5.00	10.00	10.00					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	017	0	1	04	01	H5522_017_0	2		N	Generic	4	01	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	017	0	1	04	01	H5522_017_0	2		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					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		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					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		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											890.19	33						757.85	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5522	020	0	1	04	01	H5522_020_0	3		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					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	3		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			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	3		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					5.00	10.00	10.00											20.00	40.00	60.00				5.00	10.00	10.00					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	3		N	Generic	4	01	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	3		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					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	3		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					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	3		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1010.67	33						569.14	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5522	021	0	1	04	01	H5522_021_0	2		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					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	021	0	1	04	01	H5522_021_0	2		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5522	021	0	1	04	01	H5522_021_0	2		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					5.00	10.00	10.00											20.00	40.00	60.00				5.00	10.00	10.00					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	021	0	1	04	01	H5522_021_0	2		N	Generic	4	01	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	021	0	1	04	01	H5522_021_0	2		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					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	021	0	1	04	01	H5522_021_0	2		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					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	021	0	1	04	01	H5522_021_0	2		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1024.43	33						569.83	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5522	022	0	1	04	01	H5522_022_0	3		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					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	022	0	1	04	01	H5522_022_0	3		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5522	022	0	1	04	01	H5522_022_0	3		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								20.00	40.00	60.00					10.00	20.00	20.00											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												
H5522	022	0	1	04	01	H5522_022_0	3		N	Generic	4	01	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	20.00											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										1		
H5522	022	0	1	04	01	H5522_022_0	3		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					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	022	0	1	04	01	H5522_022_0	3		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					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	022	0	1	04	01	H5522_022_0	3		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1010.67	33						569.14	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	004	0	1	04	01	H5525_004_0	3		Y	Preferred Generic	4	11	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	6.00		18.00																									10.00		30.00				6.00		0.00				6.00				6.00		0.20				0.33	0.20	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	004	0	1	04	01	H5525_004_0	3		Y	Generic	4	11	1	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	15.00		45.00																									20.00		60.00				15.00		0.00				15.00				15.00		0.50				0.67	0.50	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	004	0	1	04	01	H5525_004_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	004	0	1	04	01	H5525_004_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	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												
H5525	004	0	1	04	01	H5525_004_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					29																										29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	005	0	1	04	01	H5525_005_0	4		Y	Preferred Generic	4	11	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	5.00		15.00																									10.00		30.00				5.00		0.00				5.00				5.00		0.17				0.33	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	005	0	1	04	01	H5525_005_0	4		Y	Generic	4	11	1	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	15.00		45.00																									20.00		60.00				15.00		0.00				15.00				15.00		0.50				0.67	0.50	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	005	0	1	04	01	H5525_005_0	4		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		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	4		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		290.00				100.00				100.00		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	4		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	006	0	1	04	01	H5525_006_0	4		Y	Preferred Generic	4	11	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	3.00		9.00																									10.00		30.00				3.00		0.00				3.00				3.00		0.10				0.33	0.10	0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	006	0	1	04	01	H5525_006_0	4		Y	Generic	4	11	1	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	15.00		45.00																									20.00		60.00				15.00		0.00				15.00				15.00		0.50				0.67	0.50	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	006	0	1	04	01	H5525_006_0	4		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	006	0	1	04	01	H5525_006_0	4		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	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												
H5525	006	0	1	04	01	H5525_006_0	4		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	008	0	1	04	01	H5525_008_0	4		Y	Preferred Generic	4	11	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	7.00		21.00																									10.00		30.00				7.00		0.00				7.00				7.00		0.23				0.33	0.23	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	008	0	1	04	01	H5525_008_0	4		Y	Generic	4	11	1	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	17.00		51.00																									20.00		60.00				17.00		0.00				17.00				17.00		0.57				0.67	0.57	0.55	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	008	0	1	04	01	H5525_008_0	4		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		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	4		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		290.00				100.00				100.00		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	4		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					29																										29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	015	0	1	04	01	H5525_015_0	4		Y	Preferred Generic	4	11	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	5.00		15.00																									10.00		30.00				5.00		0.00				5.00				5.00		0.17				0.33	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	015	0	1	04	01	H5525_015_0	4		Y	Generic	4	11	1	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	15.00		45.00																									20.00		60.00				15.00		0.00				15.00				15.00		0.50				0.67	0.50	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	015	0	1	04	01	H5525_015_0	4		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		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		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	99.00		297.00																									100.00		300.00				99.00		287.00				99.00				99.00		3.30				3.33	3.30	3.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	015	0	1	04	01	H5525_015_0	4		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	017	0	1	04	01	H5525_017_0	4		Y	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	017	0	1	04	01	H5525_017_0	4		Y	Preferred Generic	4	11	3	2	1	3	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H5525	017	0	1	04	01	H5525_017_0	4		Y	Generic	4	11	3	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	0.00		0.00																									20.00		60.00				0.00		0.00				0.00				0.00		0				0.67	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	017	0	1	04	01	H5525_017_0	4		Y	Generic	4	11	3	2	2	3	110		01		110	1	30		90				2	2				30		90	30		31	0.00		0.00																									20.00		60.00				0.00		0.00				0.00				0.00		0				0.67	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H5525	017	0	1	04	01	H5525_017_0	4		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		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		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	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												
H5525	017	0	1	04	01	H5525_017_0	4		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	020	0	1	04	01	H5525_020_0	3		Y	Preferred Generic	4	11	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	7.00		21.00																									10.00		30.00				7.00		0.00				7.00				7.00		0.23				0.33	0.23	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	020	0	1	04	01	H5525_020_0	3		Y	Generic	4	11	1	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	17.00		51.00																									20.00		60.00				17.00		0.00				17.00				17.00		0.57				0.67	0.57	0.55	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	020	0	1	04	01	H5525_020_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	020	0	1	04	01	H5525_020_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	97.00		291.00																									100.00		300.00				97.00		281.00				97.00				97.00		3.23				3.33	3.23	3.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	020	0	1	04	01	H5525_020_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					27																										27						27					27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	022	0	1	04	01	H5525_022_0	3		Y	Preferred Generic	4	11	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	5.00		15.00																									10.00		30.00				5.00		0.00				5.00				5.00		0.17				0.33	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	022	0	1	04	01	H5525_022_0	3		Y	Generic	4	11	1	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	15.00		45.00																									20.00		60.00				15.00		0.00				15.00				15.00		0.50				0.67	0.50	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	022	0	1	04	01	H5525_022_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	022	0	1	04	01	H5525_022_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	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												
H5525	022	0	1	04	01	H5525_022_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	024	0	1	04	01	H5525_024_0	3		Y	Preferred Generic	4	11	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	7.00		21.00																									10.00		30.00				7.00		0.00				7.00				7.00		0.23				0.33	0.23	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	024	0	1	04	01	H5525_024_0	3		Y	Generic	4	11	1	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	17.00		51.00																									20.00		60.00				17.00		0.00				17.00				17.00		0.57				0.67	0.57	0.55	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	024	0	1	04	01	H5525_024_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	024	0	1	04	01	H5525_024_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	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												
H5525	024	0	1	04	01	H5525_024_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					28																										28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	026	0	1	04	01	H5525_026_0	3		Y	Preferred Generic	4	11	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	4.00		12.00																									10.00		30.00				4.00		0.00				4.00				4.00		0.13				0.33	0.13	0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	026	0	1	04	01	H5525_026_0	3		Y	Generic	4	11	1	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	12.00		36.00																									20.00		60.00				12.00		0.00				12.00				12.00		0.40				0.67	0.40	0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	026	0	1	04	01	H5525_026_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		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	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		290.00				100.00				100.00		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	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					28																										28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	027	0	1	04	01	H5525_027_0	2		Y	Preferred Generic	4	11	1	2	1	1	110		01		110	1	30		100				1	2				30		100	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	027	0	1	04	01	H5525_027_0	2		Y	Preferred Generic	4	11	1	2	1	3	110		01		110	1	30		100				1	2				30		100	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5525	027	0	1	04	01	H5525_027_0	2		Y	Generic	4	11	1	2	2	1	110		01		110	1	30		100				2	2				30		100	30		31	5.00		15.00																									20.00		60.00				5.00		0.00				5.00				5.00		0.17				0.67	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	027	0	1	04	01	H5525_027_0	2		Y	Generic	4	11	1	2	2	3	110		01		110	1	30		100				2	2				30		100	30		31	5.00		15.00																									20.00		60.00				5.00		0.00				5.00				5.00		0.17				0.67	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5525	027	0	1	04	01	H5525_027_0	2		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		100				2	2				30		100	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												
H5525	027	0	1	04	01	H5525_027_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		100				2	2				30		100	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												
H5525	027	0	1	04	01	H5525_027_0	2		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					27																										27						27					27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	030	0	1	04	01	H5525_030_0	6		Y	Preferred Generic	4	11	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	1.00		3.00																									10.00		30.00				1.00		0.00				1.00				1.00		0.03				0.33	0.03	0.03	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	030	0	1	04	01	H5525_030_0	6		Y	Generic	4	11	1	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	4.00		12.00																									20.00		60.00				4.00		0.00				4.00				4.00		0.13				0.67	0.13	0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	030	0	1	04	01	H5525_030_0	6		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		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	6		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	97.00		291.00																									100.00		300.00				97.00		281.00				97.00				97.00		3.23				3.33	3.23	3.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	030	0	1	04	01	H5525_030_0	6		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					31																										31						31					31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	034	0	1	04	01	H5525_034_0	3		Y	Preferred Generic	4	11	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	4.00		12.00																									10.00		30.00				4.00		0.00				4.00				4.00		0.13				0.33	0.13	0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	034	0	1	04	01	H5525_034_0	3		Y	Generic	4	11	1	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	12.00		36.00																									20.00		60.00				12.00		0.00				12.00				12.00		0.40				0.67	0.40	0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	034	0	1	04	01	H5525_034_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	034	0	1	04	01	H5525_034_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	99.00		297.00																									100.00		300.00				99.00		287.00				99.00				99.00		3.30				3.33	3.30	3.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	034	0	1	04	01	H5525_034_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					30																										30						30					30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	035	0	1	04	01	H5525_035_0	3		Y	Preferred Generic	4	11	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	035	0	1	04	01	H5525_035_0	3		Y	Generic	4	11	1	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	5.00		15.00																									20.00		60.00				5.00		0.00				5.00				5.00		0.17				0.67	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	035	0	1	04	01	H5525_035_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		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	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	99.00		297.00																									100.00		300.00				99.00		287.00				99.00				99.00		3.30				3.33	3.30	3.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	035	0	1	04	01	H5525_035_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					28																										28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	037	0	1	04	01	H5525_037_0	3		N	Preferred Generic	3	11	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	12.00		36.00																									13.00		39.00				12.00		0.00				12.00				12.00		0.40				0.43	0.40	0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	037	0	1	04	01	H5525_037_0	3		N	Generic	3	11	1	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	20.00		60.00																									20.00		60.00				20.00		0.00				20.00				20.00		0.67				0.67	0.67	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	037	0	1	04	01	H5525_037_0	3		N	Preferred Brand	3	11	1	1	3	1	110		01		110	1	30		90				2	2				30		90	30		31				46.00	20		20																								20		20				20		20			20			20								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	037	0	1	04	01	H5525_037_0	3		N	Non-Preferred Drug	3	11	1	1	4	1	110		01		110	1	30		90				2	2				30		90	30		31				67.00	25		25																								25		25				25		25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	037	0	1	04	01	H5525_037_0	3		N	Specialty Tier	3	11	1	1	5	1	010		01		010	1	30											30			30		31					25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	041	0	1	04	01	H5525_041_0	5		Y	Preferred Generic	4	11	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0				0	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	041	0	1	04	01	H5525_041_0	5		Y	Generic	4	11	1	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	15.00		45.00																									20.00		60.00				15.00		0.00				15.00				15.00		0.50				0.67	0.50	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	041	0	1	04	01	H5525_041_0	5		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		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	5		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	97.00		291.00																									100.00		300.00				97.00		281.00				97.00				97.00		3.23				3.33	3.23	3.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	041	0	1	04	01	H5525_041_0	5		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					29																										29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	042	0	1	04	01	H5525_042_0	4		Y	Preferred Generic	4	11	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	7.00		21.00																									10.00		30.00				7.00		0.00				7.00				7.00		0.23				0.33	0.23	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	042	0	1	04	01	H5525_042_0	4		Y	Generic	4	11	1	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	17.00		51.00																									20.00		60.00				17.00		0.00				17.00				17.00		0.57				0.67	0.57	0.55	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	042	0	1	04	01	H5525_042_0	4		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		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		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	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												
H5525	042	0	1	04	01	H5525_042_0	4		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					29																										29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	044	0	1	04	01	H5525_044_0	3		Y	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	044	0	1	04	01	H5525_044_0	3		Y	Preferred Generic	4	11	3	2	1	3	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H5525	044	0	1	04	01	H5525_044_0	3		Y	Generic	4	11	3	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	5.00		15.00																									20.00		60.00				5.00		0.00				5.00				5.00		0.17				0.67	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	044	0	1	04	01	H5525_044_0	3		Y	Generic	4	11	3	2	2	3	110		01		110	1	30		90				2	2				30		90	30		31	5.00		15.00																									20.00		60.00				5.00		0.00				5.00				5.00		0.17				0.67	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H5525	044	0	1	04	01	H5525_044_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	044	0	1	04	01	H5525_044_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	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												
H5525	044	0	1	04	01	H5525_044_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	049	0	1	04	01	H5525_049_0	3		Y	Preferred Generic	4	11	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	049	0	1	04	01	H5525_049_0	3		Y	Generic	4	11	1	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	0.00		0.00																									20.00		60.00				0.00		0.00				0.00				0.00		0				0.67	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	049	0	1	04	01	H5525_049_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	45.00		135.00																									47.00		141.00				45.00		125.00				45.00				45.00		1.50				1.57	1.50	1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	049	0	1	04	01	H5525_049_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	95.00		285.00																									100.00		300.00				95.00		275.00				95.00				95.00		3.17				3.33	3.17	3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	049	0	1	04	01	H5525_049_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	050	0	1	04	01	H5525_050_0	3		Y	Preferred Generic	4	11	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	050	0	1	04	01	H5525_050_0	3		Y	Generic	4	11	1	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	0.00		0.00																									20.00		60.00				0.00		0.00				0.00				0.00		0				0.67	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	050	0	1	04	01	H5525_050_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	45.00		135.00																									47.00		141.00				45.00		125.00				45.00				45.00		1.50				1.57	1.50	1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	050	0	1	04	01	H5525_050_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	95.00		285.00																									100.00		300.00				95.00		275.00				95.00				95.00		3.17				3.33	3.17	3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	050	0	1	04	01	H5525_050_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					29																										29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	051	1	1	04	01	H5525_051_1	4		Y	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	051	1	1	04	01	H5525_051_1	4		Y	Preferred Generic	4	11	3	2	1	3	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H5525	051	1	1	04	01	H5525_051_1	4		Y	Generic	4	11	3	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	5.00		15.00																									20.00		60.00				5.00		0.00				5.00				5.00		0.17				0.67	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	051	1	1	04	01	H5525_051_1	4		Y	Generic	4	11	3	2	2	3	110		01		110	1	30		90				2	2				30		90	30		31	5.00		15.00																									20.00		60.00				5.00		0.00				5.00				5.00		0.17				0.67	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H5525	051	1	1	04	01	H5525_051_1	4		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	47.00		141.00																									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												
H5525	051	1	1	04	01	H5525_051_1	4		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	100.00		300.00																									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												
H5525	051	1	1	04	01	H5525_051_1	4		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	051	2	1	04	01	H5525_051_2	5		Y	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	051	2	1	04	01	H5525_051_2	5		Y	Preferred Generic	4	11	3	2	1	3	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H5525	051	2	1	04	01	H5525_051_2	5		Y	Generic	4	11	3	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	5.00		15.00																									20.00		60.00				5.00		0.00				5.00				5.00		0.17				0.67	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	051	2	1	04	01	H5525_051_2	5		Y	Generic	4	11	3	2	2	3	110		01		110	1	30		90				2	2				30		90	30		31	5.00		15.00																									20.00		60.00				5.00		0.00				5.00				5.00		0.17				0.67	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H5525	051	2	1	04	01	H5525_051_2	5		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	47.00		141.00																									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												
H5525	051	2	1	04	01	H5525_051_2	5		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	100.00		300.00																									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												
H5525	051	2	1	04	01	H5525_051_2	5		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	052	0	1	04	01	H5525_052_0	2		Y	Preferred Generic	4	11	1	2	1	1	110		01		110	1	30		100				1	2				30		100	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	052	0	1	04	01	H5525_052_0	2		Y	Preferred Generic	4	11	1	2	1	3	110		01		110	1	30		100				1	2				30		100	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5525	052	0	1	04	01	H5525_052_0	2		Y	Generic	4	11	1	2	2	1	110		01		110	1	30		100				2	2				30		100	30		31	5.00		15.00																									20.00		60.00				5.00		0.00				5.00				5.00		0.17				0.67	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	052	0	1	04	01	H5525_052_0	2		Y	Generic	4	11	1	2	2	3	110		01		110	1	30		100				2	2				30		100	30		31	5.00		15.00																									20.00		60.00				5.00		0.00				5.00				5.00		0.17				0.67	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5525	052	0	1	04	01	H5525_052_0	2		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		100				2	2				30		100	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												
H5525	052	0	1	04	01	H5525_052_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		100				2	2				30		100	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												
H5525	052	0	1	04	01	H5525_052_0	2		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					28																										28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	054	0	1	04	01	H5525_054_0	2		Y	Preferred Generic	4	11	1	2	1	1	110		01		110	1	30		100				1	2				30		100	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	054	0	1	04	01	H5525_054_0	2		Y	Preferred Generic	4	11	1	2	1	3	110		01		110	1	30		100				1	2				30		100	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5525	054	0	1	04	01	H5525_054_0	2		Y	Generic	4	11	1	2	2	1	110		01		110	1	30		100				2	2				30		100	30		31	5.00		15.00																									20.00		60.00				5.00		0.00				5.00				5.00		0.17				0.67	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	054	0	1	04	01	H5525_054_0	2		Y	Generic	4	11	1	2	2	3	110		01		110	1	30		100				2	2				30		100	30		31	5.00		15.00																									20.00		60.00				5.00		0.00				5.00				5.00		0.17				0.67	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5525	054	0	1	04	01	H5525_054_0	2		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		100				2	2				30		100	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												
H5525	054	0	1	04	01	H5525_054_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		100				2	2				30		100	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												
H5525	054	0	1	04	01	H5525_054_0	2		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					29																										29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	055	0	1	04	01	H5525_055_0	5		Y	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		100				1	2				30		100	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	055	0	1	04	01	H5525_055_0	5		Y	Generic	4	11	3	2	2	1	110		01		110	1	30		100				2	2				30		100	30		31	0.00		0.00																									20.00		60.00				0.00		0.00				0.00				0.00		0				0.67	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	055	0	1	04	01	H5525_055_0	5		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		100				2	2				30		100	30		31	47.00		141.00																									47.00		141.00				47.00		94.00				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	055	0	1	04	01	H5525_055_0	5		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		100				2	2				30		100	30		31	100.00		300.00																									100.00		300.00				100.00		200.00				100.00				100.00		3.33				3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	055	0	1	04	01	H5525_055_0	5		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					29																										29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	056	0	1	04	01	H5525_056_0	4		Y	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		100				1	2				30		100	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	056	0	1	04	01	H5525_056_0	4		Y	Generic	4	11	3	2	2	1	110		01		110	1	30		100				2	2				30		100	30		31	5.00		15.00																									20.00		60.00				5.00		0.00				5.00				5.00		0.17				0.67	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	056	0	1	04	01	H5525_056_0	4		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		100				2	2				30		100	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												
H5525	056	0	1	04	01	H5525_056_0	4		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		100				2	2				30		100	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												
H5525	056	0	1	04	01	H5525_056_0	4		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					29																										29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	057	0	1	04	01	H5525_057_0	3		Y	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		100				1	2				30		100	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	057	0	1	04	01	H5525_057_0	3		Y	Preferred Generic	4	11	3	2	1	3	110		01		110	1	30		100				1	2				30		100	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H5525	057	0	1	04	01	H5525_057_0	3		Y	Generic	4	11	3	2	2	1	110		01		110	1	30		100				2	2				30		100	30		31	5.00		15.00																									20.00		60.00				5.00		0.00				5.00				5.00		0.17				0.67	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	057	0	1	04	01	H5525_057_0	3		Y	Generic	4	11	3	2	2	3	110		01		110	1	30		100				2	2				30		100	30		31	5.00		15.00																									20.00		60.00				5.00		0.00				5.00				5.00		0.17				0.67	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H5525	057	0	1	04	01	H5525_057_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		100				2	2				30		100	30		31	47.00		141.00																									47.00		141.00				47.00		94.00				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	057	0	1	04	01	H5525_057_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		100				2	2				30		100	30		31	100.00		300.00																									100.00		300.00				100.00		200.00				100.00				100.00		3.33				3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	057	0	1	04	01	H5525_057_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					27																										27						27					27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	058	0	1	04	01	H5525_058_0	3		Y	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	058	0	1	04	01	H5525_058_0	3		Y	Preferred Generic	4	11	3	2	1	3	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H5525	058	0	1	04	01	H5525_058_0	3		Y	Generic	4	11	3	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	5.00		15.00																									20.00		60.00				5.00		0.00				5.00				5.00		0.17				0.67	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	058	0	1	04	01	H5525_058_0	3		Y	Generic	4	11	3	2	2	3	110		01		110	1	30		90				2	2				30		90	30		31	5.00		15.00																									20.00		60.00				5.00		0.00				5.00				5.00		0.17				0.67	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H5525	058	0	1	04	01	H5525_058_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	058	0	1	04	01	H5525_058_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		290.00				100.00				100.00		3.33				3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	058	0	1	04	01	H5525_058_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	059	0	1	04	01	H5525_059_0	3		Y	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	059	0	1	04	01	H5525_059_0	3		Y	Preferred Generic	4	11	3	2	1	3	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H5525	059	0	1	04	01	H5525_059_0	3		Y	Generic	4	11	3	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	5.00		15.00																									20.00		60.00				5.00		0.00				5.00				5.00		0.17				0.67	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	059	0	1	04	01	H5525_059_0	3		Y	Generic	4	11	3	2	2	3	110		01		110	1	30		90				2	2				30		90	30		31	5.00		15.00																									20.00		60.00				5.00		0.00				5.00				5.00		0.17				0.67	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H5525	059	0	1	04	01	H5525_059_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	059	0	1	04	01	H5525_059_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		290.00				100.00				100.00		3.33				3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	059	0	1	04	01	H5525_059_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					29																										29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	060	0	1	04	01	H5525_060_0	4		Y	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	060	0	1	04	01	H5525_060_0	4		Y	Preferred Generic	4	11	3	2	1	3	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H5525	060	0	1	04	01	H5525_060_0	4		Y	Generic	4	11	3	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	0.00		0.00																									20.00		60.00				0.00		0.00				0.00				0.00		0				0.67	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	060	0	1	04	01	H5525_060_0	4		Y	Generic	4	11	3	2	2	3	110		01		110	1	30		90				2	2				30		90	30		31	0.00		0.00																									20.00		60.00				0.00		0.00				0.00				0.00		0				0.67	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H5525	060	0	1	04	01	H5525_060_0	4		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	060	0	1	04	01	H5525_060_0	4		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		290.00				100.00				100.00		3.33				3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	060	0	1	04	01	H5525_060_0	4		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	061	0	1	04	01	H5525_061_0	3		Y	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	061	0	1	04	01	H5525_061_0	3		Y	Preferred Generic	4	11	3	2	1	3	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H5525	061	0	1	04	01	H5525_061_0	3		Y	Generic	4	11	3	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	0.00		0.00																									20.00		60.00				0.00		0.00				0.00				0.00		0				0.67	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	061	0	1	04	01	H5525_061_0	3		Y	Generic	4	11	3	2	2	3	110		01		110	1	30		90				2	2				30		90	30		31	0.00		0.00																									20.00		60.00				0.00		0.00				0.00				0.00		0				0.67	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H5525	061	0	1	04	01	H5525_061_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	061	0	1	04	01	H5525_061_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		290.00				100.00				100.00		3.33				3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	061	0	1	04	01	H5525_061_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	062	0	1	04	01	H5525_062_0	4		Y	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	062	0	1	04	01	H5525_062_0	4		Y	Preferred Generic	4	11	3	2	1	3	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H5525	062	0	1	04	01	H5525_062_0	4		Y	Generic	4	11	3	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	0.00		0.00																									20.00		60.00				0.00		0.00				0.00				0.00		0				0.67	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	062	0	1	04	01	H5525_062_0	4		Y	Generic	4	11	3	2	2	3	110		01		110	1	30		90				2	2				30		90	30		31	0.00		0.00																									20.00		60.00				0.00		0.00				0.00				0.00		0				0.67	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H5525	062	0	1	04	01	H5525_062_0	4		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	062	0	1	04	01	H5525_062_0	4		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		290.00				100.00				100.00		3.33				3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	062	0	1	04	01	H5525_062_0	4		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	063	0	1	04	01	H5525_063_0	3		Y	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	063	0	1	04	01	H5525_063_0	3		Y	Preferred Generic	4	11	3	2	1	3	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H5525	063	0	1	04	01	H5525_063_0	3		Y	Generic	4	11	3	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	5.00		15.00																									20.00		60.00				5.00		0.00				5.00				5.00		0.17				0.67	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	063	0	1	04	01	H5525_063_0	3		Y	Generic	4	11	3	2	2	3	110		01		110	1	30		90				2	2				30		90	30		31	5.00		15.00																									20.00		60.00				5.00		0.00				5.00				5.00		0.17				0.67	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H5525	063	0	1	04	01	H5525_063_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	063	0	1	04	01	H5525_063_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		290.00				100.00				100.00		3.33				3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	063	0	1	04	01	H5525_063_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					29																										29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	067	0	1	04	01	H5525_067_0	4		Y	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	067	0	1	04	01	H5525_067_0	4		Y	Preferred Generic	4	11	3	2	1	3	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H5525	067	0	1	04	01	H5525_067_0	4		Y	Generic	4	11	3	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	5.00		15.00																									20.00		60.00				5.00		0.00				5.00				5.00		0.17				0.67	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	067	0	1	04	01	H5525_067_0	4		Y	Generic	4	11	3	2	2	3	110		01		110	1	30		90				2	2				30		90	30		31	5.00		15.00																									20.00		60.00				5.00		0.00				5.00				5.00		0.17				0.67	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H5525	067	0	1	04	01	H5525_067_0	4		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	067	0	1	04	01	H5525_067_0	4		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		290.00				100.00				100.00		3.33				3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	067	0	1	04	01	H5525_067_0	4		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					27																										27						27					27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	068	0	1	04	01	H5525_068_0	4		Y	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	068	0	1	04	01	H5525_068_0	4		Y	Preferred Generic	4	11	3	2	1	3	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H5525	068	0	1	04	01	H5525_068_0	4		Y	Generic	4	11	3	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	5.00		15.00																									20.00		60.00				5.00		0.00				5.00				5.00		0.17				0.67	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	068	0	1	04	01	H5525_068_0	4		Y	Generic	4	11	3	2	2	3	110		01		110	1	30		90				2	2				30		90	30		31	5.00		15.00																									20.00		60.00				5.00		0.00				5.00				5.00		0.17				0.67	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H5525	068	0	1	04	01	H5525_068_0	4		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	47.00		141.00																									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												
H5525	068	0	1	04	01	H5525_068_0	4		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	100.00		300.00																									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												
H5525	068	0	1	04	01	H5525_068_0	4		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					29																										29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	069	0	1	04	01	H5525_069_0	3		Y	Preferred Generic	4	11	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	5.00		15.00																									10.00		30.00				5.00		0.00				5.00				5.00		0.17				0.33	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	069	0	1	04	01	H5525_069_0	3		Y	Preferred Generic	4	11	1	2	1	3	110		01		110	1	30		90				1	2				30		90	30		31	5.00		15.00																									10.00		30.00				5.00		0.00				5.00				5.00		0.17				0.33	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5525	069	0	1	04	01	H5525_069_0	3		Y	Generic	4	11	1	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	15.00		45.00																									20.00		60.00				15.00		0.00				15.00				15.00		0.50				0.67	0.50	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	069	0	1	04	01	H5525_069_0	3		Y	Generic	4	11	1	2	2	3	110		01		110	1	30		90				2	2				30		90	30		31	15.00		45.00																									20.00		60.00				15.00		0.00				15.00				15.00		0.50				0.67	0.50	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5525	069	0	1	04	01	H5525_069_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	47.00		141.00																									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												
H5525	069	0	1	04	01	H5525_069_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	100.00		300.00																									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												
H5525	069	0	1	04	01	H5525_069_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5526	004	0	1	04	01	H5526_004_0	8		Y	Preferred Generic	4	01	1	2	1	1		110	01		110	1				31		90	1	2				31		90	31		31								7.00		21.00					2.00		6.00											7.00		17.50				2.00		0.00				7.00				7.00			0.23	0.06		0.23	0.06	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5526	004	0	1	04	01	H5526_004_0	8		Y	Generic	4	01	1	2	2	1		110	01		110	1				31		90	1	2				31		90	31		31								13.00		39.00					8.00		24.00											13.00		32.50				8.00		20.00				13.00				13.00			0.42	0.26		0.42	0.26	0.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5526	004	0	1	04	01	H5526_004_0	8		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				31		90	1	2				31		90	31		31								47.00		141.00					42.00		126.00											47.00		117.50				42.00		105.00				47.00				47.00			1.52	1.35		1.52	1.35	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5526	004	0	1	04	01	H5526_004_0	8		Y	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					94.00		282.00											99.00		247.50				94.00		235.00				99.00				99.00			3.19	3.03		3.19	3.03	3.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5526	004	0	1	04	01	H5526_004_0	8		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				31								31			31		31												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	7		Y	Preferred Generic	4	01	1	2	1	1		110	01		110	1				31		90	1	2				31		90	31		31								9.00		27.00					4.00		12.00											9.00		22.50				4.00		0.00				9.00				9.00			0.29	0.13		0.29	0.13	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5526	016	0	1	04	01	H5526_016_0	7		Y	Generic	4	01	1	2	2	1		110	01		110	1				31		90	1	2				31		90	31		31								15.00		45.00					10.00		30.00											15.00		37.50				10.00		25.00				15.00				15.00			0.48	0.32		0.48	0.32	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5526	016	0	1	04	01	H5526_016_0	7		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				31		90	1	2				31		90	31		31								47.00		141.00					42.00		126.00											47.00		117.50				42.00		105.00				47.00				47.00			1.52	1.35		1.52	1.35	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5526	016	0	1	04	01	H5526_016_0	7		Y	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				31		90	1	2				31		90	31		31								100.00		300.00					94.00		282.00											100.00		250.00				94.00		235.00				100.00				100.00			3.23	3.03		3.23	3.03	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5526	016	0	1	04	01	H5526_016_0	7		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				31								31			31		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5526	018	0	1	04	01	H5526_018_0	7		Y	Preferred Generic	4	01	1	2	1	1		110	01		110	1				31		90	1	2				31		90	31		31								7.00		21.00					2.00		6.00											7.00		17.50				2.00		0.00				7.00				7.00			0.23	0.06		0.23	0.06	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5526	018	0	1	04	01	H5526_018_0	7		Y	Generic	4	01	1	2	2	1		110	01		110	1				31		90	1	2				31		90	31		31								15.00		45.00					10.00		30.00											15.00		37.50				10.00		25.00				15.00				15.00			0.48	0.32		0.48	0.32	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5526	018	0	1	04	01	H5526_018_0	7		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				31		90	1	2				31		90	31		31								47.00		141.00					42.00		126.00											47.00		117.50				42.00		105.00				47.00				47.00			1.52	1.35		1.52	1.35	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5526	018	0	1	04	01	H5526_018_0	7		Y	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				31		90	1	2				31		90	31		31								100.00		300.00					94.00		282.00											100.00		250.00				94.00		235.00				100.00				100.00			3.23	3.03		3.23	3.03	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5526	018	0	1	04	01	H5526_018_0	7		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				31								31			31		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5526	020	0	1	04	01	H5526_020_0	7		Y	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		12.50				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												
H5526	020	0	1	04	01	H5526_020_0	7		Y	Generic	4	01	1	2	2	1		110	01		110	1				31		90	1	2				31		90	31		31								17.00		51.00					12.00		36.00											17.00		42.50				12.00		0.00				17.00				17.00			0.55	0.39		0.55	0.39	0.55	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5526	020	0	1	04	01	H5526_020_0	7		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				31		90	1	2				31		90	31		31								47.00		141.00					42.00		126.00											47.00		117.50				42.00		105.00				47.00				47.00			1.52	1.35		1.52	1.35	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5526	020	0	1	04	01	H5526_020_0	7		Y	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				31		90	1	2				31		90	31		31								100.00		300.00					94.00		282.00											100.00		250.00				94.00		235.00				100.00				100.00			3.23	3.03		3.23	3.03	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5526	020	0	1	04	01	H5526_020_0	7		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				31								31			31		31												29							29												29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5526	021	0	1	04	01	H5526_021_0	7		Y	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		12.50				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												
H5526	021	0	1	04	01	H5526_021_0	7		Y	Generic	4	01	1	2	2	1		110	01		110	1				31		90	1	2				31		90	31		31								17.00		51.00					12.00		36.00											17.00		42.50				12.00		0.00				17.00				17.00			0.55	0.39		0.55	0.39	0.55	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5526	021	0	1	04	01	H5526_021_0	7		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				31		90	1	2				31		90	31		31								47.00		141.00					42.00		126.00											47.00		117.50				42.00		105.00				47.00				47.00			1.52	1.35		1.52	1.35	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5526	021	0	1	04	01	H5526_021_0	7		Y	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				31		90	1	2				31		90	31		31								100.00		300.00					94.00		282.00											100.00		250.00				94.00		235.00				100.00				100.00			3.23	3.03		3.23	3.03	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5526	021	0	1	04	01	H5526_021_0	7		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				31								31			31		31												30							30												30						30					30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5526	022	0	1	04	01	H5526_022_0	7			Preferred Generic	4	01	1	2	1	1		110	01		110	1				31		90	1	2				31		90	31		31								7.00		21.00					2.00		6.00											7.00		17.50				2.00		0.00				7.00				7.00			0.23	0.06		0.23	0.06	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5526	022	0	1	04	01	H5526_022_0	7			Generic	4	01	1	2	2	1		110	01		110	1				31		90	1	2				31		90	31		31								19.00		57.00					14.00		42.00											19.00		47.50				14.00		35.00				19.00				19.00			0.61	0.45		0.61	0.45	0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5526	022	0	1	04	01	H5526_022_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					42.00		126.00											47.00		117.50				42.00		105.00				47.00				47.00			1.52	1.35		1.52	1.35	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5526	022	0	1	04	01	H5526_022_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					94.00		282.00											100.00		250.00				94.00		235.00				100.00				100.00			3.23	3.03		3.23	3.03	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5526	022	0	1	04	01	H5526_022_0	7			Specialty Tier	4	11	1	1	5	1		010	01		010	1				31								31			31		31												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		Y	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		Y	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		Y	Preferred Brand	4	11	1	2	3	1		111	01		100	1				30	60	90	1	2						90	30		31								47.00	94.00	141.00					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		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01		100	1				30	60	90	1	2						90	30		31								100.00	200.00	300.00					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		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											1230.02	33						809.68	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		Y	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		Y	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		Y	Preferred Brand	4	11	1	2	3	1		111	01		100	1				30	60	90	1	2						90	30		31								47.00	94.00	141.00					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		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01		100	1				30	60	90	1	2						90	30		31								100.00	200.00	300.00					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		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											948.89	33						1141.97	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		Y	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		Y	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		Y	Preferred Brand	4	11	1	2	3	1		111	01		100	1				30	60	90	1	2						90	30		31								47.00	94.00	141.00					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		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01		100	1				30	60	90	1	2						90	30		31								100.00	200.00	300.00					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		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											863.63	33						774.62	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5533	009	0	1	04	01	H5533_009_0	8		Y	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	8		Y	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	8		Y	Preferred Brand	4	11	1	2	3	1		111	01		100	1				30	60	90	1	2						90	30		31								47.00	94.00	141.00					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	8		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01		100	1				30	60	90	1	2						90	30		31								100.00	200.00	300.00					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	8		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											957.04	33						816.55	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5533	011	0	1	04	01	H5533_011_0	8		Y	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	8		Y	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	8		Y	Preferred Brand	4	11	1	2	3	1		111	01		100	1				30	60	90	1	2						90	30		31								47.00	94.00	141.00					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	8		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01		100	1				30	60	90	1	2						90	30		31								100.00	200.00	300.00					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	8		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											956.69	33						816.68	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5533	013	0	1	04	01	H5533_013_0	8		Y	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	013	0	1	04	01	H5533_013_0	8		Y	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	013	0	1	04	01	H5533_013_0	8		Y	Preferred Brand	4	11	1	2	3	1		111	01		100	1				30	60	90	1	2						90	30		31								47.00	94.00	141.00					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	013	0	1	04	01	H5533_013_0	8		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01		100	1				30	60	90	1	2						90	30		31								100.00	200.00	300.00					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	013	0	1	04	01	H5533_013_0	8		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											976.71	33						811.62	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5533	014	0	1	04	01	H5533_014_0	8		Y	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	014	0	1	04	01	H5533_014_0	8		Y	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	014	0	1	04	01	H5533_014_0	8		Y	Preferred Brand	4	11	1	2	3	1		111	01		100	1				30	60	90	1	2						90	30		31								47.00	94.00	141.00					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	014	0	1	04	01	H5533_014_0	8		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01		100	1				30	60	90	1	2						90	30		31								100.00	200.00	300.00					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	014	0	1	04	01	H5533_014_0	8		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											977.04	33						811.98	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5549	003	0	1	01	01	H5549_003_0	7		N	Preferred Generic	2	01	1	2	1	1	111		01	100		1	30	60	90				2	2			90				30		31	8.00	16.00	24.00																					24.00																8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5549	003	0	1	01	01	H5549_003_0	7		N	Generic	2	01	1	2	2	1	111		01	100		1	30	60	90				2	2			90				30		31	20.00	40.00	60.00																					60.00																20.00				20.00		0.66						0.62	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5549	003	0	1	01	01	H5549_003_0	7		N	Preferred Brand	2	10	1	1	3	1	111		01	100		1	30	60	90				1	2			90				30		31				89.42	20	20	20																				20															20			20								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5549	003	0	1	01	01	H5549_003_0	7		N	Non-Preferred Brand	2	10	1	1	4	1	111		01	100		1	30	60	90				1	2			90				30		31				67.53	35	35	35																				35															35			35								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5549	003	0	1	01	01	H5549_003_0	7		N	Specialty Tier	2	11	1	1	5	1	010		01	010		1	30								30						30		31					25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5549	012	0	1	01	01	H5549_012_0	6			Preferred Generic	4	01	1	2	1	1	111		01	100		1	30	60	90				1	2			90				30		31	15.00	30.00	45.00																					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	6			Generic	4	01	1	2	2	1	111		01	100		1	30	60	90				1	2			90				30		31	20.00	40.00	60.00																					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	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																					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	6			Non-Preferred Brand	4	10	1	2	4	1	111		01	100		1	30	60	90				1	2			90				30		31	100.00	200.00	300.00																					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	6			Specialty Tier	4	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 Brand, Specialty Tier, Select Care Drugs												
H5549	012	0	1	01	01	H5549_012_0	6			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 Brand, Specialty Tier, Select Care Drugs												
H5576	017	1	1	02	01	H5576_017_1	10		Y	Preferred Generic	4	01	1	2	1	1		110	01		110	1				31		100	1	2				31		100	31		31								5.00		15.00					0.00		0.00											5.00		15.00				0.00		0.00				5.00				5.00			0.16	0.00		0.16	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5576	017	1	1	02	01	H5576_017_1	10		Y	Preferred Generic	4	01	1	2	1	3		110	01		110	1				31		100	1	2				31		100	31		31								5.00		15.00					0.00		0.00											5.00		15.00				0.00		0.00				5.00				5.00			0.16	0.00		0.16	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5576	017	1	1	02	01	H5576_017_1	10		Y	Generic	4	01	1	2	2	1		110	01		100	1				31		100	1	2						100	31		31								14.00		42.00					14.00		42.00													42.00						42.00				14.00				14.00			0.45	0.45				0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5576	017	1	1	02	01	H5576_017_1	10		Y	Preferred Brand	4	10	1	2	3	1		110	01		100	1				31		100	1	2						100	31		31								47.00		141.00					47.00		141.00													141.00						141.00				47.00				47.00			1.52	1.52				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5576	017	1	1	02	01	H5576_017_1	10		Y	Non-Preferred Brand	4	10	1	2	4	1		110	01		100	1				31		100	1	2						100	31		31								100.00		300.00					100.00		300.00													300.00						300.00				100.00				100.00			3.23	3.23				3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5576	017	1	1	02	01	H5576_017_1	10		Y	Specialty Tier	4	10	1	1	5	1		010	01		010	1				31								31			31		31											2105.81	25						802.56	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5576	017	2	1	02	01	H5576_017_2	10		Y	Preferred Generic	4	01	1	2	1	1		110	01		110	1				31		100	1	2				31		100	31		31								5.00		15.00					0.00		0.00											5.00		15.00				0.00		0.00				5.00				5.00			0.16	0.00		0.16	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5576	017	2	1	02	01	H5576_017_2	10		Y	Preferred Generic	4	01	1	2	1	3		110	01		110	1				31		100	1	2				31		100	31		31								5.00		15.00					0.00		0.00											5.00		15.00				0.00		0.00				5.00				5.00			0.16	0.00		0.16	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5576	017	2	1	02	01	H5576_017_2	10		Y	Generic	4	01	1	2	2	1		110	01		100	1				31		100	1	2						100	31		31								14.00		42.00					14.00		42.00													42.00						42.00				14.00				14.00			0.45	0.45				0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5576	017	2	1	02	01	H5576_017_2	10		Y	Preferred Brand	4	10	1	2	3	1		110	01		100	1				31		100	1	2						100	31		31								47.00		141.00					47.00		141.00													141.00						141.00				47.00				47.00			1.52	1.52				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5576	017	2	1	02	01	H5576_017_2	10		Y	Non-Preferred Brand	4	10	1	2	4	1		110	01		100	1				31		100	1	2						100	31		31								100.00		300.00					100.00		300.00													300.00						300.00				100.00				100.00			3.23	3.23				3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5576	017	2	1	02	01	H5576_017_2	10		Y	Specialty Tier	4	10	1	1	5	1		010	01		010	1				31								31			31		31											2105.81	25						802.56	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5576	018	1	1	02	01	H5576_018_1	10		Y	Preferred Generic	4	01	1	2	1	1		110	01		110	1				31		100	1	2				31		100	31		31								5.00		15.00					0.00		0.00											5.00		15.00				0.00		0.00				5.00				5.00			0.16	0.00		0.16	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5576	018	1	1	02	01	H5576_018_1	10		Y	Preferred Generic	4	01	1	2	1	3		110	01		110	1				31		100	1	2				31		100	31		31								5.00		15.00					0.00		0.00											5.00		15.00				0.00		0.00				5.00				5.00			0.16	0.00		0.16	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5576	018	1	1	02	01	H5576_018_1	10		Y	Generic	4	01	1	2	2	1		110	01		100	1				31		100	1	2						100	31		31								14.00		42.00					14.00		42.00													42.00						42.00				14.00				14.00			0.45	0.45				0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5576	018	1	1	02	01	H5576_018_1	10		Y	Preferred Brand	4	10	1	2	3	1		110	01		100	1				31		100	1	2						100	31		31								47.00		141.00					47.00		141.00													141.00						141.00				47.00				47.00			1.52	1.52				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5576	018	1	1	02	01	H5576_018_1	10		Y	Non-Preferred Brand	4	10	1	2	4	1		110	01		100	1				31		100	1	2						100	31		31								100.00		300.00					100.00		300.00													300.00						300.00				100.00				100.00			3.23	3.23				3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5576	018	1	1	02	01	H5576_018_1	10		Y	Specialty Tier	4	10	1	1	5	1		010	01		010	1				31								31			31		31											2042.28	33						876.75	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5576	018	2	1	02	01	H5576_018_2	10		Y	Preferred Generic	4	01	1	2	1	1		110	01		110	1				31		100	1	2				31		100	31		31								5.00		15.00					0.00		0.00											5.00		15.00				0.00		0.00				5.00				5.00			0.16	0.00		0.16	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5576	018	2	1	02	01	H5576_018_2	10		Y	Preferred Generic	4	01	1	2	1	3		110	01		110	1				31		100	1	2				31		100	31		31								5.00		15.00					0.00		0.00											5.00		15.00				0.00		0.00				5.00				5.00			0.16	0.00		0.16	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5576	018	2	1	02	01	H5576_018_2	10		Y	Generic	4	01	1	2	2	1		110	01		100	1				31		100	1	2						100	31		31								14.00		42.00					14.00		42.00													42.00						42.00				14.00				14.00			0.45	0.45				0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5576	018	2	1	02	01	H5576_018_2	10		Y	Preferred Brand	4	10	1	2	3	1		110	01		100	1				31		100	1	2						100	31		31								47.00		141.00					47.00		141.00													141.00						141.00				47.00				47.00			1.52	1.52				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5576	018	2	1	02	01	H5576_018_2	10		Y	Non-Preferred Brand	4	10	1	2	4	1		110	01		100	1				31		100	1	2						100	31		31								100.00		300.00					100.00		300.00													300.00						300.00				100.00				100.00			3.23	3.23				3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5576	018	2	1	02	01	H5576_018_2	10		Y	Specialty Tier	4	10	1	1	5	1		010	01		010	1				31								31			31		31											2042.28	33						876.75	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5576	020	1	1	02	01	H5576_020_1	10		Y	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	10		Y	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	10		Y	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	10		Y	Preferred Brand	4	10	1	2	3	1		110	01		100	1				31		100	1	2						100	31		31								47.00		141.00					47.00		141.00													141.00						141.00				47.00				47.00			1.52	1.52				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5576	020	1	1	02	01	H5576_020_1	10		Y	Non-Preferred Brand	4	10	1	2	4	1		110	01		100	1				31		100	1	2						100	31		31								100.00		300.00					100.00		300.00													300.00						300.00				100.00				100.00			3.23	3.23				3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5576	020	1	1	02	01	H5576_020_1	10		Y	Specialty Tier	4	10	1	1	5	1		010	01		010	1				31								31			31		31											1404.77	25						1014.08	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5576	020	2	1	02	01	H5576_020_2	10		Y	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	10		Y	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	10		Y	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	10		Y	Preferred Brand	4	10	1	2	3	1		110	01		100	1				31		100	1	2						100	31		31								47.00		141.00					47.00		141.00													141.00						141.00				47.00				47.00			1.52	1.52				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5576	020	2	1	02	01	H5576_020_2	10		Y	Non-Preferred Brand	4	10	1	2	4	1		110	01		100	1				31		100	1	2						100	31		31								100.00		300.00					100.00		300.00													300.00						300.00				100.00				100.00			3.23	3.23				3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5576	020	2	1	02	01	H5576_020_2	10		Y	Specialty Tier	4	10	1	1	5	1		010	01		010	1				31								31			31		31											1404.77	25						1014.08	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5576	022	0	1	02	01	H5576_022_0	10		Y	Preferred Generic	4	01	1	2	1	1		110	01		110	1				31		100	1	2				31		100	31		31								5.00		15.00					0.00		0.00											5.00		15.00				0.00		0.00				5.00				5.00			0.16	0.00		0.16	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5576	022	0	1	02	01	H5576_022_0	10		Y	Preferred Generic	4	01	1	2	1	3		110	01		110	1				31		100	1	2				31		100	31		31								5.00		15.00					0.00		0.00											5.00		15.00				0.00		0.00				5.00				5.00			0.16	0.00		0.16	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5576	022	0	1	02	01	H5576_022_0	10		Y	Generic	4	01	1	2	2	1		110	01		100	1				31		100	1	2						100	31		31								14.00		42.00					14.00		42.00													42.00						42.00				14.00				14.00			0.45	0.45				0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5576	022	0	1	02	01	H5576_022_0	10		Y	Preferred Brand	4	10	1	2	3	1		110	01		100	1				31		100	1	2						100	31		31								47.00		141.00					47.00		141.00													141.00						141.00				47.00				47.00			1.52	1.52				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5576	022	0	1	02	01	H5576_022_0	10		Y	Non-Preferred Brand	4	10	1	2	4	1		110	01		100	1				31		100	1	2						100	31		31								100.00		300.00					100.00		300.00													300.00						300.00				100.00				100.00			3.23	3.23				3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5576	022	0	1	02	01	H5576_022_0	10		Y	Specialty Tier	4	10	1	1	5	1		010	01		010	1				31								31			31		31											2260.36	33						854.32	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5576	023	0	1	02	01	H5576_023_0	10		Y	Preferred Generic	4	01	1	2	1	1		110	01		110	1				31		100	1	2				31		100	31		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.32	0.00		0.32	0.00	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5576	023	0	1	02	01	H5576_023_0	10		Y	Preferred Generic	4	01	1	2	1	3		110	01		110	1				31		100	1	2				31		100	31		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.32	0.00		0.32	0.00	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5576	023	0	1	02	01	H5576_023_0	10		Y	Generic	4	01	1	2	2	1		110	01		100	1				31		100	1	2						100	31		31								20.00		60.00					20.00		60.00													60.00						60.00				20.00				20.00			0.65	0.65				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5576	023	0	1	02	01	H5576_023_0	10		Y	Preferred Brand	4	10	1	2	3	1		110	01		100	1				31		100	1	2						100	31		31								47.00		141.00					47.00		141.00													141.00						141.00				47.00				47.00			1.52	1.52				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5576	023	0	1	02	01	H5576_023_0	10		Y	Non-Preferred Brand	4	10	1	2	4	1		110	01		100	1				31		100	1	2						100	31		31								100.00		300.00					100.00		300.00													300.00						300.00				100.00				100.00			3.23	3.23				3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5576	023	0	1	02	01	H5576_023_0	10		Y	Specialty Tier	4	10	1	1	5	1		010	01		010	1				31								31			31		31											1002.42	25						1015.64	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5577	005	0	1	01	01	H5577_005_0	7		Y	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	7		Y	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	7		Y	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	7		Y	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	7		Y	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	7		Y	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	7		Y	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	7		Y	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	7		Y	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	7		Y	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	7		Y	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	7		Y	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	7		Y	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	7		Y	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	7		Y	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	7		Y	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31					33																																					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs												
H5577	008	0	1	02	01	H5577_008_0	7		Y	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	7		Y	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	014	0	1	01	01	H5577_014_0	5		Y	Preferred Generic	4	01	1	2	1	1	111		01	100		1	30	60	90				2	2			90				30		31	2.00	4.00	6.00																					4.00																2.00				2.00		0.07						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs												
H5577	014	0	1	01	01	H5577_014_0	5		Y	Preferred Generic	4	01	1	2	1	3	111		01	100		1	30	60	90				2	2			90				30		31	2.00	4.00	6.00																					4.00																2.00				2.00		0.07						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs										1		
H5577	014	0	1	01	01	H5577_014_0	5		Y	Generic	4	01	3	2	2	1	111		01	100		1	30	60	90				2	2			90				30		31	3.00	6.00	9.00																					6.00																3.00				3.00		0.10						0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs												
H5577	014	0	1	01	01	H5577_014_0	5		Y	Generic	4	01	3	2	2	3	111		01	100		1	30	60	90				2	2			90				30		31	3.00	6.00	9.00																					6.00																3.00				3.00		0.10						0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs										1		3
H5577	014	0	1	01	01	H5577_014_0	5		Y	Preferred Brand	4	10	1	2	3	1	111		01	100		1	30	60	90				2	1			90				30		31	10.00	20.00	30.00																					20.00																10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs												
H5577	014	0	1	01	01	H5577_014_0	5		Y	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	014	0	1	01	01	H5577_014_0	5		Y	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	014	0	1	01	01	H5577_014_0	5		Y	Select Diabetic Drugs	4	11	1	2	6	1	111		01	100		1	30	60	90				2	1			90				30		31	2.00	4.00	6.00																					4.00																2.00				2.00		0.07						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs												
H5577	014	0	1	01	01	H5577_014_0	5		Y	Select Diabetic Drugs	4	11	1	2	6	3	111		01	100		1	30	60	90				2	1			90				30		31	2.00	4.00	6.00																					4.00																2.00				2.00		0.07						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs										1		
H5577	031	0	1	01	01	H5577_031_0	7		Y	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	7		Y	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	7		Y	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	7		Y	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	7		Y	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	031	0	1	01	01	H5577_031_0	7		Y	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	031	0	1	01	01	H5577_031_0	7		Y	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	7		Y	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	7		Y	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	8		Y	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	8		Y	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	8		Y	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	8		Y	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	8		Y	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	8		Y	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	038	0	1	01	01	H5577_038_0	8		Y	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	8		Y	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	8		Y	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	7		Y	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	7		Y	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	7		Y	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	7		Y	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	7		Y	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	7		Y	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	7		Y	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	7		Y	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	7		Y	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	7		Y	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	7		Y	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	7		Y	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	7		Y	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	7		Y	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	7		Y	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	7		Y	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31					33																																					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs												
H5577	042	0	1	01	01	H5577_042_0	7		Y	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	7		Y	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	7		Y	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	7		Y	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	7		Y	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	7		Y	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	7		Y	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	7		Y	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	7		Y	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	7		Y	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	7		Y	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	7		Y	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	7		Y	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	7		Y	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	7		Y	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	7		Y	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	7		Y	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	7		Y	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	7		Y	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	7		Y	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	8		Y	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	8		Y	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	8		Y	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	8		Y	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	8		Y	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	8		Y	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	8		Y	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31					33																																					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs												
H5577	045	0	1	01	01	H5577_045_0	8		Y	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	8		Y	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	047	0	1	01	01	H5577_047_0	8		Y	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	047	0	1	01	01	H5577_047_0	8		Y	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	047	0	1	01	01	H5577_047_0	8		Y	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	047	0	1	01	01	H5577_047_0	8		Y	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	047	0	1	01	01	H5577_047_0	8		Y	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	047	0	1	01	01	H5577_047_0	8		Y	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	047	0	1	01	01	H5577_047_0	8		Y	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	047	0	1	01	01	H5577_047_0	8		Y	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	047	0	1	01	01	H5577_047_0	8		Y	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	049	0	1	01	01	H5577_049_0	7		Y	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	049	0	1	01	01	H5577_049_0	7		Y	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	049	0	1	01	01	H5577_049_0	7		Y	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	049	0	1	01	01	H5577_049_0	7		Y	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	049	0	1	01	01	H5577_049_0	7		Y	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	049	0	1	01	01	H5577_049_0	7		Y	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	049	0	1	01	01	H5577_049_0	7		Y	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	049	0	1	01	01	H5577_049_0	7		Y	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	049	0	1	01	01	H5577_049_0	7		Y	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	050	0	1	02	01	H5577_050_0	6		Y	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	050	0	1	02	01	H5577_050_0	6		Y	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	050	0	1	02	01	H5577_050_0	6		Y	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	050	0	1	02	01	H5577_050_0	6		Y	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	050	0	1	02	01	H5577_050_0	6		Y	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	050	0	1	02	01	H5577_050_0	6		Y	Non-Preferred Brand	4	10	1	2	4	1	111		01	100		1	30	60	90				2	1			90				30		31	10.00	20.00	30.00																					20.00																10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs												
H5577	050	0	1	02	01	H5577_050_0	6		Y	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	050	0	1	02	01	H5577_050_0	6		Y	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	050	0	1	02	01	H5577_050_0	6		Y	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	051	0	1	01	01	H5577_051_0	8		Y	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	051	0	1	01	01	H5577_051_0	8		Y	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	051	0	1	01	01	H5577_051_0	8		Y	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	051	0	1	01	01	H5577_051_0	8		Y	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	051	0	1	01	01	H5577_051_0	8		Y	Preferred Brand	4	10	1	2	3	1	111		01	100		1	30	60	90				2	1			90				30		31	2.00	4.00	6.00																					4.00																2.00				2.00		0.07						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs												
H5577	051	0	1	01	01	H5577_051_0	8		Y	Non-Preferred Brand	4	10	1	2	4	1	111		01	100		1	30	60	90				2	1			90				30		31	12.00	24.00	36.00																					24.00																12.00				12.00		0.40						0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs												
H5577	051	0	1	01	01	H5577_051_0	8		Y	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	051	0	1	01	01	H5577_051_0	8		Y	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	051	0	1	01	01	H5577_051_0	8		Y	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	052	0	1	01	01	H5577_052_0	7		Y	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	052	0	1	01	01	H5577_052_0	7		Y	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	052	0	1	01	01	H5577_052_0	7		Y	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	052	0	1	01	01	H5577_052_0	7		Y	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	052	0	1	01	01	H5577_052_0	7		Y	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	052	0	1	01	01	H5577_052_0	7		Y	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	052	0	1	01	01	H5577_052_0	7		Y	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	052	0	1	01	01	H5577_052_0	7		Y	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	052	0	1	01	01	H5577_052_0	7		Y	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	053	0	1	01	01	H5577_053_0	7		Y	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	053	0	1	01	01	H5577_053_0	7		Y	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	053	0	1	01	01	H5577_053_0	7		Y	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	053	0	1	01	01	H5577_053_0	7		Y	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	053	0	1	01	01	H5577_053_0	7		Y	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	053	0	1	01	01	H5577_053_0	7		Y	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	053	0	1	01	01	H5577_053_0	7		Y	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	053	0	1	01	01	H5577_053_0	7		Y	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	053	0	1	01	01	H5577_053_0	7		Y	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								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00				15.00				15.00			0.5	0.00		0.5	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, 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												29							29												29						29					29			29								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	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, 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	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												
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	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, 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											98.20	45	45	45				98.20	45	45	45										45	45	45				45	45	45			45			45								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			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	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	4		Y	Preferred Generic	4	11	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								4.00	8.00	12.00					0.00	0.00	0.00					4.00	8.00	10.00																4.00				4.00			0.13	0.00	0.13			0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5591	005	0	1	02	01	H5591_005_0	4		Y	Generic	4	11	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								18.00	36.00	54.00					10.00	20.00	30.00					18.00	36.00	45.00																18.00				18.00			0.60	0.33	0.60			0.58	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5591	005	0	1	02	01	H5591_005_0	4		Y	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					40.00	80.00	120.00					47.00	94.00	117.50																47.00				47.00			1.57	1.33	1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5591	005	0	1	02	01	H5591_005_0	4		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	300.00					95.00	190.00	285.00					100.00	200.00	250.00																100.00				100.00			3.33	3.17	3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5591	005	0	1	02	01	H5591_005_0	4		Y	Specialty Tier	4	10	1	1	5	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											600.00	33	33	33				600.00	33	33	33				33	33	33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5591	006	1	1	02	01	H5591_006_1	4		Y	Preferred Generic	4	11	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								4.00	8.00	12.00					0.00	0.00	0.00					4.00	8.00	10.00																4.00				4.00			0.13	0.00	0.13			0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5591	006	1	1	02	01	H5591_006_1	4		Y	Generic	4	11	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								18.00	36.00	54.00					10.00	20.00	30.00					18.00	36.00	45.00																18.00				18.00			0.60	0.33	0.60			0.58	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5591	006	1	1	02	01	H5591_006_1	4		Y	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					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	4		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	300.00					95.00	190.00	285.00					100.00	200.00	250.00																100.00				100.00			3.33	3.17	3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5591	006	1	1	02	01	H5591_006_1	4		Y	Specialty Tier	4	10	1	1	5	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											600.00	33	33	33				600.00	33	33	33				33	33	33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5591	006	2	1	02	01	H5591_006_2	4		Y	Preferred Generic	4	11	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								4.00	8.00	12.00					0.00	0.00	0.00					4.00	8.00	10.00																4.00				4.00			0.13	0.00	0.13			0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5591	006	2	1	02	01	H5591_006_2	4		Y	Generic	4	11	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								18.00	36.00	54.00					10.00	20.00	30.00					18.00	36.00	45.00																18.00				18.00			0.60	0.33	0.60			0.58	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5591	006	2	1	02	01	H5591_006_2	4		Y	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					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	4		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	300.00					95.00	190.00	285.00					100.00	200.00	250.00																100.00				100.00			3.33	3.17	3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5591	006	2	1	02	01	H5591_006_2	4		Y	Specialty Tier	4	10	1	1	5	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											600.00	33	33	33				600.00	33	33	33				33	33	33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5591	006	4	1	02	01	H5591_006_4	4		Y	Preferred Generic	4	11	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								4.00	8.00	12.00					0.00	0.00	0.00					4.00	8.00	10.00																4.00				4.00			0.13	0.00	0.13			0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5591	006	4	1	02	01	H5591_006_4	4		Y	Generic	4	11	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								18.00	36.00	54.00					10.00	20.00	30.00					18.00	36.00	45.00																18.00				18.00			0.60	0.33	0.60			0.58	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5591	006	4	1	02	01	H5591_006_4	4		Y	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					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	4		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	300.00					95.00	190.00	285.00					100.00	200.00	250.00																100.00				100.00			3.33	3.17	3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5591	006	4	1	02	01	H5591_006_4	4		Y	Specialty Tier	4	10	1	1	5	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											600.00	33	33	33				600.00	33	33	33				33	33	33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5591	006	5	1	02	01	H5591_006_5	5		Y	Preferred Generic	4	11	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								4.00	8.00	12.00					0.00	0.00	0.00					4.00	8.00	10.00																4.00				4.00			0.13	0.00	0.13			0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5591	006	5	1	02	01	H5591_006_5	5		Y	Generic	4	11	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								18.00	36.00	54.00					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	5		Y	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					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	5		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	300.00					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	5		Y	Specialty Tier	4	10	1	1	5	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											600.00	33	33	33				600.00	33	33	33				33	33	33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5591	007	0	1	01	01	H5591_007_0	4		Y	Preferred Generic	4	11	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								4.00	8.00	12.00					0.00	0.00	0.00					4.00	8.00	10.00																4.00				4.00			0.13	0.00	0.13			0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5591	007	0	1	01	01	H5591_007_0	4		Y	Preferred Generic	4	11	1	2	1	3		111	01	111		1				30	60	90	1	2	30	60	90				30		31								4.00	8.00	12.00					0.00	0.00	0.00					4.00	8.00	10.00																4.00				4.00			0.13	0.00	0.13			0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5591	007	0	1	01	01	H5591_007_0	4		Y	Generic	4	11	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								18.00	36.00	54.00					10.00	20.00	30.00					18.00	36.00	45.00																18.00				18.00			0.60	0.33	0.60			0.58	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5591	007	0	1	01	01	H5591_007_0	4		Y	Generic	4	11	1	2	2	3		111	01	111		1				30	60	90	1	2	30	60	90				30		31								18.00	36.00	54.00					10.00	20.00	30.00					18.00	36.00	45.00																18.00				18.00			0.60	0.33	0.60			0.58	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5591	007	0	1	01	01	H5591_007_0	4		Y	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					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	4		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	300.00					95.00	190.00	285.00					100.00	200.00	250.00																100.00				100.00			3.33	3.17	3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5591	007	0	1	01	01	H5591_007_0	4		Y	Specialty Tier	4	10	1	1	5	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											600.00	33	33	33				600.00	33	33	33				33	33	33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5591	009	0	1	01	01	H5591_009_0	5		Y	Preferred Generic	4	11	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								4.00	8.00	12.00					0.00	0.00	0.00					4.00	8.00	10.00																4.00				4.00			0.13	0.00	0.13			0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5591	009	0	1	01	01	H5591_009_0	5		Y	Generic	4	11	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								18.00	36.00	54.00					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		Y	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					40.00	80.00	120.00					47.00	94.00	117.50																47.00				47.00			1.57	1.33	1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5591	009	0	1	01	01	H5591_009_0	5		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	300.00					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		Y	Specialty Tier	4	10	1	1	5	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											600.00	28	28	28				600.00	28	28	28				28	28	28															28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5591	013	0	1	01	01	H5591_013_0	5		Y	Preferred Generic	4	11	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								4.00	8.00	12.00					0.00	0.00	0.00					4.00	8.00	10.00																4.00				4.00			0.13	0.00	0.13			0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5591	013	0	1	01	01	H5591_013_0	5		Y	Generic	4	11	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								18.00	36.00	54.00					10.00	20.00	30.00					18.00	36.00	45.00																18.00				18.00			0.60	0.33	0.60			0.58	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5591	013	0	1	01	01	H5591_013_0	5		Y	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					40.00	80.00	120.00					47.00	94.00	117.50																47.00				47.00			1.57	1.33	1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5591	013	0	1	01	01	H5591_013_0	5		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	300.00					95.00	190.00	285.00					100.00	200.00	250.00																100.00				100.00			3.33	3.17	3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5591	013	0	1	01	01	H5591_013_0	5		Y	Specialty Tier	4	10	1	1	5	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											600.00	28	28	28				600.00	28	28	28				28	28	28															28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5591	015	1	1	02	01	H5591_015_1	4		Y	Preferred Generic	4	11	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								4.00	8.00	12.00					0.00	0.00	0.00					4.00	8.00	10.00																4.00				4.00			0.13	0.00	0.13			0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5591	015	1	1	02	01	H5591_015_1	4		Y	Generic	4	11	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								18.00	36.00	54.00					10.00	20.00	30.00					18.00	36.00	45.00																18.00				18.00			0.60	0.33	0.60			0.58	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5591	015	1	1	02	01	H5591_015_1	4		Y	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					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	4		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	300.00					95.00	190.00	285.00					100.00	200.00	250.00																100.00				100.00			3.33	3.17	3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5591	015	1	1	02	01	H5591_015_1	4		Y	Specialty Tier	4	10	1	1	5	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											600.00	33	33	33				600.00	33	33	33				33	33	33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5591	015	2	1	02	01	H5591_015_2	4		Y	Preferred Generic	4	11	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								4.00	8.00	12.00					0.00	0.00	0.00					4.00	8.00	10.00																4.00				4.00			0.13	0.00	0.13			0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5591	015	2	1	02	01	H5591_015_2	4		Y	Generic	4	11	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								18.00	36.00	54.00					10.00	20.00	30.00					18.00	36.00	45.00																18.00				18.00			0.60	0.33	0.60			0.58	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5591	015	2	1	02	01	H5591_015_2	4		Y	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					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	4		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	300.00					95.00	190.00	285.00					100.00	200.00	250.00																100.00				100.00			3.33	3.17	3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5591	015	2	1	02	01	H5591_015_2	4		Y	Specialty Tier	4	10	1	1	5	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											600.00	33	33	33				600.00	33	33	33				33	33	33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5594	001	0	1	01	01	H5594_001_0	5		N	Preferred Generic	4	11	3	2	1	1	110		01	110		1	30		100				2	2	30		100				30		34	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5594	001	0	1	01	01	H5594_001_0	5		N	Preferred Generic	4	11	3	2	1	3	110		01	110		1	30		100				2	2	30		100				30		34	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H5594	001	0	1	01	01	H5594_001_0	5		N	Preferred Brand	4	11	3	2	2	1	110		01	110		1	30		90				2	2	30		90				30		34	30.00		90.00																			30.00		60.00																30.00				30.00		1.00			1.00			0.88	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5594	001	0	1	01	01	H5594_001_0	5		N	Non-Preferred Drug	4	11	3	2	3	1	110		01	110		1	30		90				2	2	30		90				30		34	70.00		210.00																			70.00		140.00																70.00				70.00		2.33			2.33			2.06	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5594	001	0	1	01	01	H5594_001_0	5		N	Specialty Tier	4	11	1	1	4	1	010		01	010		1	30								30						30		34					33																				33																	33			33								Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5594	002	0	1	01	01	H5594_002_0	5		N	Preferred Generic	4	11	3	2	1	1	110		01	110		1	30		100				2	2	30		100				30		34	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5594	002	0	1	01	01	H5594_002_0	5		N	Preferred Generic	4	11	3	2	1	3	110		01	110		1	30		100				2	2	30		100				30		34	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H5594	002	0	1	01	01	H5594_002_0	5		N	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	5		N	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	5		N	Specialty Tier	4	11	1	1	4	1	010		01	010		1	30								30						30		34					33																				33																	33			33								Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5594	016	0	1	01	01	H5594_016_0	5		N	Preferred Generic	4	11	3	2	1	1	110		01	110		1	30		100				2	2	30		100				30		34	15.00		45.00																			15.00		45.00																15.00				15.00		0.50			0.50			0.44	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5594	016	0	1	01	01	H5594_016_0	5		N	Preferred Brand	4	11	3	2	2	1	110		01	110		1	30		90				2	2	30		90				30		34	45.00		135.00																			45.00		135.00																45.00				45.00		1.50			1.50			1.32	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5594	016	0	1	01	01	H5594_016_0	5		N	Non-Preferred Drug	4	11	3	2	3	1	110		01	110		1	30		90				2	2	30		90				30		34	95.00		285.00																			95.00		285.00																95.00				95.00		3.17			3.17			2.79	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5594	016	0	1	01	01	H5594_016_0	5		N	Specialty Tier	4	11	1	1	4	1	010		01	010		1	30								30						30		34					25																				25																	25			25								Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5594	017	0	1	01	01	H5594_017_0	5		N	Preferred Generic	4	11	3	2	1	1	110		01	110		1	30		100				2	2	30		100				30		34	15.00		45.00																			15.00		45.00																15.00				15.00		0.50			0.50			0.44	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5594	017	0	1	01	01	H5594_017_0	5		N	Preferred Brand	4	11	3	2	2	1	110		01	110		1	30		90				2	2	30		90				30		34	45.00		135.00																			45.00		135.00																45.00				45.00		1.50			1.50			1.32	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5594	017	0	1	01	01	H5594_017_0	5		N	Non-Preferred Drug	4	11	3	2	3	1	110		01	110		1	30		90				2	2	30		90				30		34	95.00		285.00																			95.00		285.00																95.00				95.00		3.17			3.17			2.79	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5594	017	0	1	01	01	H5594_017_0	5		N	Specialty Tier	4	11	1	1	4	1	010		01	010		1	30								30						30		34					25																				25																	25			25								Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5594	019	0	1	01	01	H5594_019_0	5		N	Preferred Generic	4	11	3	2	1	1	110		01	110		1	30		100				2	2	30		100				30		34	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5594	019	0	1	01	01	H5594_019_0	5		N	Preferred Generic	4	11	3	2	1	3	110		01	110		1	30		100				2	2	30		100				30		34	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H5594	019	0	1	01	01	H5594_019_0	5		N	Preferred Brand	4	11	3	2	2	1	110		01	110		1	30		90				2	2	30		90				30		34	35.00		105.00																			35.00		70.00																35.00				35.00		1.17			1.17			1.03	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5594	019	0	1	01	01	H5594_019_0	5		N	Non-Preferred Drug	4	11	3	2	3	1	110		01	110		1	30		90				2	2	30		90				30		34	85.00		255.00																			85.00		170.00																85.00				85.00		2.83			2.83			2.50	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5594	019	0	1	01	01	H5594_019_0	5		N	Specialty Tier	4	11	1	1	4	1	010		01	010		1	30								30						30		34					33																				33																	33			33								Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5594	022	0	1	01	01	H5594_022_0	5		N	Preferred Generic	4	11	3	2	1	1	110		01	110		1	30		100				2	2	30		100				30		34	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5594	022	0	1	01	01	H5594_022_0	5		N	Preferred Generic	4	11	3	2	1	3	110		01	110		1	30		100				2	2	30		100				30		34	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H5594	022	0	1	01	01	H5594_022_0	5		N	Preferred Brand	4	11	3	2	2	1	110		01	110		1	30		90				2	2	30		90				30		34	35.00		105.00																			35.00		70.00																35.00				35.00		1.17			1.17			1.03	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5594	022	0	1	01	01	H5594_022_0	5		N	Non-Preferred Drug	4	11	3	2	3	1	110		01	110		1	30		90				2	2	30		90				30		34	85.00		255.00																			85.00		170.00																85.00				85.00		2.83			2.83			2.50	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5594	022	0	1	01	01	H5594_022_0	5		N	Specialty Tier	4	11	1	1	4	1	010		01	010		1	30								30						30		34					33																				33																	33			33								Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5594	026	0	1	01	01	H5594_026_0	5		N	Preferred Generic	4	11	3	2	1	1	110		01	110		1	30		100				2	2	30		100				30		34	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5594	026	0	1	01	01	H5594_026_0	5		N	Preferred Generic	4	11	3	2	1	3	110		01	110		1	30		100				2	2	30		100				30		34	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H5594	026	0	1	01	01	H5594_026_0	5		N	Preferred Brand	4	11	3	2	2	1	110		01	110		1	30		90				2	2	30		90				30		34	35.00		105.00																			35.00		70.00																35.00				35.00		1.17			1.17			1.03	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5594	026	0	1	01	01	H5594_026_0	5		N	Non-Preferred Drug	4	11	3	2	3	1	110		01	110		1	30		90				2	2	30		90				30		34	85.00		255.00																			85.00		170.00																85.00				85.00		2.83			2.83			2.50	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5594	026	0	1	01	01	H5594_026_0	5		N	Specialty Tier	4	11	1	1	4	1	010		01	010		1	30								30						30		34					33																				33																	33			33								Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5594	028	0	1	01	01	H5594_028_0	6		Y	Preferred Generic	4	11	3	2	1	1	110		01	110		1	30		100				2	2	30		100				30		34	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs												
H5594	028	0	1	01	01	H5594_028_0	6		Y	Preferred Generic	4	11	3	2	1	3	110		01	110		1	30		100				2	2	30		100				30		34	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs										1		3
H5594	028	0	1	01	01	H5594_028_0	6		Y	Preferred Brand	4	11	3	2	2	1	110		01	110		1	30		90				2	2	30		90				30		34	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	6		Y	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	6		Y	Specialty Tier	4	11	1	1	4	1	010		01	010		1	30								30						30		34					33																				33																	33			33								Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs												
H5594	028	0	1	01	01	H5594_028_0	6		Y	Select Diabetic Drugs	4	10	1	2	5	1	110		01	110		1	30		90				1	2	30		90				30		34	10.00		30.00																			10.00		20.00																10.00				10.00		0.33			0.33			0.29	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs												
H5594	028	0	1	01	01	H5594_028_0	6		Y	Select Diabetic Drugs	4	10	1	2	5	3	110		01	110		1	30		90				1	2	30		90				30		34	10.00		30.00																			10.00		20.00																10.00				10.00		0.33			0.33			0.29	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs										1		
H5594	029	0	1	01	01	H5594_029_0	5		N	Preferred Generic	4	11	3	2	1	1	110		01	110		1	30		100				2	2	30		100				30		34	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5594	029	0	1	01	01	H5594_029_0	5		N	Preferred Generic	4	11	3	2	1	3	110		01	110		1	30		100				2	2	30		100				30		34	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H5594	029	0	1	01	01	H5594_029_0	5		N	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	5		N	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	5		N	Specialty Tier	4	11	1	1	4	1	010		01	010		1	30								30						30		34					33																				33																	33			33								Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5594	030	0	1	01	01	H5594_030_0	10		N	Preferred Generic	4	11	3	2	1	1	110		01	110		1	30		100				2	2	30		100				30		34	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs												
H5594	030	0	1	01	01	H5594_030_0	10		N	Preferred Generic	4	11	3	2	1	3	110		01	110		1	30		100				2	2	30		100				30		34	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs										1		3
H5594	030	0	1	01	01	H5594_030_0	10		N	Preferred Brand	4	11	3	2	2	1	110		01	110		1	30		90				2	2	30		90				30		34	30.00		90.00																			30.00		60.00																30.00				30.00		1.00			1.00			0.88	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs												
H5594	030	0	1	01	01	H5594_030_0	10		N	Non-Preferred Drug	4	11	3	2	3	1	110		01	110		1	30		90				2	2	30		90				30		34	80.00		240.00																			80.00		160.00																80.00				80.00		2.67			2.67			2.35	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs												
H5594	030	0	1	01	01	H5594_030_0	10		N	Specialty Tier	4	11	1	1	4	1	010		01	010		1	30								30						30		34					33																				33																	33			33								Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs												
H5594	030	0	1	01	01	H5594_030_0	10		N	Select Diabetic Drugs	4	10	1	2	5	1	110		01	110		1	30		90				1	2	30		90				30		34	10.00		30.00																			10.00		20.00																10.00				10.00		0.33			0.33			0.29	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs												
H5594	031	0	1	01	01	H5594_031_0	5		N	Preferred Generic	4	11	3	2	1	1	110		01	110		1	30		100				2	2	30		100				30		34	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5594	031	0	1	01	01	H5594_031_0	5		N	Preferred Generic	4	11	3	2	1	3	110		01	110		1	30		100				2	2	30		100				30		34	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H5594	031	0	1	01	01	H5594_031_0	5		N	Preferred Brand	4	11	3	2	2	1	110		01	110		1	30		90				2	2	30		90				30		34	30.00		90.00																			30.00		60.00																30.00				30.00		1.00			1.00			0.88	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5594	031	0	1	01	01	H5594_031_0	5		N	Non-Preferred Drug	4	11	3	2	3	1	110		01	110		1	30		90				2	2	30		90				30		34	80.00		240.00																			80.00		160.00																80.00				80.00		2.67			2.67			2.35	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5594	031	0	1	01	01	H5594_031_0	5		N	Specialty Tier	4	11	1	1	4	1	010		01	010		1	30								30						30		34					33																				33																	33			33								Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5594	032	0	1	01	01	H5594_032_0	5		N	Preferred Generic	4	11	3	2	1	1	110		01	110		1	30		100				2	2	30		100				30		34	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5594	032	0	1	01	01	H5594_032_0	5		N	Preferred Generic	4	11	3	2	1	3	110		01	110		1	30		100				2	2	30		100				30		34	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H5594	032	0	1	01	01	H5594_032_0	5		N	Preferred Brand	4	11	3	2	2	1	110		01	110		1	30		90				2	2	30		90				30		34	20.00		60.00																			20.00		40.00																20.00				20.00		0.67			0.67			0.59	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5594	032	0	1	01	01	H5594_032_0	5		N	Non-Preferred Drug	4	11	3	2	3	1	110		01	110		1	30		90				2	2	30		90				30		34	60.00		180.00																			60.00		120.00																60.00				60.00		2.00			2.00			1.76	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5594	032	0	1	01	01	H5594_032_0	5		N	Specialty Tier	4	11	1	1	4	1	010		01	010		1	30								30						30		34					33																				33																	33			33								Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5594	034	0	1	01	01	H5594_034_0	5		N	Preferred Generic	4	11	3	2	1	1	110		01	110		1	30		100				2	2	30		100				30		34	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5594	034	0	1	01	01	H5594_034_0	5		N	Preferred Brand	4	11	3	2	2	1	110		01	110		1	30		90				2	2	30		90				30		34	35.00		105.00																			35.00		70.00																35.00				35.00		1.17			1.17			1.03	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5594	034	0	1	01	01	H5594_034_0	5		N	Non-Preferred Drug	4	11	3	2	3	1	110		01	110		1	30		90				2	2	30		90				30		34	85.00		255.00																			85.00		170.00																85.00				85.00		2.83			2.83			2.50	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5594	034	0	1	01	01	H5594_034_0	5		N	Specialty Tier	4	11	1	1	4	1	010		01	010		1	30								30						30		34					33																				33																	33			33								Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5594	035	0	1	01	01	H5594_035_0	5		N	Preferred Generic	4	11	3	2	1	1	110		01	110		1	30		100				2	2	30		100				30		34	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5594	035	0	1	01	01	H5594_035_0	5		N	Preferred Brand	4	11	3	2	2	1	110		01	110		1	30		90				2	2	30		90				30		34	35.00		105.00																			35.00		70.00																35.00				35.00		1.17			1.17			1.03	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5594	035	0	1	01	01	H5594_035_0	5		N	Non-Preferred Drug	4	11	3	2	3	1	110		01	110		1	30		90				2	2	30		90				30		34	85.00		255.00																			85.00		170.00																85.00				85.00		2.83			2.83			2.50	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5594	035	0	1	01	01	H5594_035_0	5		N	Specialty Tier	4	11	1	1	4	1	010		01	010		1	30								30						30		34					33																				33																	33			33								Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5599	002	0	1	02	01	H5599_002_0	4			Preferred Generic	4	11	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								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												
H5599	002	0	1	02	01	H5599_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	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												
H5599	002	0	1	02	01	H5599_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	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, Select Care Drugs												
H5599	002	0	1	02	01	H5599_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											95.74	50	50	50				95.74	50	50	50										50	50	50				50	50	50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5599	002	0	1	02	01	H5599_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												
H5599	002	0	1	02	01	H5599_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												
H5599	004	0	1	01	01	H5599_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												
H5599	004	0	1	01	01	H5599_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					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	4			Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											47.00	94.00	141.00				37.00	74.00	74.00				47.00				47.00			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	4			Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											68.51	50	50	50				65.77	48	48	48										50	50	50				48	48	48			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5599	004	0	1	01	01	H5599_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												
H5599	004	0	1	01	01	H5599_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												
H5608	002	0	1	01	01	H5608_002_0	8		Y	Preferred Generic	4	01	1	2	1	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												
H5608	002	0	1	01	01	H5608_002_0	8		Y	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																					0.00																	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	8		Y	Preferred Brand	4	10	1	2	3	1	111		10	100		1	30	60	100				1	2			100					10	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												
H5608	002	0	1	01	01	H5608_002_0	8		Y	Non-Preferred Brand	4	10	1	2	4	1	111		10	100		1	30	60	100				1	2			100					10	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, Select Care Drugs												
H5608	002	0	1	01	01	H5608_002_0	8		Y	Specialty Tier	4	11	1	1	5	1	010		10	010		1	30								30							10	31				319.00	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	8		Y	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	2		Y	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	001	0	1	01	01	H5619_001_0	2		Y	Preferred Generic	4	11	3	2	1	3	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H5619	001	0	1	01	01	H5619_001_0	2		Y	Generic	4	11	3	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	5.00		15.00																									20.00		60.00				5.00		0.00				5.00				5.00		0.17				0.67	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	001	0	1	01	01	H5619_001_0	2		Y	Generic	4	11	3	2	2	3	110		01		110	1	30		90				2	2				30		90	30		31	5.00		15.00																									20.00		60.00				5.00		0.00				5.00				5.00		0.17				0.67	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H5619	001	0	1	01	01	H5619_001_0	2		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		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	2		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		290.00				100.00				100.00		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	2		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					26																										26						26					26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	012	0	1	01	01	H5619_012_0	3		Y	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		100				1	2				30		100	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	012	0	1	01	01	H5619_012_0	3		Y	Generic	4	11	3	2	2	1	110		01		110	1	30		100				2	2				30		100	30		31	5.00		15.00																									20.00		60.00				5.00		0.00				5.00				5.00		0.17				0.67	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	012	0	1	01	01	H5619_012_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		100				2	2				30		100	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												
H5619	012	0	1	01	01	H5619_012_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		100				2	2				30		100	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												
H5619	012	0	1	01	01	H5619_012_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	013	0	1	01	01	H5619_013_0	3		Y	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		100				1	2				30		100	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	013	0	1	01	01	H5619_013_0	3		Y	Generic	4	11	3	2	2	1	110		01		110	1	30		100				2	2				30		100	30		31	5.00		15.00																									20.00		60.00				5.00		0.00				5.00				5.00		0.17				0.67	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	013	0	1	01	01	H5619_013_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		100				2	2				30		100	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												
H5619	013	0	1	01	01	H5619_013_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		100				2	2				30		100	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												
H5619	013	0	1	01	01	H5619_013_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	015	0	1	01	01	H5619_015_0	5		Y	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		100				1	2				30		100	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	015	0	1	01	01	H5619_015_0	5		Y	Generic	4	11	3	2	2	1	110		01		110	1	30		100				2	2				30		100	30		31	5.00		15.00																									20.00		60.00				5.00		0.00				5.00				5.00		0.17				0.67	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	015	0	1	01	01	H5619_015_0	5		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		100				2	2				30		100	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												
H5619	015	0	1	01	01	H5619_015_0	5		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		100				2	2				30		100	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												
H5619	015	0	1	01	01	H5619_015_0	5		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	016	0	1	01	01	H5619_016_0	3		Y	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		100				1	2				30		100	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	016	0	1	01	01	H5619_016_0	3		Y	Generic	4	11	3	2	2	1	110		01		110	1	30		100				2	2				30		100	30		31	5.00		15.00																									20.00		60.00				5.00		0.00				5.00				5.00		0.17				0.67	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	016	0	1	01	01	H5619_016_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		100				2	2				30		100	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												
H5619	016	0	1	01	01	H5619_016_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		100				2	2				30		100	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												
H5619	016	0	1	01	01	H5619_016_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	021	0	1	01	01	H5619_021_0	2		Y	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		100				1	2				30		100	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	021	0	1	01	01	H5619_021_0	2		Y	Preferred Generic	4	11	3	2	1	3	110		01		110	1	30		100				1	2				30		100	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H5619	021	0	1	01	01	H5619_021_0	2		Y	Generic	4	11	3	2	2	1	110		01		110	1	30		100				2	2				30		100	30		31	0.00		0.00																									20.00		60.00				0.00		0.00				0.00				0.00		0				0.67	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	021	0	1	01	01	H5619_021_0	2		Y	Generic	4	11	3	2	2	3	110		01		110	1	30		100				2	2				30		100	30		31	0.00		0.00																									20.00		60.00				0.00		0.00				0.00				0.00		0				0.67	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H5619	021	0	1	01	01	H5619_021_0	2		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		100				2	2				30		100	30		31	35.00		105.00																									47.00		141.00				35.00		70.00				35.00				35.00		1.17				1.57	1.17	1.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	021	0	1	01	01	H5619_021_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		100				2	2				30		100	30		31	100.00		300.00																									100.00		300.00				100.00		200.00				100.00				100.00		3.33				3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	021	0	1	01	01	H5619_021_0	2		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	026	0	1	01	01	H5619_026_0	3		Y	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		100				1	2				30		100	30		31	4.00		12.00																									10.00		30.00				4.00		0.00				4.00				4.00		0.13				0.33	0.13	0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	026	0	1	01	01	H5619_026_0	3		Y	Generic	4	11	3	2	2	1	110		01		110	1	30		100				2	2				30		100	30		31	15.00		45.00																									20.00		60.00				15.00		0.00				15.00				15.00		0.50				0.67	0.50	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	026	0	1	01	01	H5619_026_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		100				2	2				30		100	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												
H5619	026	0	1	01	01	H5619_026_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		100				2	2				30		100	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												
H5619	026	0	1	01	01	H5619_026_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					29																										29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	029	0	1	01	01	H5619_029_0	3		Y	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		100				1	2				30		100	30		31	5.00		15.00																									10.00		30.00				5.00		0.00				5.00				5.00		0.17				0.33	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	029	0	1	01	01	H5619_029_0	3		Y	Generic	4	11	3	2	2	1	110		01		110	1	30		100				2	2				30		100	30		31	12.00		36.00																									20.00		60.00				12.00		0.00				12.00				12.00		0.40				0.67	0.40	0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	029	0	1	01	01	H5619_029_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		100				2	2				30		100	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												
H5619	029	0	1	01	01	H5619_029_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		100				2	2				30		100	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												
H5619	029	0	1	01	01	H5619_029_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					26																										26						26					26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	032	0	1	01	01	H5619_032_0	3		Y	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		100				1	2				30		100	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	032	0	1	01	01	H5619_032_0	3		Y	Generic	4	11	3	2	2	1	110		01		110	1	30		100				2	2				30		100	30		31	5.00		15.00																									20.00		60.00				5.00		0.00				5.00				5.00		0.17				0.67	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	032	0	1	01	01	H5619_032_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		100				2	2				30		100	30		31	47.00		141.00																									47.00		141.00				47.00		94.00				47.00				47.00		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	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		100				2	2				30		100	30		31	100.00		300.00																									100.00		300.00				100.00		200.00				100.00				100.00		3.33				3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	032	0	1	01	01	H5619_032_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	038	0	1	01	01	H5619_038_0	3		N	Preferred Generic	4	11	1	2	1	1	110		01		110	1	30		100				1	2				30		100	30		31	13.00		39.00																									14.00		42.00				13.00		0.00				13.00				13.00		0.43				0.47	0.43	0.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	038	0	1	01	01	H5619_038_0	3		N	Generic	4	11	1	2	2	1	110		01		110	1	30		100				2	2				30		100	30		31	20.00		60.00																									20.00		60.00				20.00		0.00				20.00				20.00		0.67				0.67	0.67	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	038	0	1	01	01	H5619_038_0	3		N	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		100				2	2				30		100	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												
H5619	038	0	1	01	01	H5619_038_0	3		N	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		100				2	2				30		100	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												
H5619	038	0	1	01	01	H5619_038_0	3		N	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	039	1	1	01	01	H5619_039_1	3		Y	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		100				1	2				30		100	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	039	1	1	01	01	H5619_039_1	3		Y	Preferred Generic	4	11	3	2	1	3	110		01		110	1	30		100				1	2				30		100	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H5619	039	1	1	01	01	H5619_039_1	3		Y	Generic	4	11	3	2	2	1	110		01		110	1	30		100				2	2				30		100	30		31	5.00		15.00																									20.00		60.00				5.00		0.00				5.00				5.00		0.17				0.67	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	039	1	1	01	01	H5619_039_1	3		Y	Generic	4	11	3	2	2	3	110		01		110	1	30		100				2	2				30		100	30		31	5.00		15.00																									20.00		60.00				5.00		0.00				5.00				5.00		0.17				0.67	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H5619	039	1	1	01	01	H5619_039_1	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		100				2	2				30		100	30		31	47.00		141.00																									47.00		141.00				47.00		94.00				47.00				47.00		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	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		100				2	2				30		100	30		31	100.00		300.00																									100.00		300.00				100.00		200.00				100.00				100.00		3.33				3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	039	1	1	01	01	H5619_039_1	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	039	2	1	01	01	H5619_039_2	3		Y	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		100				1	2				30		100	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	039	2	1	01	01	H5619_039_2	3		Y	Preferred Generic	4	11	3	2	1	3	110		01		110	1	30		100				1	2				30		100	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H5619	039	2	1	01	01	H5619_039_2	3		Y	Generic	4	11	3	2	2	1	110		01		110	1	30		100				2	2				30		100	30		31	5.00		15.00																									20.00		60.00				5.00		0.00				5.00				5.00		0.17				0.67	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	039	2	1	01	01	H5619_039_2	3		Y	Generic	4	11	3	2	2	3	110		01		110	1	30		100				2	2				30		100	30		31	5.00		15.00																									20.00		60.00				5.00		0.00				5.00				5.00		0.17				0.67	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H5619	039	2	1	01	01	H5619_039_2	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		100				2	2				30		100	30		31	47.00		141.00																									47.00		141.00				47.00		94.00				47.00				47.00		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	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		100				2	2				30		100	30		31	100.00		300.00																									100.00		300.00				100.00		200.00				100.00				100.00		3.33				3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	039	2	1	01	01	H5619_039_2	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	041	0	1	01	01	H5619_041_0	3		Y	Preferred Generic	4	11	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	041	0	1	01	01	H5619_041_0	3		Y	Generic	4	11	1	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	0.00		0.00																									20.00		60.00				0.00		0.00				0.00				0.00		0				0.67	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	041	0	1	01	01	H5619_041_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	45.00		135.00																									47.00		141.00				45.00		125.00				45.00				45.00		1.50				1.57	1.50	1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	041	0	1	01	01	H5619_041_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	95.00		285.00																									100.00		300.00				95.00		275.00				95.00				95.00		3.17				3.33	3.17	3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	041	0	1	01	01	H5619_041_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	046	0	1	01	01	H5619_046_0	3		Y	Preferred Generic	4	11	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5619	046	0	1	01	01	H5619_046_0	3		Y	Generic	4	11	1	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	5.00		15.00																									20.00		60.00				5.00		0.00				5.00				5.00		0.17				0.67	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5619	046	0	1	01	01	H5619_046_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				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												
H5619	046	0	1	01	01	H5619_046_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		290.00				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												
H5619	046	0	1	01	01	H5619_046_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					30																										30						30					30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5619	046	0	1	01	01	H5619_046_0	3		Y	Select Care Drugs	4	11	1	2	6	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0				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	3		Y	Preferred Generic	4	11	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	047	0	1	01	01	H5619_047_0	3		Y	Generic	4	11	1	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	0.00		0.00																									20.00		60.00				0.00		0.00				0.00				0.00		0				0.67	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	047	0	1	01	01	H5619_047_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	45.00		135.00																									47.00		141.00				45.00		125.00				45.00				45.00		1.50				1.57	1.50	1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	047	0	1	01	01	H5619_047_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	95.00		285.00																									100.00		300.00				95.00		275.00				95.00				95.00		3.17				3.33	3.17	3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	047	0	1	01	01	H5619_047_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	049	0	1	02	01	H5619_049_0	4		Y	Preferred Generic	4	11	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	049	0	1	02	01	H5619_049_0	4		Y	Preferred Generic	4	11	1	2	1	3	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5619	049	0	1	02	01	H5619_049_0	4		Y	Generic	4	11	1	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	0.00		0.00																									20.00		60.00				0.00		0.00				0.00				0.00		0				0.67	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	049	0	1	02	01	H5619_049_0	4		Y	Generic	4	11	1	2	2	3	110		01		110	1	30		90				2	2				30		90	30		31	0.00		0.00																									20.00		60.00				0.00		0.00				0.00				0.00		0				0.67	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5619	049	0	1	02	01	H5619_049_0	4		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	049	0	1	02	01	H5619_049_0	4		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		290.00				100.00				100.00		3.33				3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	049	0	1	02	01	H5619_049_0	4		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	050	0	1	01	01	H5619_050_0	4		Y	Preferred Generic	4	11	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	050	0	1	01	01	H5619_050_0	4		Y	Preferred Generic	4	11	1	2	1	3	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5619	050	0	1	01	01	H5619_050_0	4		Y	Generic	4	11	1	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	5.00		15.00																									20.00		60.00				5.00		0.00				5.00				5.00		0.17				0.67	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	050	0	1	01	01	H5619_050_0	4		Y	Generic	4	11	1	2	2	3	110		01		110	1	30		90				2	2				30		90	30		31	5.00		15.00																									20.00		60.00				5.00		0.00				5.00				5.00		0.17				0.67	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5619	050	0	1	01	01	H5619_050_0	4		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	050	0	1	01	01	H5619_050_0	4		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	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												
H5619	050	0	1	01	01	H5619_050_0	4		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					31																										31						31					31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	051	0	1	02	01	H5619_051_0	4		Y	Preferred Generic	4	11	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	051	0	1	02	01	H5619_051_0	4		Y	Preferred Generic	4	11	1	2	1	3	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5619	051	0	1	02	01	H5619_051_0	4		Y	Generic	4	11	1	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	0.00		0.00																									20.00		60.00				0.00		0.00				0.00				0.00		0				0.67	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	051	0	1	02	01	H5619_051_0	4		Y	Generic	4	11	1	2	2	3	110		01		110	1	30		90				2	2				30		90	30		31	0.00		0.00																									20.00		60.00				0.00		0.00				0.00				0.00		0				0.67	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5619	051	0	1	02	01	H5619_051_0	4		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	051	0	1	02	01	H5619_051_0	4		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		290.00				100.00				100.00		3.33				3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	051	0	1	02	01	H5619_051_0	4		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	052	0	1	01	01	H5619_052_0	4		Y	Preferred Generic	4	11	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	052	0	1	01	01	H5619_052_0	4		Y	Preferred Generic	4	11	1	2	1	3	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5619	052	0	1	01	01	H5619_052_0	4		Y	Generic	4	11	1	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	5.00		15.00																									20.00		60.00				5.00		0.00				5.00				5.00		0.17				0.67	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	052	0	1	01	01	H5619_052_0	4		Y	Generic	4	11	1	2	2	3	110		01		110	1	30		90				2	2				30		90	30		31	5.00		15.00																									20.00		60.00				5.00		0.00				5.00				5.00		0.17				0.67	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5619	052	0	1	01	01	H5619_052_0	4		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	052	0	1	01	01	H5619_052_0	4		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	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												
H5619	052	0	1	01	01	H5619_052_0	4		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	053	0	1	02	01	H5619_053_0	4		Y	Preferred Generic	4	11	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	053	0	1	02	01	H5619_053_0	4		Y	Preferred Generic	4	11	1	2	1	3	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5619	053	0	1	02	01	H5619_053_0	4		Y	Generic	4	11	1	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	5.00		15.00																									20.00		60.00				5.00		0.00				5.00				5.00		0.17				0.67	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	053	0	1	02	01	H5619_053_0	4		Y	Generic	4	11	1	2	2	3	110		01		110	1	30		90				2	2				30		90	30		31	5.00		15.00																									20.00		60.00				5.00		0.00				5.00				5.00		0.17				0.67	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5619	053	0	1	02	01	H5619_053_0	4		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	053	0	1	02	01	H5619_053_0	4		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		290.00				100.00				100.00		3.33				3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	053	0	1	02	01	H5619_053_0	4		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	055	0	1	01	01	H5619_055_0	5		Y	Preferred Generic	4	11	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	7.00		21.00																									10.00		30.00				7.00		0.00				7.00				7.00		0.23				0.33	0.23	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5619	055	0	1	01	01	H5619_055_0	5		Y	Generic	4	11	1	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	17.00		51.00																									20.00		60.00				17.00		0.00				17.00				17.00		0.57				0.67	0.57	0.55	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5619	055	0	1	01	01	H5619_055_0	5		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				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												
H5619	055	0	1	01	01	H5619_055_0	5		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	97.00		291.00																									100.00		300.00				97.00		281.00				97.00				97.00		3.23				3.33	3.23	3.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5619	055	0	1	01	01	H5619_055_0	5		Y	Specialty Tier	4	11	1	1	5	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												
H5619	055	0	1	01	01	H5619_055_0	5		Y	Select Care Drugs	4	11	1	2	6	1	110		01		110	1	30		90				1	2				30		90	30		31	7.00		21.00																									11.00		33.00				7.00		0.00				7.00				7.00		0.23				0.37	0.23	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5619	056	0	1	01	01	H5619_056_0	2		Y	Preferred Generic	4	11	1	2	1	1	110		01		110	1	30		100				1	2				30		100	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	056	0	1	01	01	H5619_056_0	2		Y	Preferred Generic	4	11	1	2	1	3	110		01		110	1	30		100				1	2				30		100	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5619	056	0	1	01	01	H5619_056_0	2		Y	Generic	4	11	1	2	2	1	110		01		110	1	30		100				2	2				30		100	30		31	5.00		15.00																									20.00		60.00				5.00		0.00				5.00				5.00		0.17				0.67	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	056	0	1	01	01	H5619_056_0	2		Y	Generic	4	11	1	2	2	3	110		01		110	1	30		100				2	2				30		100	30		31	5.00		15.00																									20.00		60.00				5.00		0.00				5.00				5.00		0.17				0.67	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5619	056	0	1	01	01	H5619_056_0	2		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		100				2	2				30		100	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												
H5619	056	0	1	01	01	H5619_056_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		100				2	2				30		100	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												
H5619	056	0	1	01	01	H5619_056_0	2		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					30																										30						30					30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	057	0	1	01	01	H5619_057_0	4		Y	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		100				1	2				30		100	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	057	0	1	01	01	H5619_057_0	4		Y	Preferred Generic	4	11	3	2	1	3	110		01		110	1	30		100				1	2				30		100	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H5619	057	0	1	01	01	H5619_057_0	4		Y	Generic	4	11	3	2	2	1	110		01		110	1	30		100				2	2				30		100	30		31	0.00		0.00																									20.00		60.00				0.00		0.00				0.00				0.00		0				0.67	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	057	0	1	01	01	H5619_057_0	4		Y	Generic	4	11	3	2	2	3	110		01		110	1	30		100				2	2				30		100	30		31	0.00		0.00																									20.00		60.00				0.00		0.00				0.00				0.00		0				0.67	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H5619	057	0	1	01	01	H5619_057_0	4		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		100				2	2				30		100	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												
H5619	057	0	1	01	01	H5619_057_0	4		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		100				2	2				30		100	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												
H5619	057	0	1	01	01	H5619_057_0	4		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	059	0	1	01	01	H5619_059_0	3		Y	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		100				1	2				30		100	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	059	0	1	01	01	H5619_059_0	3		Y	Preferred Generic	4	11	3	2	1	3	110		01		110	1	30		100				1	2				30		100	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H5619	059	0	1	01	01	H5619_059_0	3		Y	Generic	4	11	3	2	2	1	110		01		110	1	30		100				2	2				30		100	30		31	0.00		0.00																									20.00		60.00				0.00		0.00				0.00				0.00		0				0.67	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	059	0	1	01	01	H5619_059_0	3		Y	Generic	4	11	3	2	2	3	110		01		110	1	30		100				2	2				30		100	30		31	0.00		0.00																									20.00		60.00				0.00		0.00				0.00				0.00		0				0.67	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H5619	059	0	1	01	01	H5619_059_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		100				2	2				30		100	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												
H5619	059	0	1	01	01	H5619_059_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		100				2	2				30		100	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												
H5619	059	0	1	01	01	H5619_059_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					32																										32						32					32			32								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	060	0	1	01	01	H5619_060_0	2		Y	Preferred Generic	4	11	1	2	1	1	110		01		110	1	30		100				1	2				30		100	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	060	0	1	01	01	H5619_060_0	2		Y	Preferred Generic	4	11	1	2	1	3	110		01		110	1	30		100				1	2				30		100	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5619	060	0	1	01	01	H5619_060_0	2		Y	Generic	4	11	1	2	2	1	110		01		110	1	30		100				2	2				30		100	30		31	5.00		15.00																									20.00		60.00				5.00		0.00				5.00				5.00		0.17				0.67	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	060	0	1	01	01	H5619_060_0	2		Y	Generic	4	11	1	2	2	3	110		01		110	1	30		100				2	2				30		100	30		31	5.00		15.00																									20.00		60.00				5.00		0.00				5.00				5.00		0.17				0.67	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5619	060	0	1	01	01	H5619_060_0	2		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		100				2	2				30		100	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												
H5619	060	0	1	01	01	H5619_060_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		100				2	2				30		100	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												
H5619	060	0	1	01	01	H5619_060_0	2		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					29																										29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	061	0	1	01	01	H5619_061_0	2		Y	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		100				1	2				30		100	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	061	0	1	01	01	H5619_061_0	2		Y	Preferred Generic	4	11	3	2	1	3	110		01		110	1	30		100				1	2				30		100	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H5619	061	0	1	01	01	H5619_061_0	2		Y	Generic	4	11	3	2	2	1	110		01		110	1	30		100				2	2				30		100	30		31	5.00		15.00																									20.00		60.00				5.00		0.00				5.00				5.00		0.17				0.67	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	061	0	1	01	01	H5619_061_0	2		Y	Generic	4	11	3	2	2	3	110		01		110	1	30		100				2	2				30		100	30		31	5.00		15.00																									20.00		60.00				5.00		0.00				5.00				5.00		0.17				0.67	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H5619	061	0	1	01	01	H5619_061_0	2		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		100				2	2				30		100	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												
H5619	061	0	1	01	01	H5619_061_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		100				2	2				30		100	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												
H5619	061	0	1	01	01	H5619_061_0	2		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					32																										32						32					32			32								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	063	0	1	01	01	H5619_063_0	3		Y	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		100				1	2				30		100	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	063	0	1	01	01	H5619_063_0	3		Y	Preferred Generic	4	11	3	2	1	3	110		01		110	1	30		100				1	2				30		100	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H5619	063	0	1	01	01	H5619_063_0	3		Y	Generic	4	11	3	2	2	1	110		01		110	1	30		100				2	2				30		100	30		31	5.00		15.00																									20.00		60.00				5.00		0.00				5.00				5.00		0.17				0.67	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	063	0	1	01	01	H5619_063_0	3		Y	Generic	4	11	3	2	2	3	110		01		110	1	30		100				2	2				30		100	30		31	5.00		15.00																									20.00		60.00				5.00		0.00				5.00				5.00		0.17				0.67	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H5619	063	0	1	01	01	H5619_063_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		100				2	2				30		100	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												
H5619	063	0	1	01	01	H5619_063_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		100				2	2				30		100	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												
H5619	063	0	1	01	01	H5619_063_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					29																										29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	064	0	1	01	01	H5619_064_0	2		Y	Preferred Generic	4	11	1	2	1	1	110		01		110	1	30		100				1	2				30		100	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	064	0	1	01	01	H5619_064_0	2		Y	Preferred Generic	4	11	1	2	1	3	110		01		110	1	30		100				1	2				30		100	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5619	064	0	1	01	01	H5619_064_0	2		Y	Generic	4	11	1	2	2	1	110		01		110	1	30		100				2	2				30		100	30		31	5.00		15.00																									20.00		60.00				5.00		0.00				5.00				5.00		0.17				0.67	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	064	0	1	01	01	H5619_064_0	2		Y	Generic	4	11	1	2	2	3	110		01		110	1	30		100				2	2				30		100	30		31	5.00		15.00																									20.00		60.00				5.00		0.00				5.00				5.00		0.17				0.67	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5619	064	0	1	01	01	H5619_064_0	2		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		100				2	2				30		100	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												
H5619	064	0	1	01	01	H5619_064_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		100				2	2				30		100	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												
H5619	064	0	1	01	01	H5619_064_0	2		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					29																										29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	065	0	1	01	01	H5619_065_0	3		Y	Preferred Generic	4	11	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									19.00		57.00				0.00		0.00				0.00				0.00		0				0.63	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	065	0	1	01	01	H5619_065_0	3		Y	Preferred Generic	4	11	1	2	1	3	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									19.00		57.00				0.00		0.00				0.00				0.00		0				0.63	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5619	065	0	1	01	01	H5619_065_0	3		Y	Generic	4	11	1	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	5.00		15.00																									20.00		60.00				5.00		0.00				5.00				5.00		0.17				0.67	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	065	0	1	01	01	H5619_065_0	3		Y	Generic	4	11	1	2	2	3	110		01		110	1	30		90				2	2				30		90	30		31	5.00		15.00																									20.00		60.00				5.00		0.00				5.00				5.00		0.17				0.67	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5619	065	0	1	01	01	H5619_065_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	065	0	1	01	01	H5619_065_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	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												
H5619	065	0	1	01	01	H5619_065_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	066	0	1	01	01	H5619_066_0	3		N	Preferred Generic	4	11	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	066	0	1	01	01	H5619_066_0	3		N	Preferred Generic	4	11	1	2	1	3	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5619	066	0	1	01	01	H5619_066_0	3		N	Generic	4	11	1	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	5.00		15.00																									20.00		60.00				5.00		0.00				5.00				5.00		0.17				0.67	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	066	0	1	01	01	H5619_066_0	3		N	Generic	4	11	1	2	2	3	110		01		110	1	30		90				2	2				30		90	30		31	5.00		15.00																									20.00		60.00				5.00		0.00				5.00				5.00		0.17				0.67	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5619	066	0	1	01	01	H5619_066_0	3		N	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	066	0	1	01	01	H5619_066_0	3		N	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		290.00				100.00				100.00		3.33				3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	066	0	1	01	01	H5619_066_0	3		N	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					27																										27						27					27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	069	0	1	02	01	H5619_069_0	3		Y	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	6.00		18.00																									10.00		30.00				6.00		0.00				6.00				6.00		0.20				0.33	0.20	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	069	0	1	02	01	H5619_069_0	3		Y	Generic	4	11	3	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	11.00		33.00																									20.00		60.00				11.00		0.00				11.00				11.00		0.37				0.67	0.37	0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	069	0	1	02	01	H5619_069_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	47.00		141.00																									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												
H5619	069	0	1	02	01	H5619_069_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	99.00		297.00																									100.00		300.00				99.00		287.00				99.00				99.00		3.30				3.33	3.30	3.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	069	0	1	02	01	H5619_069_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					30																										30						30					30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	071	0	1	01	01	H5619_071_0	4		Y	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	071	0	1	01	01	H5619_071_0	4		Y	Preferred Generic	4	11	3	2	1	3	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H5619	071	0	1	01	01	H5619_071_0	4		Y	Generic	4	11	3	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	0.00		0.00																									20.00		60.00				0.00		0.00				0.00				0.00		0				0.67	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	071	0	1	01	01	H5619_071_0	4		Y	Generic	4	11	3	2	2	3	110		01		110	1	30		90				2	2				30		90	30		31	0.00		0.00																									20.00		60.00				0.00		0.00				0.00				0.00		0				0.67	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H5619	071	0	1	01	01	H5619_071_0	4		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	42.00		126.00																									47.00		141.00				42.00		116.00				42.00				42.00		1.40				1.57	1.40	1.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	071	0	1	01	01	H5619_071_0	4		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	100.00		300.00																									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												
H5619	071	0	1	01	01	H5619_071_0	4		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	077	0	1	01	01	H5619_077_0	2		Y	Preferred Generic	4	11	1	2	1	1	110		01		110	1	30		100				1	2				30		100	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	077	0	1	01	01	H5619_077_0	2		Y	Preferred Generic	4	11	1	2	1	3	110		01		110	1	30		100				1	2				30		100	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5619	077	0	1	01	01	H5619_077_0	2		Y	Generic	4	11	1	2	2	1	110		01		110	1	30		100				2	2				30		100	30		31	5.00		15.00																									20.00		60.00				5.00		0.00				5.00				5.00		0.17				0.67	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	077	0	1	01	01	H5619_077_0	2		Y	Generic	4	11	1	2	2	3	110		01		110	1	30		100				2	2				30		100	30		31	5.00		15.00																									20.00		60.00				5.00		0.00				5.00				5.00		0.17				0.67	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5619	077	0	1	01	01	H5619_077_0	2		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		100				2	2				30		100	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												
H5619	077	0	1	01	01	H5619_077_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		100				2	2				30		100	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												
H5619	077	0	1	01	01	H5619_077_0	2		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					30																										30						30					30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	078	0	1	01	01	H5619_078_0	2		Y	Preferred Generic	4	11	1	2	1	1	110		01		110	1	30		100				1	2				30		100	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	078	0	1	01	01	H5619_078_0	2		Y	Preferred Generic	4	11	1	2	1	3	110		01		110	1	30		100				1	2				30		100	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5619	078	0	1	01	01	H5619_078_0	2		Y	Generic	4	11	1	2	2	1	110		01		110	1	30		100				2	2				30		100	30		31	5.00		15.00																									20.00		60.00				5.00		0.00				5.00				5.00		0.17				0.67	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	078	0	1	01	01	H5619_078_0	2		Y	Generic	4	11	1	2	2	3	110		01		110	1	30		100				2	2				30		100	30		31	5.00		15.00																									20.00		60.00				5.00		0.00				5.00				5.00		0.17				0.67	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5619	078	0	1	01	01	H5619_078_0	2		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		100				2	2				30		100	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												
H5619	078	0	1	01	01	H5619_078_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		100				2	2				30		100	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												
H5619	078	0	1	01	01	H5619_078_0	2		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					29																										29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	083	0	1	01	01	H5619_083_0	3		Y	Preferred Generic	4	11	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	4.00		12.00																									10.00		30.00				4.00		0.00				4.00				4.00		0.13				0.33	0.13	0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	083	0	1	01	01	H5619_083_0	3		Y	Generic	4	11	1	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	12.00		36.00																									20.00		60.00				12.00		0.00				12.00				12.00		0.40				0.67	0.40	0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	083	0	1	01	01	H5619_083_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		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	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		290.00				100.00				100.00		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	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					29																										29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	087	0	1	01	01	H5619_087_0	3		Y	Preferred Generic	4	11	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	4.00		12.00																									10.00		30.00				4.00		0.00				4.00				4.00		0.13				0.33	0.13	0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5619	087	0	1	01	01	H5619_087_0	3		Y	Generic	4	11	1	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	12.00		36.00																									20.00		60.00				12.00		0.00				12.00				12.00		0.40				0.67	0.40	0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5619	087	0	1	01	01	H5619_087_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				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												
H5619	087	0	1	01	01	H5619_087_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		290.00				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												
H5619	087	0	1	01	01	H5619_087_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					30																										30						30					30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5619	087	0	1	01	01	H5619_087_0	3		Y	Select Care Drugs	4	11	1	2	6	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0				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	3		Y	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	088	0	1	01	01	H5619_088_0	3		Y	Generic	4	11	3	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	0.00		0.00																									20.00		60.00				0.00		0.00				0.00				0.00		0				0.67	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	088	0	1	01	01	H5619_088_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		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	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	97.00		291.00																									100.00		300.00				97.00		281.00				97.00				97.00		3.23				3.33	3.23	3.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	088	0	1	01	01	H5619_088_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	089	0	1	01	01	H5619_089_0	3		Y	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	089	0	1	01	01	H5619_089_0	3		Y	Generic	4	11	3	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	0.00		0.00																									20.00		60.00				0.00		0.00				0.00				0.00		0				0.67	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	089	0	1	01	01	H5619_089_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		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	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	97.00		291.00																									100.00		300.00				97.00		281.00				97.00				97.00		3.23				3.33	3.23	3.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	089	0	1	01	01	H5619_089_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	090	0	1	01	01	H5619_090_0	3		Y	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	090	0	1	01	01	H5619_090_0	3		Y	Generic	4	11	3	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	0.00		0.00																									20.00		60.00				0.00		0.00				0.00				0.00		0				0.67	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	090	0	1	01	01	H5619_090_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	090	0	1	01	01	H5619_090_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	97.00		291.00																									100.00		300.00				97.00		281.00				97.00				97.00		3.23				3.33	3.23	3.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	090	0	1	01	01	H5619_090_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	091	0	1	01	01	H5619_091_0	3		Y	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	091	0	1	01	01	H5619_091_0	3		Y	Generic	4	11	3	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	0.00		0.00																									20.00		60.00				0.00		0.00				0.00				0.00		0				0.67	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	091	0	1	01	01	H5619_091_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	091	0	1	01	01	H5619_091_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	97.00		291.00																									100.00		300.00				97.00		281.00				97.00				97.00		3.23				3.33	3.23	3.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	091	0	1	01	01	H5619_091_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	094	0	1	01	01	H5619_094_0	3		Y	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	094	0	1	01	01	H5619_094_0	3		Y	Generic	4	11	3	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	0.00		0.00																									20.00		60.00				0.00		0.00				0.00				0.00		0				0.67	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	094	0	1	01	01	H5619_094_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		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	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	97.00		291.00																									100.00		300.00				97.00		281.00				97.00				97.00		3.23				3.33	3.23	3.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	094	0	1	01	01	H5619_094_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	095	0	1	01	01	H5619_095_0	3		Y	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	095	0	1	01	01	H5619_095_0	3		Y	Generic	4	11	3	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	0.00		0.00																									20.00		60.00				0.00		0.00				0.00				0.00		0				0.67	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	095	0	1	01	01	H5619_095_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	095	0	1	01	01	H5619_095_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	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												
H5619	095	0	1	01	01	H5619_095_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	099	0	1	01	01	H5619_099_0	2		Y	Preferred Generic	4	11	1	2	1	1	110		01		110	1	30		100				1	2				30		100	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	099	0	1	01	01	H5619_099_0	2		Y	Preferred Generic	4	11	1	2	1	3	110		01		110	1	30		100				1	2				30		100	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5619	099	0	1	01	01	H5619_099_0	2		Y	Generic	4	11	1	2	2	1	110		01		110	1	30		100				2	2				30		100	30		31	5.00		15.00																									20.00		60.00				5.00		0.00				5.00				5.00		0.17				0.67	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	099	0	1	01	01	H5619_099_0	2		Y	Generic	4	11	1	2	2	3	110		01		110	1	30		100				2	2				30		100	30		31	5.00		15.00																									20.00		60.00				5.00		0.00				5.00				5.00		0.17				0.67	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5619	099	0	1	01	01	H5619_099_0	2		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		100				2	2				30		100	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												
H5619	099	0	1	01	01	H5619_099_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		100				2	2				30		100	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												
H5619	099	0	1	01	01	H5619_099_0	2		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					30																										30						30					30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	100	0	1	01	01	H5619_100_0	4		Y	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		100				1	2				30		100	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	100	0	1	01	01	H5619_100_0	4		Y	Preferred Generic	4	11	3	2	1	3	110		01		110	1	30		100				1	2				30		100	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H5619	100	0	1	01	01	H5619_100_0	4		Y	Generic	4	11	3	2	2	1	110		01		110	1	30		100				2	2				30		100	30		31	5.00		15.00																									20.00		60.00				5.00		0.00				5.00				5.00		0.17				0.67	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	100	0	1	01	01	H5619_100_0	4		Y	Generic	4	11	3	2	2	3	110		01		110	1	30		100				2	2				30		100	30		31	5.00		15.00																									20.00		60.00				5.00		0.00				5.00				5.00		0.17				0.67	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H5619	100	0	1	01	01	H5619_100_0	4		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		100				2	2				30		100	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												
H5619	100	0	1	01	01	H5619_100_0	4		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		100				2	2				30		100	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												
H5619	100	0	1	01	01	H5619_100_0	4		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	111	0	1	02	01	H5619_111_0	4		Y	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	111	0	1	02	01	H5619_111_0	4		Y	Preferred Generic	4	11	3	2	1	3	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H5619	111	0	1	02	01	H5619_111_0	4		Y	Generic	4	11	3	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	0.00		0.00																									20.00		60.00				0.00		0.00				0.00				0.00		0				0.67	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	111	0	1	02	01	H5619_111_0	4		Y	Generic	4	11	3	2	2	3	110		01		110	1	30		90				2	2				30		90	30		31	0.00		0.00																									20.00		60.00				0.00		0.00				0.00				0.00		0				0.67	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H5619	111	0	1	02	01	H5619_111_0	4		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	111	0	1	02	01	H5619_111_0	4		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	99.00		297.00																									100.00		300.00				99.00		287.00				99.00				99.00		3.30				3.33	3.30	3.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	111	0	1	02	01	H5619_111_0	4		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	112	0	1	01	01	H5619_112_0	3		Y	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	112	0	1	01	01	H5619_112_0	3		Y	Generic	4	11	3	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	0.00		0.00																									20.00		60.00				0.00		0.00				0.00				0.00		0				0.67	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	112	0	1	01	01	H5619_112_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		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	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		290.00				100.00				100.00		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	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	113	0	1	01	01	H5619_113_0	3		Y	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	113	0	1	01	01	H5619_113_0	3		Y	Preferred Generic	4	11	3	2	1	3	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H5619	113	0	1	01	01	H5619_113_0	3		Y	Generic	4	11	3	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	0.00		0.00																									20.00		60.00				0.00		0.00				0.00				0.00		0				0.67	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	113	0	1	01	01	H5619_113_0	3		Y	Generic	4	11	3	2	2	3	110		01		110	1	30		90				2	2				30		90	30		31	0.00		0.00																									20.00		60.00				0.00		0.00				0.00				0.00		0				0.67	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H5619	113	0	1	01	01	H5619_113_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		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	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		290.00				100.00				100.00		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	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	114	0	1	01	01	H5619_114_0	2		Y	Preferred Generic	4	11	1	2	1	1	110		01		110	1	30		100				1	2				30		100	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	114	0	1	01	01	H5619_114_0	2		Y	Generic	4	11	1	2	2	1	110		01		110	1	30		100				2	2				30		100	30		31	0.00		0.00																									20.00		60.00				0.00		0.00				0.00				0.00		0				0.67	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	114	0	1	01	01	H5619_114_0	2		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		100				2	2				30		100	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												
H5619	114	0	1	01	01	H5619_114_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		100				2	2				30		100	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												
H5619	114	0	1	01	01	H5619_114_0	2		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					30																										30						30					30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	116	0	1	01	01	H5619_116_0	3		Y	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		100				1	2				30		100	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	116	0	1	01	01	H5619_116_0	3		Y	Generic	4	11	3	2	2	1	110		01		110	1	30		100				2	2				30		100	30		31	5.00		15.00																									20.00		60.00				5.00		0.00				5.00				5.00		0.17				0.67	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	116	0	1	01	01	H5619_116_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		100				2	2				30		100	30		31	47.00		141.00																									47.00		141.00				47.00		94.00				47.00				47.00		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	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		100				2	2				30		100	30		31	100.00		300.00																									100.00		300.00				100.00		200.00				100.00				100.00		3.33				3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	116	0	1	01	01	H5619_116_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	119	0	1	01	01	H5619_119_0	3		Y	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		100				1	2				30		100	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	119	0	1	01	01	H5619_119_0	3		Y	Preferred Generic	4	11	3	2	1	3	110		01		110	1	30		100				1	2				30		100	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H5619	119	0	1	01	01	H5619_119_0	3		Y	Generic	4	11	3	2	2	1	110		01		110	1	30		100				2	2				30		100	30		31	5.00		15.00																									20.00		60.00				5.00		0.00				5.00				5.00		0.17				0.67	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	119	0	1	01	01	H5619_119_0	3		Y	Generic	4	11	3	2	2	3	110		01		110	1	30		100				2	2				30		100	30		31	5.00		15.00																									20.00		60.00				5.00		0.00				5.00				5.00		0.17				0.67	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H5619	119	0	1	01	01	H5619_119_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		100				2	2				30		100	30		31	47.00		141.00																									47.00		141.00				47.00		94.00				47.00				47.00		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	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		100				2	2				30		100	30		31	100.00		300.00																									100.00		300.00				100.00		200.00				100.00				100.00		3.33				3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	119	0	1	01	01	H5619_119_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	122	0	1	01	01	H5619_122_0	3		Y	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	6.00		18.00																									10.00		30.00				6.00		0.00				6.00				6.00		0.20				0.33	0.20	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	122	0	1	01	01	H5619_122_0	3		Y	Generic	4	11	3	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	11.00		33.00																									20.00		60.00				11.00		0.00				11.00				11.00		0.37				0.67	0.37	0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	122	0	1	01	01	H5619_122_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		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	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	99.00		297.00																									100.00		300.00				99.00		287.00				99.00				99.00		3.30				3.33	3.30	3.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	122	0	1	01	01	H5619_122_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	128	0	1	01	01	H5619_128_0	3		Y	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	128	0	1	01	01	H5619_128_0	3		Y	Preferred Generic	4	11	3	2	1	3	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H5619	128	0	1	01	01	H5619_128_0	3		Y	Generic	4	11	3	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	5.00		15.00																									20.00		60.00				5.00		0.00				5.00				5.00		0.17				0.67	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	128	0	1	01	01	H5619_128_0	3		Y	Generic	4	11	3	2	2	3	110		01		110	1	30		90				2	2				30		90	30		31	5.00		15.00																									20.00		60.00				5.00		0.00				5.00				5.00		0.17				0.67	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H5619	128	0	1	01	01	H5619_128_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		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	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		290.00				100.00				100.00		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	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	130	1	1	01	01	H5619_130_1	3		Y	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		100				1	2				30		100	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	130	1	1	01	01	H5619_130_1	3		Y	Generic	4	11	3	2	2	1	110		01		110	1	30		100				2	2				30		100	30		31	5.00		15.00																									20.00		60.00				5.00		0.00				5.00				5.00		0.17				0.67	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	130	1	1	01	01	H5619_130_1	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		100				2	2				30		100	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												
H5619	130	1	1	01	01	H5619_130_1	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		100				2	2				30		100	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												
H5619	130	1	1	01	01	H5619_130_1	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	130	2	1	01	01	H5619_130_2	3		Y	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		100				1	2				30		100	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	130	2	1	01	01	H5619_130_2	3		Y	Generic	4	11	3	2	2	1	110		01		110	1	30		100				2	2				30		100	30		31	5.00		15.00																									20.00		60.00				5.00		0.00				5.00				5.00		0.17				0.67	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	130	2	1	01	01	H5619_130_2	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		100				2	2				30		100	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												
H5619	130	2	1	01	01	H5619_130_2	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		100				2	2				30		100	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												
H5619	130	2	1	01	01	H5619_130_2	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	131	0	1	01	01	H5619_131_0	3		Y	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		100				1	2				30		100	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	131	0	1	01	01	H5619_131_0	3		Y	Generic	4	11	3	2	2	1	110		01		110	1	30		100				2	2				30		100	30		31	0.00		0.00																									20.00		60.00				0.00		0.00				0.00				0.00		0				0.67	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	131	0	1	01	01	H5619_131_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		100				2	2				30		100	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												
H5619	131	0	1	01	01	H5619_131_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		100				2	2				30		100	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												
H5619	131	0	1	01	01	H5619_131_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	133	0	1	01	01	H5619_133_0	2		Y	Preferred Generic	4	11	1	2	1	1	110		01		110	1	30		100				1	2				30		100	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	133	0	1	01	01	H5619_133_0	2		Y	Preferred Generic	4	11	1	2	1	3	110		01		110	1	30		100				1	2				30		100	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5619	133	0	1	01	01	H5619_133_0	2		Y	Generic	4	11	1	2	2	1	110		01		110	1	30		100				2	2				30		100	30		31	0.00		0.00																									20.00		60.00				0.00		0.00				0.00				0.00		0				0.67	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	133	0	1	01	01	H5619_133_0	2		Y	Generic	4	11	1	2	2	3	110		01		110	1	30		100				2	2				30		100	30		31	0.00		0.00																									20.00		60.00				0.00		0.00				0.00				0.00		0				0.67	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5619	133	0	1	01	01	H5619_133_0	2		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		100				2	2				30		100	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												
H5619	133	0	1	01	01	H5619_133_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		100				2	2				30		100	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												
H5619	133	0	1	01	01	H5619_133_0	2		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					29																										29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	134	0	1	01	01	H5619_134_0	2		N	Preferred Generic	3	11	1	2	1	1	110		01		110	1	30		100				1	2				30		100	30		31	1.00		3.00																									5.00		15.00				1.00		0.00				1.00				1.00		0.03				0.17	0.03	0.03	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	134	0	1	01	01	H5619_134_0	2		N	Generic	3	11	1	2	2	1	110		01		110	1	30		100				2	2				30		100	30		31	15.00		45.00																									20.00		60.00				15.00		0.00				15.00				15.00		0.50				0.67	0.50	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	134	0	1	01	01	H5619_134_0	2		N	Preferred Brand	3	11	1	1	3	1	110		01		110	1	30		100				2	2				30		100	30		31				53.00	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	2		N	Non-Preferred Drug	3	11	1	1	4	1	110		01		110	1	30		100				2	2				30		100	30		31				53.00	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	2		N	Specialty Tier	3	11	1	1	5	1	010		01		010	1	30											30			30		31					25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	135	0	1	01	01	H5619_135_0	3		Y	Preferred Generic	4	11	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	2.00		6.00																									10.00		30.00				2.00		0.00				2.00				2.00		0.07				0.33	0.07	0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	135	0	1	01	01	H5619_135_0	3		Y	Generic	4	11	1	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	8.00		24.00																									20.00		60.00				8.00		0.00				8.00				8.00		0.27				0.67	0.27	0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	135	0	1	01	01	H5619_135_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	45.00		135.00																									47.00		141.00				45.00		125.00				45.00				45.00		1.50				1.57	1.50	1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	135	0	1	01	01	H5619_135_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	95.00		285.00																									100.00		300.00				95.00		275.00				95.00				95.00		3.17				3.33	3.17	3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	135	0	1	01	01	H5619_135_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	136	1	1	01	01	H5619_136_1	4		N	Preferred Generic	4	11	1	2	1	1	110		01		110	1	30		100				1	2				30		100	30		31	2.00		6.00																									10.00		30.00				2.00		0.00				2.00				2.00		0.07				0.33	0.07	0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	136	1	1	01	01	H5619_136_1	4		N	Generic	4	11	1	2	2	1	110		01		110	1	30		100				2	2				30		100	30		31	19.00		57.00																									20.00		60.00				19.00		0.00				19.00				19.00		0.63				0.67	0.63	0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	136	1	1	01	01	H5619_136_1	4		N	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		100				2	2				30		100	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												
H5619	136	1	1	01	01	H5619_136_1	4		N	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		100				2	2				30		100	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												
H5619	136	1	1	01	01	H5619_136_1	4		N	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	136	2	1	01	01	H5619_136_2	5		N	Preferred Generic	4	11	1	2	1	1	110		01		110	1	30		100				1	2				30		100	30		31	2.00		6.00																									10.00		30.00				2.00		0.00				2.00				2.00		0.07				0.33	0.07	0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	136	2	1	01	01	H5619_136_2	5		N	Generic	4	11	1	2	2	1	110		01		110	1	30		100				2	2				30		100	30		31	19.00		57.00																									20.00		60.00				19.00		0.00				19.00				19.00		0.63				0.67	0.63	0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	136	2	1	01	01	H5619_136_2	5		N	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		100				2	2				30		100	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												
H5619	136	2	1	01	01	H5619_136_2	5		N	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		100				2	2				30		100	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												
H5619	136	2	1	01	01	H5619_136_2	5		N	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	136	3	1	01	01	H5619_136_3	5		N	Preferred Generic	4	11	1	2	1	1	110		01		110	1	30		100				1	2				30		100	30		31	2.00		6.00																									10.00		30.00				2.00		0.00				2.00				2.00		0.07				0.33	0.07	0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	136	3	1	01	01	H5619_136_3	5		N	Generic	4	11	1	2	2	1	110		01		110	1	30		100				2	2				30		100	30		31	19.00		57.00																									20.00		60.00				19.00		0.00				19.00				19.00		0.63				0.67	0.63	0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	136	3	1	01	01	H5619_136_3	5		N	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		100				2	2				30		100	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												
H5619	136	3	1	01	01	H5619_136_3	5		N	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		100				2	2				30		100	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												
H5619	136	3	1	01	01	H5619_136_3	5		N	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	136	4	1	01	01	H5619_136_4	3		N	Preferred Generic	4	11	1	2	1	1	110		01		110	1	30		100				1	2				30		100	30		31	2.00		6.00																									10.00		30.00				2.00		0.00				2.00				2.00		0.07				0.33	0.07	0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	136	4	1	01	01	H5619_136_4	3		N	Generic	4	11	1	2	2	1	110		01		110	1	30		100				2	2				30		100	30		31	19.00		57.00																									20.00		60.00				19.00		0.00				19.00				19.00		0.63				0.67	0.63	0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	136	4	1	01	01	H5619_136_4	3		N	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		100				2	2				30		100	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												
H5619	136	4	1	01	01	H5619_136_4	3		N	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		100				2	2				30		100	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												
H5619	136	4	1	01	01	H5619_136_4	3		N	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	137	0	1	01	01	H5619_137_0	2		Y	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	137	0	1	01	01	H5619_137_0	2		Y	Preferred Generic	4	11	3	2	1	3	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H5619	137	0	1	01	01	H5619_137_0	2		Y	Generic	4	11	3	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	5.00		15.00																									20.00		60.00				5.00		0.00				5.00				5.00		0.17				0.67	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	137	0	1	01	01	H5619_137_0	2		Y	Generic	4	11	3	2	2	3	110		01		110	1	30		90				2	2				30		90	30		31	5.00		15.00																									20.00		60.00				5.00		0.00				5.00				5.00		0.17				0.67	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H5619	137	0	1	01	01	H5619_137_0	2		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	47.00		141.00																									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												
H5619	137	0	1	01	01	H5619_137_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	100.00		300.00																									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												
H5619	137	0	1	01	01	H5619_137_0	2		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					26																										26						26					26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	138	0	1	01	01	H5619_138_0	3		Y	Preferred Generic	4	11	1	2	1	1	110		01		110	1	30		100				1	2				30		100	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	138	0	1	01	01	H5619_138_0	3		Y	Generic	4	11	1	2	2	1	110		01		110	1	30		100				2	2				30		100	30		31	5.00		15.00																									20.00		60.00				5.00		0.00				5.00				5.00		0.17				0.67	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	138	0	1	01	01	H5619_138_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		100				2	2				30		100	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												
H5619	138	0	1	01	01	H5619_138_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		100				2	2				30		100	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												
H5619	138	0	1	01	01	H5619_138_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					31																										31						31					31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	139	1	1	01	01	H5619_139_1	3		Y	Preferred Generic	4	11	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	139	1	1	01	01	H5619_139_1	3		Y	Generic	4	11	1	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	0.00		0.00																									20.00		60.00				0.00		0.00				0.00				0.00		0				0.67	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	139	1	1	01	01	H5619_139_1	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		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	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		290.00				100.00				100.00		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	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	139	2	1	01	01	H5619_139_2	3		Y	Preferred Generic	4	11	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	139	2	1	01	01	H5619_139_2	3		Y	Generic	4	11	1	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	0.00		0.00																									20.00		60.00				0.00		0.00				0.00				0.00		0				0.67	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	139	2	1	01	01	H5619_139_2	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		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	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		290.00				100.00				100.00		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	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	140	1	1	01	01	H5619_140_1	3		Y	Preferred Generic	4	11	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	140	1	1	01	01	H5619_140_1	3		Y	Generic	4	11	1	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	0.00		0.00																									20.00		60.00				0.00		0.00				0.00				0.00		0				0.67	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	140	1	1	01	01	H5619_140_1	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		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	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		290.00				100.00				100.00		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	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	140	2	1	01	01	H5619_140_2	3		Y	Preferred Generic	4	11	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	140	2	1	01	01	H5619_140_2	3		Y	Generic	4	11	1	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	0.00		0.00																									20.00		60.00				0.00		0.00				0.00				0.00		0				0.67	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	140	2	1	01	01	H5619_140_2	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		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	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		290.00				100.00				100.00		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	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	141	0	1	02	01	H5619_141_0	4		Y	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5619	141	0	1	02	01	H5619_141_0	4		Y	Preferred Generic	4	11	3	2	1	3	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		3
H5619	141	0	1	02	01	H5619_141_0	4		Y	Generic	4	11	3	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	0.00		0.00																									20.00		60.00				0.00		0.00				0.00				0.00		0				0.67	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5619	141	0	1	02	01	H5619_141_0	4		Y	Generic	4	11	3	2	2	3	110		01		110	1	30		90				2	2				30		90	30		31	0.00		0.00																									20.00		60.00				0.00		0.00				0.00				0.00		0				0.67	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		3
H5619	141	0	1	02	01	H5619_141_0	4		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				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												
H5619	141	0	1	02	01	H5619_141_0	4		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	99.00		297.00																									100.00		300.00				99.00		287.00				99.00				99.00		3.30				3.33	3.30	3.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5619	141	0	1	02	01	H5619_141_0	4		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5619	141	0	1	02	01	H5619_141_0	4		Y	Select Care Drugs	4	11	1	2	6	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0				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	2		Y	Preferred Generic	4	11	1	2	1	1	110		01		110	1	30		100				1	2				30		100	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	143	0	1	01	01	H5619_143_0	2		Y	Preferred Generic	4	11	1	2	1	3	110		01		110	1	30		100				1	2				30		100	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5619	143	0	1	01	01	H5619_143_0	2		Y	Generic	4	11	1	2	2	1	110		01		110	1	30		100				2	2				30		100	30		31	5.00		15.00																									20.00		60.00				5.00		0.00				5.00				5.00		0.17				0.67	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	143	0	1	01	01	H5619_143_0	2		Y	Generic	4	11	1	2	2	3	110		01		110	1	30		100				2	2				30		100	30		31	5.00		15.00																									20.00		60.00				5.00		0.00				5.00				5.00		0.17				0.67	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5619	143	0	1	01	01	H5619_143_0	2		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		100				2	2				30		100	30		31	45.00		135.00																									47.00		141.00				45.00		125.00				45.00				45.00		1.50				1.57	1.50	1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	143	0	1	01	01	H5619_143_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		100				2	2				30		100	30		31	95.00		285.00																									100.00		300.00				95.00		275.00				95.00				95.00		3.17				3.33	3.17	3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	143	0	1	01	01	H5619_143_0	2		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	145	0	1	01	01	H5619_145_0	5		Y	Preferred Generic	4	11	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	10.00		30.00																									19.00		57.00				10.00		0.00				10.00				10.00		0.33				0.63	0.33	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	145	0	1	01	01	H5619_145_0	5		Y	Generic	4	11	1	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	20.00		60.00																									20.00		60.00				20.00		0.00				20.00				20.00		0.67				0.67	0.67	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	145	0	1	01	01	H5619_145_0	5		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	145	0	1	01	01	H5619_145_0	5		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	99.00		297.00																									100.00		300.00				99.00		287.00				99.00				99.00		3.30				3.33	3.30	3.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	145	0	1	01	01	H5619_145_0	5		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	146	0	1	01	01	H5619_146_0	3		Y	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		100				1	2				30		100	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	146	0	1	01	01	H5619_146_0	3		Y	Preferred Generic	4	11	3	2	1	3	110		01		110	1	30		100				1	2				30		100	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H5619	146	0	1	01	01	H5619_146_0	3		Y	Generic	4	11	3	2	2	1	110		01		110	1	30		100				2	2				30		100	30		31	0.00		0.00																									20.00		60.00				0.00		0.00				0.00				0.00		0				0.67	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	146	0	1	01	01	H5619_146_0	3		Y	Generic	4	11	3	2	2	3	110		01		110	1	30		100				2	2				30		100	30		31	0.00		0.00																									20.00		60.00				0.00		0.00				0.00				0.00		0				0.67	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H5619	146	0	1	01	01	H5619_146_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		100				2	2				30		100	30		31	47.00		141.00																									47.00		141.00				47.00		94.00				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	146	0	1	01	01	H5619_146_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		100				2	2				30		100	30		31	100.00		300.00																									100.00		300.00				100.00		200.00				100.00				100.00		3.33				3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	146	0	1	01	01	H5619_146_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	147	0	1	01	01	H5619_147_0	3		Y	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		100				1	2				30		100	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	147	0	1	01	01	H5619_147_0	3		Y	Generic	4	11	3	2	2	1	110		01		110	1	30		100				2	2				30		100	30		31	0.00		0.00																									20.00		60.00				0.00		0.00				0.00				0.00		0				0.67	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	147	0	1	01	01	H5619_147_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		100				2	2				30		100	30		31	47.00		141.00																									47.00		141.00				47.00		94.00				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	147	0	1	01	01	H5619_147_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		100				2	2				30		100	30		31	100.00		300.00																									100.00		300.00				100.00		200.00				100.00				100.00		3.33				3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	147	0	1	01	01	H5619_147_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	148	0	1	01	01	H5619_148_0	3		Y	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		100				1	2				30		100	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	148	0	1	01	01	H5619_148_0	3		Y	Generic	4	11	3	2	2	1	110		01		110	1	30		100				2	2				30		100	30		31	5.00		15.00																									20.00		60.00				5.00		0.00				5.00				5.00		0.17				0.67	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	148	0	1	01	01	H5619_148_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		100				2	2				30		100	30		31	40.00		120.00																									47.00		141.00				40.00		110.00				40.00				40.00		1.33				1.57	1.33	1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	148	0	1	01	01	H5619_148_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		100				2	2				30		100	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												
H5619	148	0	1	01	01	H5619_148_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	149	0	1	01	01	H5619_149_0	3		Y	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		100				1	2				30		100	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	149	0	1	01	01	H5619_149_0	3		Y	Preferred Generic	4	11	3	2	1	3	110		01		110	1	30		100				1	2				30		100	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H5619	149	0	1	01	01	H5619_149_0	3		Y	Generic	4	11	3	2	2	1	110		01		110	1	30		100				2	2				30		100	30		31	5.00		15.00																									20.00		60.00				5.00		0.00				5.00				5.00		0.17				0.67	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	149	0	1	01	01	H5619_149_0	3		Y	Generic	4	11	3	2	2	3	110		01		110	1	30		100				2	2				30		100	30		31	5.00		15.00																									20.00		60.00				5.00		0.00				5.00				5.00		0.17				0.67	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H5619	149	0	1	01	01	H5619_149_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		100				2	2				30		100	30		31	40.00		120.00																									47.00		141.00				40.00		80.00				40.00				40.00		1.33				1.57	1.33	1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	149	0	1	01	01	H5619_149_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		100				2	2				30		100	30		31	100.00		300.00																									100.00		300.00				100.00		200.00				100.00				100.00		3.33				3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	149	0	1	01	01	H5619_149_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	150	0	1	01	01	H5619_150_0	3		Y	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		100				1	2				30		100	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	150	0	1	01	01	H5619_150_0	3		Y	Generic	4	11	3	2	2	1	110		01		110	1	30		100				2	2				30		100	30		31	0.00		0.00																									20.00		60.00				0.00		0.00				0.00				0.00		0				0.67	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	150	0	1	01	01	H5619_150_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		100				2	2				30		100	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												
H5619	150	0	1	01	01	H5619_150_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		100				2	2				30		100	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												
H5619	150	0	1	01	01	H5619_150_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					31																										31						31					31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	152	0	1	01	01	H5619_152_0	3		Y	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	152	0	1	01	01	H5619_152_0	3		Y	Preferred Generic	4	11	3	2	1	3	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H5619	152	0	1	01	01	H5619_152_0	3		Y	Generic	4	11	3	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	0.00		0.00																									20.00		60.00				0.00		0.00				0.00				0.00		0				0.67	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	152	0	1	01	01	H5619_152_0	3		Y	Generic	4	11	3	2	2	3	110		01		110	1	30		90				2	2				30		90	30		31	0.00		0.00																									20.00		60.00				0.00		0.00				0.00				0.00		0				0.67	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H5619	152	0	1	01	01	H5619_152_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	152	0	1	01	01	H5619_152_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		290.00				100.00				100.00		3.33				3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	152	0	1	01	01	H5619_152_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5628	001	0	1	01	01	H5628_001_0	8		N	Preferred Generic	4	11	1	2	1	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5628	001	0	1	01	01	H5628_001_0	8		N	Generic	4	11	1	2	2	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5628	001	0	1	01	01	H5628_001_0	8		N	Preferred Brand	4	11	1	2	3	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31	23.00	46.00	69.00																			23.00	46.00	69.00																23.00				23.00		0.74			0.74			0.74	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5628	001	0	1	01	01	H5628_001_0	8		N	Non-Preferred Drug	4	11	1	1	4	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31				92.58	42	42	42																		42	42	42															42			42								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5628	001	0	1	01	01	H5628_001_0	8		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	31								31						31		31				689.57	25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5628	007	0	1	01	01	H5628_007_0	7		Y	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	7		Y	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	7		Y	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	7		Y	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	7		Y	Specialty Tier	4	11	1	1	5	1	010		01	010		1	31								31						31		31				838.32	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	7		Y	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	8		N	Preferred Generic	4	11	1	2	1	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5628	008	0	1	01	01	H5628_008_0	8		N	Generic	4	11	1	2	2	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5628	008	0	1	01	01	H5628_008_0	8		N	Preferred Brand	4	11	1	2	3	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31	23.00	46.00	69.00																			23.00	46.00	69.00																23.00				23.00		0.74			0.74			0.74	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5628	008	0	1	01	01	H5628_008_0	8		N	Non-Preferred Drug	4	11	1	1	4	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31				92.35	35	35	35																		35	35	35															35			35								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5628	008	0	1	01	01	H5628_008_0	8		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	31								31						31		31				867.93	25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5628	010	0	1	01	01	H5628_010_0	7		Y	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	7		Y	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	7		Y	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	7		Y	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	7		Y	Specialty Tier	4	11	1	1	5	1	010		01	010		1	31								31						31		31				952.92	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	7		Y	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	7		N	Preferred Generic	4	11	1	2	1	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5628	011	0	1	01	01	H5628_011_0	7		N	Generic	4	11	1	2	2	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5628	011	0	1	01	01	H5628_011_0	7		N	Preferred Brand	4	11	1	2	3	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31	23.00	46.00	69.00																			23.00	46.00	69.00																23.00				23.00		0.74			0.74			0.74	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5628	011	0	1	01	01	H5628_011_0	7		N	Non-Preferred Drug	4	11	1	1	4	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31				91.29	35	35	35																		35	35	35															35			35								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5628	011	0	1	01	01	H5628_011_0	7		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	31								31						31		31				735.59	25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5628	012	0	1	01	01	H5628_012_0	7		N	Preferred Generic	4	11	1	2	1	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5628	012	0	1	01	01	H5628_012_0	7		N	Generic	4	11	1	2	2	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5628	012	0	1	01	01	H5628_012_0	7		N	Preferred Brand	4	11	1	2	3	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31	23.00	46.00	69.00																			23.00	46.00	69.00																23.00				23.00		0.74			0.74			0.74	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5628	012	0	1	01	01	H5628_012_0	7		N	Non-Preferred Drug	4	11	1	1	4	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31				95.53	43	43	43																		43	43	43															43			43								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5628	012	0	1	01	01	H5628_012_0	7		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	31								31						31		31				690.19	25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5649	001	0	1	01	01	H5649_001_0	7		N	Preferred Generic	4	11	1	2	1	1	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5649	001	0	1	01	01	H5649_001_0	7		N	Preferred Generic	4	11	1	2	1	3	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H5649	001	0	1	01	01	H5649_001_0	7		N	Generic	4	11	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												
H5649	001	0	1	01	01	H5649_001_0	7		N	Generic	4	11	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		
H5649	001	0	1	01	01	H5649_001_0	7		N	Preferred Brand	4	11	1	2	3	1	110		01	100		1	30		90				2	2			90				30		31	35.00		105.00																					70.00																35.00				35.00		1.17						1.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5649	001	0	1	01	01	H5649_001_0	7		N	Non-Preferred Drug	4	11	1	2	4	1	110		01	100		1	30		90				2	2			90				30		31	75.00		225.00																					150.00																75.00				75.00		2.50						2.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5649	001	0	1	01	01	H5649_001_0	7		N	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 Care Drugs												
H5649	001	0	1	01	01	H5649_001_0	7		N	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												
H5649	001	0	1	01	01	H5649_001_0	7		N	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
H5649	002	0	1	01	01	H5649_002_0	8		N	Preferred Generic	4	11	1	2	1	1	110		01	100		1	30		90				1	2			90				30		31	0		0																					0																0				0		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5649	002	0	1	01	01	H5649_002_0	8		N	Preferred Generic	4	11	1	2	1	3	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H5649	002	0	1	01	01	H5649_002_0	8		N	Generic	4	11	1	1	2	1	110		01	100		1	30		90				2	2			90				30		31				8.43	25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5649	002	0	1	01	01	H5649_002_0	8		N	Preferred Brand	4	11	1	1	3	1	110		01	100		1	30		90				2	2			90				30		31				102.08	25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5649	002	0	1	01	01	H5649_002_0	8		N	Non-Preferred Drug	4	11	1	1	4	1	110		01	100		1	30		90				2	2			90				30		31				60.45	25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5649	002	0	1	01	01	H5649_002_0	8		N	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												
H5649	002	0	1	01	01	H5649_002_0	8		N	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												
H5649	002	0	1	01	01	H5649_002_0	8		N	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
H5649	006	0	1	01	01	H5649_006_0	7		Y	Preferred Generic	4	11	1	2	1	1	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5649	006	0	1	01	01	H5649_006_0	7		Y	Preferred Generic	4	11	1	2	1	3	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H5649	006	0	1	01	01	H5649_006_0	7		Y	Generic	4	11	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												
H5649	006	0	1	01	01	H5649_006_0	7		Y	Generic	4	11	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		
H5649	006	0	1	01	01	H5649_006_0	7		Y	Preferred Brand	4	11	1	2	3	1	110		01	100		1	30		90				2	2			90				30		31	35.00		105.00																					70.00																35.00				35.00		1.17						1.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5649	006	0	1	01	01	H5649_006_0	7		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01	100		1	30		90				2	2			90				30		31	75.00		225.00																					150.00																75.00				75.00		2.50						2.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5649	006	0	1	01	01	H5649_006_0	7		Y	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 Care Drugs												
H5649	006	0	1	01	01	H5649_006_0	7		Y	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												
H5649	006	0	1	01	01	H5649_006_0	7		Y	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
H5649	008	0	1	01	01	H5649_008_0	8			Preferred Generic	4	11	1	2	1	1	110		01	100		1	30		90				1	2			90				30		31	0		0																					0																0				0		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5649	008	0	1	01	01	H5649_008_0	8			Preferred Generic	4	11	1	2	1	3	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H5649	008	0	1	01	01	H5649_008_0	8			Generic	4	11	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												
H5649	008	0	1	01	01	H5649_008_0	8			Preferred Brand	4	11	1	2	3	1	110		01	100		1	30		90				2	2			90				30		31	47.00		141.00																					94.00																47.00				47.00		1.57						1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5649	008	0	1	01	01	H5649_008_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																					200																100.00				100.00		3.33						3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5649	008	0	1	01	01	H5649_008_0	8			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												
H5649	008	0	1	01	01	H5649_008_0	8			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												
H5649	008	0	1	01	01	H5649_008_0	8			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
H5649	009	0	1	01	01	H5649_009_0	8		N	Preferred Generic	4	11	1	2	1	1	110		01	100		1	30		90				1	2			90				30		31	0		0																					0																0				0		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5649	009	0	1	01	01	H5649_009_0	8		N	Preferred Generic	4	11	1	2	1	3	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H5649	009	0	1	01	01	H5649_009_0	8		N	Generic	4	11	1	1	2	1	110		01	100		1	30		90				2	2			90				30		31				8.43	25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5649	009	0	1	01	01	H5649_009_0	8		N	Preferred Brand	4	11	1	1	3	1	110		01	100		1	30		90				2	2			90				30		31				102.08	25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5649	009	0	1	01	01	H5649_009_0	8		N	Non-Preferred Drug	4	11	1	1	4	1	110		01	100		1	30		90				2	2			90				30		31				60.45	25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5649	009	0	1	01	01	H5649_009_0	8		N	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												
H5649	009	0	1	01	01	H5649_009_0	8		N	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												
H5649	009	0	1	01	01	H5649_009_0	8		N	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
H5649	018	0	1	01	01	H5649_018_0	7			Preferred Generic	4	11	1	2	1	1	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5649	018	0	1	01	01	H5649_018_0	7			Preferred Generic	4	11	1	2	1	3	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H5649	018	0	1	01	01	H5649_018_0	7			Generic	4	11	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												
H5649	018	0	1	01	01	H5649_018_0	7			Generic	4	11	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		
H5649	018	0	1	01	01	H5649_018_0	7			Preferred Brand	4	11	1	2	3	1	110		01	100		1	30		90				2	2			90				30		31	35.00		105.00																					70.00																35.00				35.00		1.17						1.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5649	018	0	1	01	01	H5649_018_0	7			Non-Preferred Drug	4	11	1	2	4	1	110		01	100		1	30		90				2	2			90				30		31	75.00		225.00																					150.00																75.00				75.00		2.50						2.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5649	018	0	1	01	01	H5649_018_0	7			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 Care Drugs												
H5649	018	0	1	01	01	H5649_018_0	7			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												
H5649	018	0	1	01	01	H5649_018_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
H5649	019	0	1	01	01	H5649_019_0	8		N	Preferred Generic	4	11	1	2	1	1	110		01	100		1	30		90				1	2			90				30		31	0		0																					0																0				0		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5649	019	0	1	01	01	H5649_019_0	8		N	Preferred Generic	4	11	1	2	1	3	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H5649	019	0	1	01	01	H5649_019_0	8		N	Generic	4	11	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												
H5649	019	0	1	01	01	H5649_019_0	8		N	Preferred Brand	4	11	1	2	3	1	110		01	100		1	30		90				2	2			90				30		31	47.00		141.00																					94.00																47.00				47.00		1.57						1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5649	019	0	1	01	01	H5649_019_0	8		N	Non-Preferred Drug	4	11	1	2	4	1	110		01	100		1	30		90				2	2			90				30		31	100.00		300.00																					200																100.00				100.00		3.33						3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5649	019	0	1	01	01	H5649_019_0	8		N	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												
H5649	019	0	1	01	01	H5649_019_0	8		N	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												
H5649	019	0	1	01	01	H5649_019_0	8		N	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
H5649	020	1	1	01	01	H5649_020_1	7		N	Preferred Generic	4	11	1	2	1	1	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5649	020	1	1	01	01	H5649_020_1	7		N	Preferred Generic	4	11	1	2	1	3	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H5649	020	1	1	01	01	H5649_020_1	7		N	Generic	4	11	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												
H5649	020	1	1	01	01	H5649_020_1	7		N	Generic	4	11	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		
H5649	020	1	1	01	01	H5649_020_1	7		N	Preferred Brand	4	11	1	2	3	1	110		01	100		1	30		90				2	2			90				30		31	35.00		105.00																					70.00																35.00				35.00		1.17						1.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5649	020	1	1	01	01	H5649_020_1	7		N	Non-Preferred Drug	4	11	1	2	4	1	110		01	100		1	30		90				2	2			90				30		31	75.00		225.00																					150.00																75.00				75.00		2.50						2.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5649	020	1	1	01	01	H5649_020_1	7		N	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 Care Drugs												
H5649	020	1	1	01	01	H5649_020_1	7		N	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												
H5649	020	1	1	01	01	H5649_020_1	7		N	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
H5649	020	2	1	01	01	H5649_020_2	7		N	Preferred Generic	4	11	1	2	1	1	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5649	020	2	1	01	01	H5649_020_2	7		N	Preferred Generic	4	11	1	2	1	3	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H5649	020	2	1	01	01	H5649_020_2	7		N	Generic	4	11	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												
H5649	020	2	1	01	01	H5649_020_2	7		N	Generic	4	11	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		
H5649	020	2	1	01	01	H5649_020_2	7		N	Preferred Brand	4	11	1	2	3	1	110		01	100		1	30		90				2	2			90				30		31	35.00		105.00																					70.00																35.00				35.00		1.17						1.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5649	020	2	1	01	01	H5649_020_2	7		N	Non-Preferred Drug	4	11	1	2	4	1	110		01	100		1	30		90				2	2			90				30		31	75.00		225.00																					150.00																75.00				75.00		2.50						2.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5649	020	2	1	01	01	H5649_020_2	7		N	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 Care Drugs												
H5649	020	2	1	01	01	H5649_020_2	7		N	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												
H5649	020	2	1	01	01	H5649_020_2	7		N	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
H5649	021	1	1	01	01	H5649_021_1	7		N	Preferred Generic	4	11	1	2	1	1	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5649	021	1	1	01	01	H5649_021_1	7		N	Preferred Generic	4	11	1	2	1	3	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H5649	021	1	1	01	01	H5649_021_1	7		N	Generic	4	11	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												
H5649	021	1	1	01	01	H5649_021_1	7		N	Generic	4	11	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		
H5649	021	1	1	01	01	H5649_021_1	7		N	Preferred Brand	4	11	1	2	3	1	110		01	100		1	30		90				2	2			90				30		31	35.00		105.00																					70.00																35.00				35.00		1.17						1.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5649	021	1	1	01	01	H5649_021_1	7		N	Non-Preferred Drug	4	11	1	2	4	1	110		01	100		1	30		90				2	2			90				30		31	75.00		225.00																					150.00																75.00				75.00		2.50						2.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5649	021	1	1	01	01	H5649_021_1	7		N	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 Care Drugs												
H5649	021	1	1	01	01	H5649_021_1	7		N	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												
H5649	021	1	1	01	01	H5649_021_1	7		N	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
H5649	021	2	1	01	01	H5649_021_2	7		N	Preferred Generic	4	11	1	2	1	1	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5649	021	2	1	01	01	H5649_021_2	7		N	Preferred Generic	4	11	1	2	1	3	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H5649	021	2	1	01	01	H5649_021_2	7		N	Generic	4	11	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												
H5649	021	2	1	01	01	H5649_021_2	7		N	Generic	4	11	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		
H5649	021	2	1	01	01	H5649_021_2	7		N	Preferred Brand	4	11	1	2	3	1	110		01	100		1	30		90				2	2			90				30		31	35.00		105.00																					70.00																35.00				35.00		1.17						1.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5649	021	2	1	01	01	H5649_021_2	7		N	Non-Preferred Drug	4	11	1	2	4	1	110		01	100		1	30		90				2	2			90				30		31	75.00		225.00																					150.00																75.00				75.00		2.50						2.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5649	021	2	1	01	01	H5649_021_2	7		N	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 Care Drugs												
H5649	021	2	1	01	01	H5649_021_2	7		N	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												
H5649	021	2	1	01	01	H5649_021_2	7		N	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
H5652	001	0	1	02	01	H5652_001_0	2		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5652	001	0	1	02	01	H5652_001_0	2		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5652	001	0	1	02	01	H5652_001_0	2		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	5.00		15.00																											15.00						0.00				5.00				5.00		0.16						0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5652	001	0	1	02	01	H5652_001_0	2		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	5.00		15.00																											15.00						0.00				5.00				5.00		0.16						0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H5652	001	0	1	02	01	H5652_001_0	2		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5652	001	0	1	02	01	H5652_001_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	85.00		255.00																											255.00						245.00				85.00				85.00		2.83						2.74	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5652	001	0	1	02	01	H5652_001_0	2		Y	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												
H5652	003	0	1	02	01	H5652_003_0	4		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5652	003	0	1	02	01	H5652_003_0	4		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5652	003	0	1	02	01	H5652_003_0	4		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5652	003	0	1	02	01	H5652_003_0	4		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H5652	003	0	1	02	01	H5652_003_0	4		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	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	4		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	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	4		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				312.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5652	004	0	1	02	01	H5652_004_0	2		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5652	004	0	1	02	01	H5652_004_0	2		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5652	004	0	1	02	01	H5652_004_0	2		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	5.00		15.00																											15.00						0.00				5.00				5.00		0.16						0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5652	004	0	1	02	01	H5652_004_0	2		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	5.00		15.00																											15.00						0.00				5.00				5.00		0.16						0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H5652	004	0	1	02	01	H5652_004_0	2		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5652	004	0	1	02	01	H5652_004_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	85.00		255.00																											255.00						245.00				85.00				85.00		2.83						2.74	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5652	004	0	1	02	01	H5652_004_0	2		Y	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												
H5652	006	0	1	02	01	H5652_006_0	2		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5652	006	0	1	02	01	H5652_006_0	2		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5652	006	0	1	02	01	H5652_006_0	2		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5652	006	0	1	02	01	H5652_006_0	2		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H5652	006	0	1	02	01	H5652_006_0	2		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5652	006	0	1	02	01	H5652_006_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	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	2		Y	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												
H5652	008	0	1	02	01	H5652_008_0	2		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5652	008	0	1	02	01	H5652_008_0	2		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5652	008	0	1	02	01	H5652_008_0	2		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	15.00		45.00																											45.00						0.00				15.00				15.00		0.50						0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5652	008	0	1	02	01	H5652_008_0	2		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	15.00		45.00																											45.00						0.00				15.00				15.00		0.50						0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H5652	008	0	1	02	01	H5652_008_0	2		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5652	008	0	1	02	01	H5652_008_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5652	008	0	1	02	01	H5652_008_0	2		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				399.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5746	016	0	1	01	01	H5746_016_0	5			Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5746	016	0	1	01	01	H5746_016_0	5			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	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												
H5746	016	0	1	01	01	H5746_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		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	285.00	285.00																100.00				100.00			3.33	3.17	3.17			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5746	016	0	1	01	01	H5746_016_0	5			Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												25							25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5746	016	0	1	01	01	H5746_016_0	5			Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5746	016	0	1	01	01	H5746_016_0	5			Select Care Drugs	4	01	1	2	6	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				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	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												
H5746	018	0	1	01	01	H5746_018_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												
H5746	018	0	1	01	01	H5746_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								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	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												
H5746	018	0	1	01	01	H5746_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												
H5746	018	0	1	01	01	H5746_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								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				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	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		
H5746	019	0	1	01	01	H5746_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								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	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												
H5746	019	0	1	01	01	H5746_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								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	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												
H5746	019	0	1	01	01	H5746_019_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												
H5746	019	0	1	01	01	H5746_019_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												
H5746	019	0	1	01	01	H5746_019_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		
H5774	005	0	1	01	01	H5774_005_0	8		Y	Preferred Generic	4	01	3	2	1	1		110	01	100		1				30		90	1	2			90				30		31								5.00		10.00					0.00		0.00							0.00																5.00				0.00			0.17	0.00				0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5774	005	0	1	01	01	H5774_005_0	8		Y	Preferred Generic	4	01	3	2	1	3		110	01	100		1				30		90	1	2			90				30		31								5.00		10.00					0.00		0.00							0.00																5.00				0.00			0.17	0.00				0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		3
H5774	005	0	1	01	01	H5774_005_0	8		Y	Generic	4	01	3	2	2	1		110	01	100		1				30		90	1	2			90				30		31								8.00		16.00					0.00		0.00							0.00																8.00				0.00			0.27	0.00				0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5774	005	0	1	01	01	H5774_005_0	8		Y	Generic	4	01	3	2	2	3		110	01	100		1				30		90	1	2			90				30		31								8.00		16.00					0.00		0.00							0.00																8.00				0.00			0.27	0.00				0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		3
H5774	005	0	1	01	01	H5774_005_0	8		Y	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		Y	Non-Preferred Brand	4	10	3	2	4	1		110	01	100		1				30		90	1	1			90				30		31								55.00		110.00					5.00		10.00							10.00																55.00				5.00			1.83	0.17				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5774	005	0	1	01	01	H5774_005_0	8		Y	Specialty Tier	4	11	1	1	5	1		110	01	100		1				30		90	1	1			90				30		31											33.00	33		33				33.00	33		33						33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5774	005	0	1	01	01	H5774_005_0	8		Y	Select Care Drugs	4	11	1	2	6	1		110	01	100		1				30		90	1	2			90				30		31								3.00		6.00					0.00		0.00							0.00																3.00				0.00			0.10	0.00				0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5774	005	0	1	01	01	H5774_005_0	8		Y	Select Care Drugs	4	11	1	2	6	3		110	01	100		1				30		90	1	2			90				30		31								3.00		6.00					0.00		0.00							0.00																3.00				0.00			0.10	0.00				0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H5774	022	0	1	01	01	H5774_022_0	8		Y	Preferred Generic	4	01	3	2	1	1		110	01	100		1				30		90	1	2			90				30		31								5.00		10.00					0.00		0.00							0.00																5.00				0.00			0.17	0.00				0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5774	022	0	1	01	01	H5774_022_0	8		Y	Preferred Generic	4	01	3	2	1	3		110	01	100		1				30		90	1	2			90				30		31								5.00		10.00					0.00		0.00							0.00																5.00				0.00			0.17	0.00				0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		3
H5774	022	0	1	01	01	H5774_022_0	8		Y	Generic	4	01	3	2	2	1		110	01	100		1				30		90	1	2			90				30		31								8.00		16.00					0.00		0.00							0.00																8.00				0.00			0.27	0.00				0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5774	022	0	1	01	01	H5774_022_0	8		Y	Generic	4	01	3	2	2	3		110	01	100		1				30		90	1	2			90				30		31								8.00		16.00					0.00		0.00							0.00																8.00				0.00			0.27	0.00				0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		3
H5774	022	0	1	01	01	H5774_022_0	8		Y	Preferred Brand	4	10	3	2	3	1		110	01	100		1				30		90	1	2			90				30		31								20.00		40.00					0.00		0.00							0.00																20.00				0.00			0.67	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		Y	Non-Preferred Brand	4	10	3	2	4	1		110	01	100		1				30		90	1	1			90				30		31								55.00		110.00					10.00		20.00							20.00																55.00				10.00			1.83	0.33				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5774	022	0	1	01	01	H5774_022_0	8		Y	Specialty Tier	4	11	1	1	5	1		110	01	100		1				30		90	1	1			90				30		31											33.00	33		33				33.00	33		33						33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5774	022	0	1	01	01	H5774_022_0	8		Y	Select Care Drugs	4	11	1	2	6	1		110	01	100		1				30		90	1	2			90				30		31								3.00		6.00					0.00		0.00							0.00																3.00				0.00			0.10	0.00				0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5774	022	0	1	01	01	H5774_022_0	8		Y	Select Care Drugs	4	11	1	2	6	3		110	01	100		1				30		90	1	2			90				30		31								3.00		6.00					0.00		0.00							0.00																3.00				0.00			0.10	0.00				0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H5774	024	0	1	01	01	H5774_024_0	8		N	Preferred Generic	2	01	1	2	1	1		110	01	100		1				30		90	1	2			90				30		31								19.00		38.00					14.00		28.00							28.00																19.00				14.00			0.63	0.47				0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5774	024	0	1	01	01	H5774_024_0	8		N	Generic	2	01	1	2	2	1		110	01	100		1				30		90	1	2			90				30		31								20.00		40.00					15.00		30.00							30.00																20.00				15.00			0.67	0.50				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5774	024	0	1	01	01	H5774_024_0	8		N	Preferred Brand	2	10	1	2	3	1		110	01	100		1				30		90	1	2			90				30		31								47.00		94.00					42.00		84.00							84.00																47.00				42.00			1.57	1.40				1.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5774	024	0	1	01	01	H5774_024_0	8		N	Non-Preferred Brand	2	10	1	2	4	1		110	01	100		1				30		90	1	1			90				30		31								100.00		200.00					95.00		190.00							190.00																100.00				95.00			3.33	3.17				3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5774	024	0	1	01	01	H5774_024_0	8		N	Specialty Tier	2	11	1	1	5	1		110	01	100		1				30		90	1	1			90				30		31												25		25					25		25						25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5774	024	0	1	01	01	H5774_024_0	8		N	Select Care Drugs	2	11	1	2	6	1		110	01	100		1				30		90	1	2			90				30		31								9.00		18.00					8.00		16.00							16.00																9.00				8.00			0.30	0.27				0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5774	025	0	1	01	01	H5774_025_0	8		N	Preferred Generic	2	01	1	2	1	1		110	01	100		1				30		90	1	2			90				30		31								19.00		38.00					14.00		28.00							28.00																19.00				14.00			0.63	0.47				0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5774	025	0	1	01	01	H5774_025_0	8		N	Generic	2	01	1	2	2	1		110	01	100		1				30		90	1	2			90				30		31								20.00		40.00					15.00		30.00							30.00																20.00				15.00			0.67	0.50				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5774	025	0	1	01	01	H5774_025_0	8		N	Preferred Brand	2	10	1	2	3	1		110	01	100		1				30		90	1	2			90				30		31								47.00		94.00					42.00		84.00							84.00																47.00				42.00			1.57	1.40				1.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5774	025	0	1	01	01	H5774_025_0	8		N	Non-Preferred Brand	2	10	1	2	4	1		110	01	100		1				30		90	1	1			90				30		31								100.00		200.00					95.00		190.00							190.00																100.00				95.00			3.33	3.17				3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5774	025	0	1	01	01	H5774_025_0	8		N	Specialty Tier	2	11	1	1	5	1		110	01	100		1				30		90	1	1			90				30		31												25		25					25		25						25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5774	025	0	1	01	01	H5774_025_0	8		N	Select Care Drugs	2	11	1	2	6	1		110	01	100		1				30		90	1	2			90				30		31								11.00		22.00					10.00		20.00							10.00																11.00				10.00			0.37	0.33				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5774	026	0	1	01	01	H5774_026_0	8		N	Preferred Generic	2	01	1	2	1	1		110	01	100		1				30		90	1	2			90				30		31								19.00		38.00					10.00		20.00							20.00																19.00				10.00			0.63	0.33				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5774	026	0	1	01	01	H5774_026_0	8		N	Generic	2	01	1	2	2	1		110	01	100		1				30		90	1	2			90				30		31								20.00		40.00					15.00		30.00							30.00																20.00				15.00			0.67	0.50				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5774	026	0	1	01	01	H5774_026_0	8		N	Preferred Brand	2	10	1	2	3	1		110	01	100		1				30		90	1	2			90				30		31								47.00		94.00					42.00		84.00							84.00																47.00				42.00			1.57	1.40				1.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5774	026	0	1	01	01	H5774_026_0	8		N	Non-Preferred Brand	2	10	1	2	4	1		110	01	100		1				30		90	1	1			90				30		31								100.00		200.00					95.00		190.00							190.00																100.00				95.00			3.33	3.17				3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5774	026	0	1	01	01	H5774_026_0	8		N	Specialty Tier	2	11	1	1	5	1		110	01	100		1				30		90	1	1			90				30		31												25		25					25		25						25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5774	026	0	1	01	01	H5774_026_0	8		N	Select Care Drugs	2	11	1	2	6	1		110	01	100		1				30		90	1	2			90				30		31								5.00		10.00					4.00		8.00							8.00																5.00				4.00			0.17	0.13				0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5774	027	0	1	02	01	H5774_027_0	8		Y	Preferred Generic	4	01	3	2	1	1		110	01	100		1				30		90	1	2			90				30		31								5.00		10.00					0.00		0.00							0.00																5.00				0.00			0.17	0.00				0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5774	027	0	1	02	01	H5774_027_0	8		Y	Preferred Generic	4	01	3	2	1	3		110	01	100		1				30		90	1	2			90				30		31								5.00		10.00					0.00		0.00							0.00																5.00				0.00			0.17	0.00				0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		3
H5774	027	0	1	02	01	H5774_027_0	8		Y	Generic	4	01	3	2	2	1		110	01	100		1				30		90	1	2			90				30		31								8.00		16.00					0.00		0.00							0.00																8.00				0.00			0.27	0.00				0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5774	027	0	1	02	01	H5774_027_0	8		Y	Generic	4	01	3	2	2	3		110	01	100		1				30		90	1	2			90				30		31								8.00		16.00					0.00		0.00							0.00																8.00				0.00			0.27	0.00				0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		3
H5774	027	0	1	02	01	H5774_027_0	8		Y	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		Y	Non-Preferred Brand	4	10	3	2	4	1		110	01	100		1				30		90	1	1			90				30		31								55.00		110.00					25.00		50.00							50.00																55.00				25.00			1.83	0.83				0.81	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5774	027	0	1	02	01	H5774_027_0	8		Y	Specialty Tier	4	11	1	1	5	1		110	01	100		1				30		90	1	1			90				30		31											33.00	33		33				33.00	33		33						33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5774	027	0	1	02	01	H5774_027_0	8		Y	Select Care Drugs	4	11	1	2	6	1		110	01	100		1				30		90	1	2			90				30		31								3.00		6.00					0.00		0.00							0.00																3.00				0.00			0.10	0.00				0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5774	027	0	1	02	01	H5774_027_0	8		Y	Select Care Drugs	4	11	1	2	6	3		110	01	100		1				30		90	1	2			90				30		31								3.00		6.00					0.00		0.00							0.00																3.00				0.00			0.10	0.00				0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H5774	028	0	1	01	01	H5774_028_0	8		N	Preferred Generic	2	01	1	2	1	1		110	01	100		1				30		90	1	2			90				30		31								15.00		30.00					10.00		20.00							20.00																15.00				10.00			0.50	0.33				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5774	028	0	1	01	01	H5774_028_0	8		N	Generic	2	01	1	2	2	1		110	01	100		1				30		90	1	2			90				30		31								20.00		40.00					15.00		30.00							30.00																20.00				15.00			0.67	0.50				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5774	028	0	1	01	01	H5774_028_0	8		N	Preferred Brand	2	10	1	2	3	1		110	01	100		1				30		90	1	2			90				30		31								47.00		94.00					42.00		84.00							84.00																47.00				42.00			1.57	1.40				1.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5774	028	0	1	01	01	H5774_028_0	8		N	Non-Preferred Brand	2	10	1	2	4	1		110	01	100		1				30		90	1	1			90				30		31								100.00		200.00					95.00		190.00							190.00																100.00				95.00			3.33	3.17				3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5774	028	0	1	01	01	H5774_028_0	8		N	Specialty Tier	2	11	1	1	5	1		110	01	100		1				30		90	1	1			90				30		31												25		25					25		25						25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5774	028	0	1	01	01	H5774_028_0	8		N	Select Care Drugs	2	11	1	2	6	1		110	01	100		1				30		90	1	2			90				30		31								11.00		22.00					10.00		20.00							20.00																11.00				10.00			0.37	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		Y	Preferred Generic	4	01	3	2	1	1		110	01	100		1				30		90	1	2			90				30		31								5.00		10.00					0.00		0.00							0.00																5.00				0.00			0.17	0.00				0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5774	031	0	1	02	01	H5774_031_0	8		Y	Preferred Generic	4	01	3	2	1	3		110	01	100		1				30		90	1	2			90				30		31								5.00		10.00					0.00		0.00							0.00																5.00				0.00			0.17	0.00				0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		3
H5774	031	0	1	02	01	H5774_031_0	8		Y	Generic	4	01	3	2	2	1		110	01	100		1				30		90	1	2			90				30		31								8.00		16.00					0.00		0.00							0.00																8.00				0.00			0.27	0.00				0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5774	031	0	1	02	01	H5774_031_0	8		Y	Generic	4	01	3	2	2	3		110	01	100		1				30		90	1	2			90				30		31								8.00		16.00					0.00		0.00							0.00																8.00				0.00			0.27	0.00				0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		3
H5774	031	0	1	02	01	H5774_031_0	8		Y	Preferred Brand	4	10	3	2	3	1		110	01	100		1				30		90	1	2			90				30		31								20.00		40.00					10.00		20.00							20.00																20.00				10.00			0.67	0.33				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5774	031	0	1	02	01	H5774_031_0	8		Y	Non-Preferred Brand	4	10	3	2	4	1		110	01	100		1				30		90	1	1			90				30		31								45.00		90.00					20.00		40.00							40.00																45.00				20.00			1.50	0.67				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5774	031	0	1	02	01	H5774_031_0	8		Y	Specialty Tier	4	11	1	1	5	1		110	01	100		1				30		90	1	1			90				30		31											33.00	33		33				33.00	33		33						33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5774	031	0	1	02	01	H5774_031_0	8		Y	Select Care Drugs	4	11	1	2	6	1		110	01	100		1				30		90	1	2			90				30		31								3.00		6.00					0.00		0.00							0.00																3.00				0.00			0.10	0.00				0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5774	031	0	1	02	01	H5774_031_0	8		Y	Select Care Drugs	4	11	1	2	6	3		110	01	100		1				30		90	1	2			90				30		31								3.00		6.00					0.00		0.00							0.00																3.00				0.00			0.10	0.00				0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H5774	035	0	1	01	01	H5774_035_0	8		N	Preferred Generic	2	01	1	2	1	1		110	01	100		1				30		90	1	2			90				30		31								19.00		38.00					14.00		28.00							28.00																19.00				14.00			0.63	0.47				0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5774	035	0	1	01	01	H5774_035_0	8		N	Generic	2	01	1	2	2	1		110	01	100		1				30		90	1	2			90				30		31								20.00		40.00					15.00		30.00							30.00																20.00				15.00			0.67	0.50				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5774	035	0	1	01	01	H5774_035_0	8		N	Preferred Brand	2	10	1	2	3	1		110	01	100		1				30		90	1	2			90				30		31								47.00		94.00					42.00		84.00							84.00																47.00				42.00			1.57	1.40				1.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5774	035	0	1	01	01	H5774_035_0	8		N	Non-Preferred Brand	2	10	1	2	4	1		110	01	100		1				30		90	1	1			90				30		31								100.00		200.00					95.00		190.00							190.00																100.00				95.00			3.33	3.17				3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5774	035	0	1	01	01	H5774_035_0	8		N	Specialty Tier	2	11	1	1	5	1		110	01	100		1				30		90	1	1			90				30		31												25		25					25		25						25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5774	035	0	1	01	01	H5774_035_0	8		N	Select Care Drugs	2	11	1	2	6	1		110	01	100		1				30		90	1	2			90				30		31								8.00		16.00					7.00		14.00							14.00																8.00				7.00			0.27	0.23				0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5774	036	0	1	01	01	H5774_036_0	8		N	Preferred Generic	2	01	1	2	1	1		110	01	100		1				30		90	1	2			90				30		31								19.00		38.00					14.00		28.00							28.00																19.00				14.00			0.63	0.47				0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5774	036	0	1	01	01	H5774_036_0	8		N	Generic	2	01	1	2	2	1		110	01	100		1				30		90	1	2			90				30		31								20.00		40.00					15.00		30.00							30.00																20.00				15.00			0.67	0.50				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5774	036	0	1	01	01	H5774_036_0	8		N	Preferred Brand	2	10	1	2	3	1		110	01	100		1				30		90	1	2			90				30		31								47.00		94.00					42.00		84.00							84.00																47.00				42.00			1.57	1.40				1.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5774	036	0	1	01	01	H5774_036_0	8		N	Non-Preferred Brand	2	10	1	2	4	1		110	01	100		1				30		90	1	1			90				30		31								100.00		200.00					95.00		190.00							190.00																100.00				95.00			3.33	3.17				3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5774	036	0	1	01	01	H5774_036_0	8		N	Specialty Tier	2	11	1	1	5	1		110	01	100		1				30		90	1	1			90				30		31												25		25					25		25						25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5774	036	0	1	01	01	H5774_036_0	8		N	Select Care Drugs	2	11	1	2	6	1		110	01	100		1				30		90	1	2			90				30		31								9.00		18.00					8.00		16.00							16.00																9.00				8.00			0.30	0.27				0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5774	037	0	1	01	01	H5774_037_0	8		Y	Preferred Generic	4	01	3	2	1	1		110	01	100		1				30		90	1	2			90				30		31								5.00		10.00					0.00		0.00							0.00																5.00				0.00			0.17	0.00				0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5774	037	0	1	01	01	H5774_037_0	8		Y	Preferred Generic	4	01	3	2	1	3		110	01	100		1				30		90	1	2			90				30		31								5.00		10.00					0.00		0.00							0.00																5.00				0.00			0.17	0.00				0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		3
H5774	037	0	1	01	01	H5774_037_0	8		Y	Generic	4	01	3	2	2	1		110	01	100		1				30		90	1	2			90				30		31								8.00		16.00					0.00		0.00							0.00																8.00				0.00			0.27	0.00				0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5774	037	0	1	01	01	H5774_037_0	8		Y	Generic	4	01	3	2	2	3		110	01	100		1				30		90	1	2			90				30		31								8.00		16.00					0.00		0.00							0.00																8.00				0.00			0.27	0.00				0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		3
H5774	037	0	1	01	01	H5774_037_0	8		Y	Preferred Brand	4	10	3	2	3	1		110	01	100		1				30		90	1	2			90				30		31								30.00		60.00					25.00		50.00							50.00																30.00				25.00			1.00	0.83				0.81	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5774	037	0	1	01	01	H5774_037_0	8		Y	Non-Preferred Brand	4	10	3	2	4	1		110	01	100		1				30		90	1	1			90				30		31								55.00		110.00					35.00		70.00							70.00																55.00				35.00			1.83	1.17				1.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5774	037	0	1	01	01	H5774_037_0	8		Y	Specialty Tier	4	11	1	1	5	1		110	01	100		1				30		90	1	1			90				30		31											33.00	33		33				33.00	33		33						33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5774	037	0	1	01	01	H5774_037_0	8		Y	Select Care Drugs	4	11	1	2	6	1		110	01	100		1				30		90	1	2			90				30		31								3.00		6.00					0.00		0.00							0.00																3.00				0.00			0.10	0.00				0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5774	037	0	1	01	01	H5774_037_0	8		Y	Select Care Drugs	4	11	1	2	6	3		110	01	100		1				30		90	1	2			90				30		31								3.00		6.00					0.00		0.00							0.00																3.00				0.00			0.10	0.00				0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H5774	038	0	1	01	01	H5774_038_0	7		Y	Preferred Generic	4	01	3	2	1	1		110	01	100		1				30		90	1	2			90				30		31								5.00		10.00					0.00		0.00							0.00																5.00				0.00			0.17	0.00				0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5774	038	0	1	01	01	H5774_038_0	7		Y	Preferred Generic	4	01	3	2	1	3		110	01	100		1				30		90	1	2			90				30		31								5.00		10.00					0.00		0.00							0.00																5.00				0.00			0.17	0.00				0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		3
H5774	038	0	1	01	01	H5774_038_0	7		Y	Generic	4	01	3	2	2	1		110	01	100		1				30		90	1	2			90				30		31								8.00		16.00					0.00		0.00							0.00																8.00				0.00			0.27	0.00				0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5774	038	0	1	01	01	H5774_038_0	7		Y	Generic	4	01	3	2	2	3		110	01	100		1				30		90	1	2			90				30		31								8.00		16.00					0.00		0.00							0.00																8.00				0.00			0.27	0.00				0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		3
H5774	038	0	1	01	01	H5774_038_0	7		Y	Preferred Brand	4	10	3	2	3	1		110	01	100		1				30		90	1	2			90				30		31								30.00		60.00					10.00		20.00							20.00																30.00				10.00			1.00	0.33				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5774	038	0	1	01	01	H5774_038_0	7		Y	Non-Preferred Brand	4	10	3	2	4	1		110	01	100		1				30		90	1	1			90				30		31								55.00		110.00					15.00		30.00							30.00																55.00				15.00			1.83	0.50				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5774	038	0	1	01	01	H5774_038_0	7		Y	Specialty Tier	4	11	1	1	5	1		110	01	100		1				30		90	1	1			90				30		31											33.00	33		33				33.00	33		33						33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5774	038	0	1	01	01	H5774_038_0	7		Y	Select Care Drugs	4	11	1	2	6	1		110	01	100		1				30		90	1	2			90				30		31								3.00		6.00					0.00		0.00							0.00																3.00				0.00			0.10	0.00				0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5774	038	0	1	01	01	H5774_038_0	7		Y	Select Care Drugs	4	11	1	2	6	3		110	01	100		1				30		90	1	2			90				30		31								3.00		6.00					0.00		0.00							0.00																3.00				0.00			0.10	0.00				0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
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											82.54	49	49	49				79.17	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	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											67.93	50	50	50				65.21	48	48	48										50	50	50				48	48	48			50			50								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	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, 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	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												
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	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, 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											97.43	42	42	42				97.43	42	42	42										42	42	42				42	42	42			42			42								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			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	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	02	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	02	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	02	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	02	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	02	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	02	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	02	01	H5793_001_0	3			Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1031.46	33						630.55	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5793	010	0	1	01	01	H5793_010_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												
H5793	010	0	1	01	01	H5793_010_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		
H5793	010	0	1	01	01	H5793_010_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												
H5793	010	0	1	01	01	H5793_010_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		
H5793	010	0	1	01	01	H5793_010_0	4			Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					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	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	010	0	1	01	01	H5793_010_0	4			Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											755.40	33						570.76	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5793	014	0	1	02	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	02	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	02	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	02	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	02	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	02	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	02	01	H5793_014_0	3			Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											823.46	30						523.64	30												30						30						30		30								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					5.00	10.00	10.00											20.00	40.00	60.00				5.00	10.00	10.00					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	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					5.00	10.00	10.00											20.00	40.00	60.00				5.00	10.00	10.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5793	015	0	1	01	01	H5793_015_0	3			Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					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											682.41	33						617.77	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5793	016	0	1	02	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	02	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	02	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					5.00	10.00	10.00											20.00	40.00	60.00				5.00	10.00	10.00					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	016	0	1	02	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					5.00	10.00	10.00											20.00	40.00	60.00				5.00	10.00	10.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5793	016	0	1	02	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	02	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	02	01	H5793_016_0	3			Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											827.27	33						506.66	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5793	018	0	1	02	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					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					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	018	0	1	02	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					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5793	018	0	1	02	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					10.00	20.00	20.00											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												
H5793	018	0	1	02	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					10.00	20.00	20.00											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										1		
H5793	018	0	1	02	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	02	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	02	01	H5793_018_0	4			Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											783.14	30						553.53	30												30						30						30		30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5793	019	0	1	02	01	H5793_019_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	019	0	1	02	01	H5793_019_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	019	0	1	02	01	H5793_019_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	019	0	1	02	01	H5793_019_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	019	0	1	02	01	H5793_019_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	019	0	1	02	01	H5793_019_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	019	0	1	02	01	H5793_019_0	3			Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											970.24	33						575.29	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5810	001	0	1	01	01	H5810_001_0	7		N	Preferred Generic	4	11	1	2	1	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5810	001	0	1	01	01	H5810_001_0	7		N	Generic	4	11	1	2	2	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31	14.00	28.00	42.00																			14.00	28.00	42.00																14.00				14.00		0.45			0.45			0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5810	001	0	1	01	01	H5810_001_0	7		N	Preferred Brand	4	11	1	2	3	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31	40.00	80.00	120.00																			40.00	80.00	120.00																40.00				40.00		1.29			1.29			1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5810	001	0	1	01	01	H5810_001_0	7		N	Non-Preferred Drug	4	11	1	1	4	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31				92.54	34	34	34																		34	34	34															34			34								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5810	001	0	1	01	01	H5810_001_0	7		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	31								31						31		31				666.66	25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5810	013	0	1	01	01	H5810_013_0	8		N	Preferred Generic	4	11	1	2	1	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5810	013	0	1	01	01	H5810_013_0	8		N	Generic	4	11	1	2	2	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31	14.00	28.00	42.00																			14.00	28.00	42.00																14.00				14.00		0.45			0.45			0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5810	013	0	1	01	01	H5810_013_0	8		N	Preferred Brand	4	11	1	2	3	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31	40.00	80.00	120.00																			40.00	80.00	120.00																40.00				40.00		1.29			1.29			1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5810	013	0	1	01	01	H5810_013_0	8		N	Non-Preferred Drug	4	11	1	1	4	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31				92.95	32	32	32																		32	32	32															32			32								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5810	013	0	1	01	01	H5810_013_0	8		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	31								31						31		31				761.17	25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5810	014	0	1	01	01	H5810_014_0	7		Y	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	7		Y	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	7		Y	Preferred Brand	4	11	1	2	3	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31	47.00	94.00	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	7		Y	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	7		Y	Specialty Tier	4	11	1	1	5	1	010		01	010		1	31								31						31		31				887.87	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5810	014	0	1	01	01	H5810_014_0	7		Y	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	7		Y	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	7		Y	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	7		Y	Preferred Brand	4	11	1	2	3	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31	47.00	94.00	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	7		Y	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	7		Y	Specialty Tier	4	11	1	1	5	1	010		01	010		1	31								31						31		31				706.88	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	7		Y	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												
H5810	016	0	1	01	01	H5810_016_0	7		N	Preferred Generic	4	11	1	2	1	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5810	016	0	1	01	01	H5810_016_0	7		N	Generic	4	11	1	2	2	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31	14.00	28.00	42.00																			14.00	28.00	42.00																14.00				14.00		0.45			0.45			0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5810	016	0	1	01	01	H5810_016_0	7		N	Preferred Brand	4	11	1	2	3	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31	40.00	80.00	120.00																			40.00	80.00	120.00																40.00				40.00		1.29			1.29			1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5810	016	0	1	01	01	H5810_016_0	7		N	Non-Preferred Drug	4	11	1	1	4	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31				91.18	34	34	34																		34	34	34															34			34								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5810	016	0	1	01	01	H5810_016_0	7		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	31								31						31		31				741.30	25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5823	006	0	1	01	01	H5823_006_0	8		N	Preferred Generic	4	11	1	2	1	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5823	006	0	1	01	01	H5823_006_0	8		N	Generic	4	11	1	2	2	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5823	006	0	1	01	01	H5823_006_0	8		N	Preferred Brand	4	11	1	2	3	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31	29.00	58.00	87.00																			29.00	58.00	87.00																29.00				29.00		0.94			0.94			0.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5823	006	0	1	01	01	H5823_006_0	8		N	Non-Preferred Drug	4	11	1	1	4	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31				92.64	46	46	46																		46	46	46															46			46								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5823	006	0	1	01	01	H5823_006_0	8		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	31								31						31		31				886.32	29																				29																	29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5823	010	0	1	01	01	H5823_010_0	8		N	Preferred Generic	4	11	1	2	1	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5823	010	0	1	01	01	H5823_010_0	8		N	Generic	4	11	1	2	2	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5823	010	0	1	01	01	H5823_010_0	8		N	Preferred Brand	4	11	1	2	3	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31	29.00	58.00	87.00																			29.00	58.00	87.00																29.00				29.00		0.94			0.94			0.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5823	010	0	1	01	01	H5823_010_0	8		N	Non-Preferred Drug	4	11	1	1	4	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31				94.32	46	46	46																		46	46	46															46			46								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5823	010	0	1	01	01	H5823_010_0	8		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	31								31						31		31				887.74	29																				29																	29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5823	011	0	1	01	01	H5823_011_0	7		Y	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	7		Y	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	7		Y	Preferred Brand	4	11	1	2	3	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31	47.00	94.00	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	7		Y	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	7		Y	Specialty Tier	4	11	1	1	5	1	010		01	010		1	31								31						31		31				841.91	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	7		Y	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		N	Preferred Generic	4	11	1	2	1	1		111	01		111	1				30	60	90	1	1				30	60	90	30		31								5.00	10.00	10.00					0.00	0.00	0.00											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		N	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	1				30	60	90	30		31								15.00	30.00	30.00					10.00	20.00	20.00											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		N	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	1				30	60	90	30		31								47.00	94.00	140.00					42.00	84.00	125.00											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		N	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	1				30	60	90	30		31											84.69	50	50	50				77.28	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		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5826	009	0	1	01	01	H5826_009_0	5		N	Preferred Generic	4	11	1	2	1	1		111	01		111	1				30	60	90	1	1				30	60	90	30		31								5.00	10.00	10.00					0.00	0.00	0.00											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		N	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	1				30	60	90	30		31								15.00	30.00	30.00					10.00	20.00	20.00											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		N	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	1				30	60	90	30		31								47.00	94.00	140.00					42.00	84.00	125.00											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		N	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	1				30	60	90	30		31											68.20	50	50	50				62.68	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		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5826	010	0	1	01	01	H5826_010_0	5		N	Preferred Generic	4	11	1	2	1	1		111	01		111	1				30	60	90	1	1				30	60	90	30		31								5.00	10.00	10.00					0.00	0.00	0.00											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	5		N	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	1				30	60	90	30		31								15.00	30.00	30.00					10.00	20.00	20.00											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	5		N	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	1				30	60	90	30		31								47.00	94.00	140.00					42.00	84.00	125.00											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	5		N	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	1				30	60	90	30		31											85.00	50	50	50				71.26	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	5		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5826	016	0	1	01	01	H5826_016_0	5		N	Preferred Generic	4	11	1	2	1	1		111	01		111	1				30	60	90	1	1				30	60	90	30		31								5.00	10.00	10.00					0.00	0.00	0.00											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		N	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	1				30	60	90	30		31								15.00	30.00	30.00					10.00	20.00	20.00											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		N	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	1				30	60	90	30		31								47.00	94.00	140.00					42.00	84.00	125.00											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		N	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	1				30	60	90	30		31											69.05	50	50	50				65.93	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		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												29							29												29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5828	001	0	1	01	01	H5828_001_0	5		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								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		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								20.00	40.00	60.00					20.00	40.00	60.00					20.00	60.00	60.00																20.00				20.00			0.67	0.67	0.67			0.59	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5828	001	0	1	01	01	H5828_001_0	5		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								47.00	94.00	141.00					47.00	94.00	141.00					47.00	141.00	141.00																47.00				47.00			1.57	1.57	1.57			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5828	001	0	1	01	01	H5828_001_0	5		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	285.00	285.00																100.00				100.00			3.33	3.17	3.17			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5828	001	0	1	01	01	H5828_001_0	5		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												27							27						27																	27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5828	001	0	1	01	01	H5828_001_0	5		N	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								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	5		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								10.00	20.00	30.00					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	5		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								20.00	40.00	60.00					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	5		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								47.00	94.00	141.00					47.00	94.00	141.00					47.00	141.00	141.00																47.00				47.00			1.57	1.57	1.57			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5828	002	0	1	01	01	H5828_002_0	5		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	285.00	285.00																100.00				100.00			3.33	3.17	3.17			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5828	002	0	1	01	01	H5828_002_0	5		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												25							25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5828	002	0	1	01	01	H5828_002_0	5		N	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								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	6		Y	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	6		Y	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	6		Y	Preferred Brand	4	11	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	6		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				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	6		Y	Specialty Tier	4	11	1	1	5	1		010	01	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	6		Y	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				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	6		Y	Select Care Drugs	4	01	1	2	6	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H5828	008	0	1	01	01	H5828_008_0	5		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								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	008	0	1	01	01	H5828_008_0	5		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								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	008	0	1	01	01	H5828_008_0	5		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								47.00	94.00	141.00					37.00	74.00	111.00					37.00	111.00	111.00																47.00				47.00			1.57	1.23	1.23			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5828	008	0	1	01	01	H5828_008_0	5		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								100.00	200.00	300.00					90.00	180.00	270.00					90.00	270.00	270.00																100.00				100.00			3.33	3.00	3.00			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5828	008	0	1	01	01	H5828_008_0	5		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												25							25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5828	008	0	1	01	01	H5828_008_0	5		N	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								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												
H5843	001	0	1	01	01	H5843_001_0	8		Y	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												
H5843	001	0	1	01	01	H5843_001_0	8		Y	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		
H5843	001	0	1	01	01	H5843_001_0	8		Y	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	8		Y	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	8		Y	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	8		Y	Specialty Tier	4	11	1	1	5	1	010		01			1	31														31		31				391.43	33																																					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5843	002	0	1	01	01	H5843_002_0	9		Y	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												
H5843	002	0	1	01	01	H5843_002_0	9		Y	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		
H5843	002	0	1	01	01	H5843_002_0	9		Y	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	9		Y	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	9		Y	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	9		Y	Specialty Tier	4	11	1	1	5	1	010		01			1	31														31		31				899.84	33																																					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5843	005	0	1	01	01	H5843_005_0	9		Y	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												
H5843	005	0	1	01	01	H5843_005_0	9		Y	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		
H5843	005	0	1	01	01	H5843_005_0	9		Y	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	9		Y	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	9		Y	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	9		Y	Specialty Tier	4	11	1	1	5	1	010		01			1	31														31		31				850.87	33																																					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5852	001	0	1	01	01	H5852_001_0	5		Y	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												
H5852	001	0	1	01	01	H5852_001_0	5		Y	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												
H5852	001	0	1	01	01	H5852_001_0	5		Y	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												
H5852	001	0	1	01	01	H5852_001_0	5		Y	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												
H5852	001	0	1	01	01	H5852_001_0	5		Y	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	5		Y	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		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								15.00	30.00	45.00					10.00	20.00	30.00					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		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								20.00	40.00	60.00					15.00	30.00	45.00					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		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								46.00	92.00	138.00					41.00	82.00	123.00					41.00	123.00	123.00																46.00				46.00			1.53	1.37	1.37			1.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5854	007	0	1	01	01	H5854_007_0	6		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	285.00	285.00																100.00				100.00			3.33	3.17	3.17			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5854	007	0	1	01	01	H5854_007_0	6		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												25							25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5854	007	0	1	01	01	H5854_007_0	6		N	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5854	007	0	1	01	01	H5854_007_0	6		N	Select Care Drugs	4	01	1	2	6	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H5854	008	0	1	01	01	H5854_008_0	6		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								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												
H5854	008	0	1	01	01	H5854_008_0	6		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								20.00	40.00	60.00					20.00	40.00	60.00					20.00	60.00	60.00																20.00				20.00			0.67	0.67	0.67			0.59	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5854	008	0	1	01	01	H5854_008_0	6		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								47.00	94.00	141.00					47.00	94.00	141.00					47.00	141.00	141.00																47.00				47.00			1.57	1.57	1.57			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5854	008	0	1	01	01	H5854_008_0	6		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	285.00	285.00																100.00				100.00			3.33	3.17	3.17			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5854	008	0	1	01	01	H5854_008_0	6		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												25							25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5854	008	0	1	01	01	H5854_008_0	6		N	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								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	009	0	1	01	01	H5854_009_0	7		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		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	7		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								20.00	40.00	60.00					15.00	30.00	45.00					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	7		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00	126.00	126.00																47.00				47.00			1.57	1.40	1.40			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5854	009	0	1	01	01	H5854_009_0	7		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	285.00	285.00																100.00				100.00			3.33	3.17	3.17			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5854	009	0	1	01	01	H5854_009_0	7		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												27							27						27																	27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5854	009	0	1	01	01	H5854_009_0	7		N	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5854	009	0	1	01	01	H5854_009_0	7		N	Select Care Drugs	4	01	1	2	6	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H5854	010	0	1	01	01	H5854_010_0	6		Y	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								5.00	10.00	15.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.15	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5854	010	0	1	01	01	H5854_010_0	6		Y	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	6		Y	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	6		Y	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	6		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	285.00	285.00																100.00				100.00			3.33	3.17	3.17			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5854	010	0	1	01	01	H5854_010_0	6		Y	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												28							28						28																	28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5854	010	0	1	01	01	H5854_010_0	6		Y	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5854	010	0	1	01	01	H5854_010_0	6		Y	Select Care Drugs	4	01	1	2	6	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H5854	011	0	1	01	01	H5854_011_0	6		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								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	011	0	1	01	01	H5854_011_0	6		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								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												
H5854	011	0	1	01	01	H5854_011_0	6		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								47.00	94.00	141.00					47.00	94.00	141.00					47.00	141.00	141.00																47.00				47.00			1.57	1.57	1.57			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5854	011	0	1	01	01	H5854_011_0	6		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	285.00	285.00																100.00				100.00			3.33	3.17	3.17			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5854	011	0	1	01	01	H5854_011_0	6		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												25							25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5854	011	0	1	01	01	H5854_011_0	6		N	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								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	012	0	1	02	01	H5854_012_0	7		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		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	7		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								14.00	28.00	42.00					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	7		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00	126.00	126.00																47.00				47.00			1.57	1.40	1.40			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5854	012	0	1	02	01	H5854_012_0	7		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								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	7		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												28							28						28																	28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5854	012	0	1	02	01	H5854_012_0	7		N	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5854	013	0	1	01	01	H5854_013_0	6		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								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												
H5854	013	0	1	01	01	H5854_013_0	6		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								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		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								47.00	94.00	141.00					47.00	94.00	141.00					47.00	141.00	141.00																47.00				47.00			1.57	1.57	1.57			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5854	013	0	1	01	01	H5854_013_0	6		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	285.00	285.00																100.00				100.00			3.33	3.17	3.17			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5854	013	0	1	01	01	H5854_013_0	6		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												25							25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5854	013	0	1	01	01	H5854_013_0	6		N	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								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	6		N	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		34	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5854	014	0	1	01	01	H5854_014_0	6		N	Preferred Generic	4	01	1	2	1	3	111		01	111		1	30	60	90				1	2	30	60	90				30		34	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H5854	014	0	1	01	01	H5854_014_0	6		N	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				2	2	30	60	90				30		34	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	6		N	Generic	4	01	1	2	2	3	111		01	111		1	30	60	90				2	2	30	60	90				30		34	7.50	15.00	22.50																			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	6		N	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				2	2	30	60	90				30		34	40.00	80.00	120.00																			40.00	80.00	80.00																40.00				40.00		1.33			1.33			1.18	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5854	014	0	1	01	01	H5854_014_0	6		N	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	90				2	2	30	60	90				30		34	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	6		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		34					33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5854	014	0	1	01	01	H5854_014_0	6		N	Select Care Drugs	4	11	1	2	6	1	111		01	111		1	30	60	100				1	2	30	60	100				30		34	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5854	014	0	1	01	01	H5854_014_0	6		N	Select Care Drugs	4	11	1	2	6	3	111		01	111		1	30	60	100				1	2	30	60	100				30		34	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	3	
H5854	015	0	1	01	01	H5854_015_0	6		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5854	015	0	1	01	01	H5854_015_0	6		N	Preferred Generic	4	01	1	2	1	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H5854	015	0	1	01	01	H5854_015_0	6		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								5.00	10.00	15.00					5.00	10.00	15.00					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		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								47.00	94.00	141.00					47.00	94.00	141.00					47.00	94.00	94.00																47.00				47.00			1.57	1.57	1.57			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5854	015	0	1	01	01	H5854_015_0	6		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	190.00	190.00																100.00				100.00			3.33	3.17	3.17			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5854	015	0	1	01	01	H5854_015_0	6		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												25							25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5854	015	0	1	01	01	H5854_015_0	6		N	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5854	015	0	1	01	01	H5854_015_0	6		N	Select Care Drugs	4	01	1	2	6	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H5883	002	1	1	02	01	H5883_002_1	6		Y	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	6		Y	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	6		Y	Generic	4	01	1	2	2	1		110	01		110	1				31		90	1	2				31		90	31		31								12.00		36.00					7.00		0.00											12.00		36.00				7.00		0.00				12.00				12.00			0.39	0.23		0.39	0.23	0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5883	002	1	1	02	01	H5883_002_1	6		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				31		90	1	2				31		90	31		31								43.00		129.00					38.00		114.00											43.00		129.00				38.00		105.00				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	6		Y	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				31		90	1	2				31		90	31		31											81.00	45		45				74.00	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	6		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				31								31			31		31											1.00	33						1.00	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5883	002	2	1	02	01	H5883_002_2	6		Y	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	6		Y	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	6		Y	Generic	4	01	1	2	2	1		110	01		110	1				31		90	1	2				31		90	31		31								12.00		36.00					7.00		0.00											12.00		36.00				7.00		0.00				12.00				12.00			0.39	0.23		0.39	0.23	0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5883	002	2	1	02	01	H5883_002_2	6		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				31		90	1	2				31		90	31		31								43.00		129.00					38.00		114.00											43.00		129.00				38.00		105.00				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	6		Y	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				31		90	1	2				31		90	31		31											81.00	45		45				74.00	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	6		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				31								31			31		31											1.00	33						1.00	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5883	002	3	1	02	01	H5883_002_3	6		Y	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	6		Y	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	6		Y	Generic	4	01	1	2	2	1		110	01		110	1				31		90	1	2				31		90	31		31								12.00		36.00					7.00		0.00											12.00		36.00				7.00		0.00				12.00				12.00			0.39	0.23		0.39	0.23	0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5883	002	3	1	02	01	H5883_002_3	6		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				31		90	1	2				31		90	31		31								43.00		129.00					38.00		114.00											43.00		129.00				38.00		105.00				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	6		Y	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				31		90	1	2				31		90	31		31											81.00	45		45				74.00	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	6		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				31								31			31		31											1.00	33						1.00	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5883	002	4	1	02	01	H5883_002_4	5		Y	Preferred Generic	4	01	1	2	1	1		110	01		110	1				31		90	1	2				31		90	31		31								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	5		Y	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	5		Y	Generic	4	01	1	2	2	1		110	01		110	1				31		90	1	2				31		90	31		31								12.00		36.00					7.00		0.00											12.00		36.00				7.00		0.00				12.00				12.00			0.39	0.23		0.39	0.23	0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5883	002	4	1	02	01	H5883_002_4	5		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				31		90	1	2				31		90	31		31								43.00		129.00					38.00		114.00											43.00		129.00				38.00		105.00				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	5		Y	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				31		90	1	2				31		90	31		31											81.00	45		45				74.00	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	5		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				31								31			31		31											1.00	33						1.00	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5883	002	7	1	02	01	H5883_002_7	5		Y	Preferred Generic	4	01	1	2	1	1		110	01		110	1				31		90	1	2				31		90	31		31								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	5		Y	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	5		Y	Generic	4	01	1	2	2	1		110	01		110	1				31		90	1	2				31		90	31		31								12.00		36.00					7.00		0.00											12.00		36.00				7.00		0.00				12.00				12.00			0.39	0.23		0.39	0.23	0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5883	002	7	1	02	01	H5883_002_7	5		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				31		90	1	2				31		90	31		31								43.00		129.00					38.00		114.00											43.00		129.00				38.00		105.00				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	5		Y	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				31		90	1	2				31		90	31		31											81.00	45		45				74.00	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	5		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				31								31			31		31											1.00	33						1.00	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5883	003	1	1	02	01	H5883_003_1	5		Y	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	5		Y	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	5		Y	Generic	4	01	1	2	2	1		110	01		110	1				31		90	1	2				31		90	31		31								12.00		36.00					7.00		0.00											12.00		36.00				7.00		0.00				12.00				12.00			0.39	0.23		0.39	0.23	0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5883	003	1	1	02	01	H5883_003_1	5		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				31		90	1	2				31		90	31		31								43.00		129.00					38.00		114.00											43.00		129.00				38.00		105.00				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	5		Y	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				31		90	1	2				31		90	31		31											78.00	45		45				85.00	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	5		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				31								31			31		31											1.00	33						1.00	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5883	003	2	1	02	01	H5883_003_2	6		Y	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	6		Y	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	6		Y	Generic	4	01	1	2	2	1		110	01		110	1				31		90	1	2				31		90	31		31								12.00		36.00					7.00		0.00											12.00		36.00				7.00		0.00				12.00				12.00			0.39	0.23		0.39	0.23	0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5883	003	2	1	02	01	H5883_003_2	6		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				31		90	1	2				31		90	31		31								43.00		129.00					38.00		114.00											43.00		129.00				38.00		105.00				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	6		Y	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				31		90	1	2				31		90	31		31											78.00	45		45				85.00	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	6		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				31								31			31		31											1.00	33						1.00	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5883	003	3	1	02	01	H5883_003_3	5		Y	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	5		Y	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	5		Y	Generic	4	01	1	2	2	1		110	01		110	1				31		90	1	2				31		90	31		31								12.00		36.00					7.00		0.00											12.00		36.00				7.00		0.00				12.00				12.00			0.39	0.23		0.39	0.23	0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5883	003	3	1	02	01	H5883_003_3	5		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				31		90	1	2				31		90	31		31								43.00		129.00					38.00		114.00											43.00		129.00				38.00		105.00				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	5		Y	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				31		90	1	2				31		90	31		31											78.00	45		45				85.00	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	5		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				31								31			31		31											1.00	33						1.00	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5883	003	4	1	02	01	H5883_003_4	5		Y	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	5		Y	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	5		Y	Generic	4	01	1	2	2	1		110	01		110	1				31		90	1	2				31		90	31		31								12.00		36.00					7.00		0.00											12.00		36.00				7.00		0.00				12.00				12.00			0.39	0.23		0.39	0.23	0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5883	003	4	1	02	01	H5883_003_4	5		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				31		90	1	2				31		90	31		31								43.00		129.00					38.00		114.00											43.00		129.00				38.00		105.00				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	5		Y	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				31		90	1	2				31		90	31		31											78.00	45		45				85.00	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	5		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				31								31			31		31											1.00	33						1.00	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5883	003	5	1	02	01	H5883_003_5	5		Y	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	5		Y	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	5		Y	Generic	4	01	1	2	2	1		110	01		110	1				31		90	1	2				31		90	31		31								12.00		36.00					7.00		0.00											12.00		36.00				7.00		0.00				12.00				12.00			0.39	0.23		0.39	0.23	0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5883	003	5	1	02	01	H5883_003_5	5		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				31		90	1	2				31		90	31		31								43.00		129.00					38.00		114.00											43.00		129.00				38.00		105.00				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	5		Y	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				31		90	1	2				31		90	31		31											78.00	45		45				85.00	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	5		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				31								31			31		31											1.00	33						1.00	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5883	007	0	1	01	01	H5883_007_0	5		Y	Preferred Generic	4	01	1	2	1	1		110	01		110	1				31		90	1	2				31		90	31		31								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	5		Y	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	5		Y	Generic	4	01	1	2	2	1		110	01		110	1				31		90	1	2				31		90	31		31								18.00		54.00					10.00		0.00											18.00		54.00				10.00		0.00				18.00				18.00			0.58	0.32		0.58	0.32	0.58	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5883	007	0	1	01	01	H5883_007_0	5		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				31		90	1	2				31		90	31		31								47.00		141.00					42.00		126.00											47.00		141.00				42.00		116.00				47.00				47.00			1.52	1.35		1.52	1.35	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5883	007	0	1	01	01	H5883_007_0	5		Y	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				31		90	1	2				31		90	31		31											98.00	46		46				82.00	46		46										46		46				46		46			46			46								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5883	007	0	1	01	01	H5883_007_0	5		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				31								31			31		31											1.00	33						1.00	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5883	012	1	1	02	01	H5883_012_1	5		N	Preferred Generic	4	01	1	2	1	1		110	01		110	1				31		90	1	2				31		90	31		31								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	5		N	Generic	4	01	1	2	2	1		110	01		110	1				31		90	1	2				31		90	31		31								20.00		60.00					10.00		0.00											20.00		60.00				10.00		0.00				20.00				20.00			0.65	0.32		0.65	0.32	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5883	012	1	1	02	01	H5883_012_1	5		N	Preferred Brand	4	11	1	2	3	1		110	01		110	1				31		90	1	2				31		90	31		31								47.00		141.00					45.00		135.00											47.00		141.00				45.00		125.00				47.00				47.00			1.52	1.45		1.52	1.45	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5883	012	1	1	02	01	H5883_012_1	5		N	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				31		90	1	2				31		90	31		31											94.00	50		50				81.00	50		50										50		50				50		50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5883	012	1	1	02	01	H5883_012_1	5		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				31								31			31		31											1.00	33						1.00	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5883	012	2	1	02	01	H5883_012_2	5		N	Preferred Generic	4	01	1	2	1	1		110	01		110	1				31		90	1	2				31		90	31		31								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	5		N	Generic	4	01	1	2	2	1		110	01		110	1				31		90	1	2				31		90	31		31								20.00		60.00					10.00		0.00											20.00		60.00				10.00		0.00				20.00				20.00			0.65	0.32		0.65	0.32	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5883	012	2	1	02	01	H5883_012_2	5		N	Preferred Brand	4	11	1	2	3	1		110	01		110	1				31		90	1	2				31		90	31		31								47.00		141.00					45.00		135.00											47.00		141.00				45.00		125.00				47.00				47.00			1.52	1.45		1.52	1.45	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5883	012	2	1	02	01	H5883_012_2	5		N	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				31		90	1	2				31		90	31		31											94.00	50		50				81.00	50		50										50		50				50		50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5883	012	2	1	02	01	H5883_012_2	5		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				31								31			31		31											1.00	33						1.00	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5883	014	1	1	02	01	H5883_014_1	5		Y	Preferred Generic	4	01	1	2	1	1		110	01		110	1				31		90	1	2				31		90	31		31								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	5		Y	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	5		Y	Generic	4	01	1	2	2	1		110	01		110	1				31		90	1	2				31		90	31		31								20.00		60.00					11.00		0.00											20.00		60.00				11.00		0.00				20.00				20.00			0.65	0.35		0.65	0.35	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5883	014	1	1	02	01	H5883_014_1	5		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				31		90	1	2				31		90	31		31								47.00		141.00					42.00		126.00											47.00		141.00				42.00		116.00				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	5		Y	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				31		90	1	2				31		90	31		31											92.00	50		50				86.00	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	5		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				31								31			31		31											1.00	33						1.00	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5883	014	2	1	02	01	H5883_014_2	5		Y	Preferred Generic	4	01	1	2	1	1		110	01		110	1				31		90	1	2				31		90	31		31								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	5		Y	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	5		Y	Generic	4	01	1	2	2	1		110	01		110	1				31		90	1	2				31		90	31		31								20.00		60.00					11.00		0.00											20.00		60.00				11.00		0.00				20.00				20.00			0.65	0.35		0.65	0.35	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5883	014	2	1	02	01	H5883_014_2	5		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				31		90	1	2				31		90	31		31								47.00		141.00					42.00		126.00											47.00		141.00				42.00		116.00				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	5		Y	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				31		90	1	2				31		90	31		31											92.00	50		50				86.00	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	5		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				31								31			31		31											1.00	33						1.00	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5883	014	3	1	02	01	H5883_014_3	5		Y	Preferred Generic	4	01	1	2	1	1		110	01		110	1				31		90	1	2				31		90	31		31								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	5		Y	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	5		Y	Generic	4	01	1	2	2	1		110	01		110	1				31		90	1	2				31		90	31		31								20.00		60.00					11.00		0.00											20.00		60.00				11.00		0.00				20.00				20.00			0.65	0.35		0.65	0.35	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5883	014	3	1	02	01	H5883_014_3	5		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				31		90	1	2				31		90	31		31								47.00		141.00					42.00		126.00											47.00		141.00				42.00		116.00				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	5		Y	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				31		90	1	2				31		90	31		31											92.00	50		50				86.00	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	5		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				31								31			31		31											1.00	33						1.00	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5883	014	4	1	02	01	H5883_014_4	5		Y	Preferred Generic	4	01	1	2	1	1		110	01		110	1				31		90	1	2				31		90	31		31								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	5		Y	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	5		Y	Generic	4	01	1	2	2	1		110	01		110	1				31		90	1	2				31		90	31		31								20.00		60.00					11.00		0.00											20.00		60.00				11.00		0.00				20.00				20.00			0.65	0.35		0.65	0.35	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5883	014	4	1	02	01	H5883_014_4	5		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				31		90	1	2				31		90	31		31								47.00		141.00					42.00		126.00											47.00		141.00				42.00		116.00				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	5		Y	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				31		90	1	2				31		90	31		31											92.00	50		50				86.00	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	5		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				31								31			31		31											1.00	33						1.00	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5883	014	5	1	02	01	H5883_014_5	5		Y	Preferred Generic	4	01	1	2	1	1		110	01		110	1				31		90	1	2				31		90	31		31								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	5		Y	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	5		Y	Generic	4	01	1	2	2	1		110	01		110	1				31		90	1	2				31		90	31		31								20.00		60.00					11.00		0.00											20.00		60.00				11.00		0.00				20.00				20.00			0.65	0.35		0.65	0.35	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5883	014	5	1	02	01	H5883_014_5	5		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				31		90	1	2				31		90	31		31								47.00		141.00					42.00		126.00											47.00		141.00				42.00		116.00				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	5		Y	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				31		90	1	2				31		90	31		31											92.00	50		50				86.00	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	5		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				31								31			31		31											1.00	33						1.00	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5883	015	0	1	01	01	H5883_015_0	6		Y	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	015	0	1	01	01	H5883_015_0	6		Y	Generic	4	01	1	2	2	1		110	01		110	1				31		90	1	2				31		90	31		31								20.00		60.00					10.00		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	015	0	1	01	01	H5883_015_0	6		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				31		90	1	2				31		90	31		31								47.00		141.00					45.00		135.00											47.00		141.00				45.00		125.00				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	015	0	1	01	01	H5883_015_0	6		Y	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				31		90	1	2				31		90	31		31											88.00	50		50				78.00	50		50										50		50				50		50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5883	015	0	1	01	01	H5883_015_0	6		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				31								31			31		31											1.00	33						1.00	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5900	001	0	1	04	01	H5900_001_0	7		Y	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								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	7		Y	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	7		Y	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	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	7		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	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	7		Y	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											1466.49	33						1466.49	33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5900	002	0	1	04	01	H5900_002_0	7		Y	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								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		Y	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		Y	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		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	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		Y	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											1437.51	33						1437.51	33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5900	003	0	1	04	01	H5900_003_0	7		Y	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								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	7		Y	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	7		Y	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	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	7		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	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	7		Y	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											1453.44	33						1453.44	33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5900	004	0	1	04	01	H5900_004_0	8		Y	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								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	8		Y	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	8		Y	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	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	8		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	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	8		Y	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											1503.00	33						1503.00	33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5900	005	0	1	04	01	H5900_005_0	7		Y	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								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	005	0	1	04	01	H5900_005_0	7		Y	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								15.00	30.00	45.00					7.00	14.00	21.00					8.00	16.00	0.00																15.00				7.00			0.50	0.23	0.27			0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5900	005	0	1	04	01	H5900_005_0	7		Y	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	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	005	0	1	04	01	H5900_005_0	7		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	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	005	0	1	04	01	H5900_005_0	7		Y	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											1436.03	33						1436.03	33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5926	001	0	1	01	01	H5926_001_0	7		N	Preferred Generic	4	11	1	2	1	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5926	001	0	1	01	01	H5926_001_0	7		N	Generic	4	11	1	2	2	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5926	001	0	1	01	01	H5926_001_0	7		N	Preferred Brand	4	11	1	2	3	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31	42.00	84.00	126.00																			42.00	84.00	126.00																42.00				42.00		1.35			1.35			1.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5926	001	0	1	01	01	H5926_001_0	7		N	Non-Preferred Drug	4	11	1	1	4	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31				94.28	36	36	36																		36	36	36															36			36								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5926	001	0	1	01	01	H5926_001_0	7		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	31								31						31		31				735.87	25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5926	005	0	1	01	01	H5926_005_0	9		N	Preferred Generic	4	11	1	2	1	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5926	005	0	1	01	01	H5926_005_0	9		N	Generic	4	11	1	2	2	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5926	005	0	1	01	01	H5926_005_0	9		N	Preferred Brand	4	11	1	2	3	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31	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	9		N	Non-Preferred Drug	4	11	1	1	4	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31				90.92	34	34	34																		34	34	34															34			34								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5926	005	0	1	01	01	H5926_005_0	9		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	31								31						31		31				737.71	25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5926	006	0	1	01	01	H5926_006_0	7		Y	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	7		Y	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	7		Y	Preferred Brand	4	11	1	2	3	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31	47.00	94.00	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	7		Y	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	7		Y	Specialty Tier	4	11	1	1	5	1	010		01	010		1	31								31						31		31				828.93	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	7		Y	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												
H5926	007	0	1	01	01	H5926_007_0	7		Y	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												
H5926	007	0	1	01	01	H5926_007_0	7		Y	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												
H5926	007	0	1	01	01	H5926_007_0	7		Y	Preferred Brand	4	11	1	2	3	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31	47.00	94.00	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	007	0	1	01	01	H5926_007_0	7		Y	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	007	0	1	01	01	H5926_007_0	7		Y	Specialty Tier	4	11	1	1	5	1	010		01	010		1	31								31						31		31				733.60	27																				27																	27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5926	007	0	1	01	01	H5926_007_0	7		Y	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												
H5928	004	0	1	01	01	H5928_004_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												
H5928	004	0	1	01	01	H5928_004_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		
H5928	004	0	1	01	01	H5928_004_0	6			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	6			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	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	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	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	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	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												
H5928	005	0	1	01	01	H5928_005_0	4		N	Preferred Generic	4	01	1	2	1	1	111		01	100		1	30	60	100				2	2			100				30		31	0.00	0.00	0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5928	005	0	1	01	01	H5928_005_0	4		N	Preferred Generic	4	01	1	2	1	3	111		01	100		1	30	60	100				2	2			100				30		31	0.00	0.00	0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5928	005	0	1	01	01	H5928_005_0	4		N	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	4		N	Preferred Brand	4	11	1	1	3	1	111		01	100		1	30	60	90				2	2			90				30		31				98.41	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	4		N	Non-Preferred Drug	4	11	1	1	4	1	111		01	100		1	30	60	90				2	2			90				30		31				96.04	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	4		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				773.11	25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5928	010	0	1	01	01	H5928_010_0	5			Preferred Generic	4	01	1	2	1	1		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	5			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	5			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	5			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	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	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	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	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	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												
H5928	054	0	1	01	01	H5928_054_0	5		N	Preferred Generic	4	01	1	2	1	1	111		01	100		1	30	60	100				2	2			100				30		31	0.00	0.00	0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5928	054	0	1	01	01	H5928_054_0	5		N	Preferred Generic	4	01	1	2	1	3	111		01	100		1	30	60	100				2	2			100				30		31	0.00	0.00	0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5928	054	0	1	01	01	H5928_054_0	5		N	Generic	4	01	1	1	2	1	111		01	100		1	30	60	90				2	2			90				30		31				5.25	25	25	25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5928	054	0	1	01	01	H5928_054_0	5		N	Preferred Brand	4	11	1	1	3	1	111		01	100		1	30	60	90				2	2			90				30		31				93.94	25	25	25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5928	054	0	1	01	01	H5928_054_0	5		N	Non-Preferred Drug	4	11	1	1	4	1	111		01	100		1	30	60	90				2	2			90				30		31				82.78	25	25	25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5928	054	0	1	01	01	H5928_054_0	5		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				842.22	25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5928	055	0	1	01	01	H5928_055_0	4		N	Preferred Generic	4	01	1	2	1	1	111		01	100		1	30	60	100				2	2			100				30		31	0.00	0.00	0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5928	055	0	1	01	01	H5928_055_0	4		N	Preferred Generic	4	01	1	2	1	3	111		01	100		1	30	60	100				2	2			100				30		31	0.00	0.00	0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5928	055	0	1	01	01	H5928_055_0	4		N	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	055	0	1	01	01	H5928_055_0	4		N	Preferred Brand	4	11	1	1	3	1	111		01	100		1	30	60	90				2	2			90				30		31				99.92	25	25	25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5928	055	0	1	01	01	H5928_055_0	4		N	Non-Preferred Drug	4	11	1	1	4	1	111		01	100		1	30	60	90				2	2			90				30		31				98.38	25	25	25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5928	055	0	1	01	01	H5928_055_0	4		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				777.26	25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5932	001	0	1	01	01	H5932_001_0	11		N	Preferred Generic	4	11	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	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												
H5932	001	0	1	01	01	H5932_001_0	11		N	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				11.00		0.37			0.37			0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5932	001	0	1	01	01	H5932_001_0	11		N	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	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												
H5932	001	0	1	01	01	H5932_001_0	11		N	Non-Preferred Drug	4	11	1	1	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31				61.25	40	40	40																		40	40	40															40			40								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5932	001	0	1	01	01	H5932_001_0	11		N	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	9		N	Preferred Generic	4	11	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	4.00	8.00	12.00																			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												
H5932	009	0	1	01	01	H5932_009_0	9		N	Generic	4	11	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	13.00	26.00	39.00																			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												
H5932	009	0	1	01	01	H5932_009_0	9		N	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	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												
H5932	009	0	1	01	01	H5932_009_0	9		N	Non-Preferred Drug	4	11	1	1	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31				60.00	45	45	45																		45	45	45															45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5932	009	0	1	01	01	H5932_009_0	9		N	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	11		N	Preferred Generic	4	11	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	4.00	8.00	12.00																			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												
H5932	012	0	1	01	01	H5932_012_0	11		N	Generic	4	11	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	12.00	24.00	36.00																			12.00	24.00	36.00																12.00				12.00		0.40			0.40			0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5932	012	0	1	01	01	H5932_012_0	11		N	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	38.00	76.00	114.00																			38.00	76.00	114.00																38.00				38.00		1.27			1.27			1.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5932	012	0	1	01	01	H5932_012_0	11		N	Non-Preferred Drug	4	11	1	1	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31				55.30	40	40	40																		40	40	40															40			40								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5932	012	0	1	01	01	H5932_012_0	11		N	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	9		N	Preferred Generic	4	11	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	4.00	8.00	12.00																			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												
H5932	013	0	1	01	01	H5932_013_0	9		N	Generic	4	11	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	13.00	26.00	39.00																			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												
H5932	013	0	1	01	01	H5932_013_0	9		N	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	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												
H5932	013	0	1	01	01	H5932_013_0	9		N	Non-Preferred Drug	4	11	1	1	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31				61.14	45	45	45																		45	45	45															45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5932	013	0	1	01	01	H5932_013_0	9		N	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	10		Y	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5938	001	0	1	01	01	H5938_001_0	10		Y	Preferred Generic	4	01	1	2	1	3	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H5938	001	0	1	01	01	H5938_001_0	10		Y	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	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	10		Y	Generic	4	01	1	2	2	3	111		01	111		1	30	60	90				1	2	30	60	90				30		31	7.00	14.00	21.00																			7.00	14.00	17.50																7.00				7.00		0.23			0.23			0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H5938	001	0	1	01	01	H5938_001_0	10		Y	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	45.00	90.00	135.00																			45.00	90.00	112.50																45.00				45.00		1.50			1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5938	001	0	1	01	01	H5938_001_0	10		Y	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	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	10		Y	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31					33																																					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5938	001	0	1	01	01	H5938_001_0	10		Y	Select Care Drugs	4	01	1	2	6	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5938	001	0	1	01	01	H5938_001_0	10		Y	Select Care Drugs	4	01	1	2	6	3	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H5938	006	0	1	01	01	H5938_006_0	10		Y	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5938	006	0	1	01	01	H5938_006_0	10		Y	Preferred Generic	4	01	1	2	1	3	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H5938	006	0	1	01	01	H5938_006_0	10		Y	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	7.00	14.00	21.00																			7.00	14.00	17.50																7.00				7.00		0.23			0.23			0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5938	006	0	1	01	01	H5938_006_0	10		Y	Generic	4	01	1	2	2	3	111		01	111		1	30	60	90				1	2	30	60	90				30		31	7.00	14.00	21.00																			7.00	14.00	17.50																7.00				7.00		0.23			0.23			0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H5938	006	0	1	01	01	H5938_006_0	10		Y	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	45.00	90.00	135.00																			45.00	90.00	112.50																45.00				45.00		1.50			1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5938	006	0	1	01	01	H5938_006_0	10		Y	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	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	10		Y	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31					33																																					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5938	006	0	1	01	01	H5938_006_0	10		Y	Select Care Drugs	4	01	1	2	6	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5938	006	0	1	01	01	H5938_006_0	10		Y	Select Care Drugs	4	01	1	2	6	3	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H5938	008	0	1	01	01	H5938_008_0	10		Y	Preferred Generic	4	01	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												
H5938	008	0	1	01	01	H5938_008_0	10		Y	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	10		Y	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					40.00	80.00	120.00					40.00	80.00	100.00																47.00				47.00			1.57	1.33	1.33			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5938	008	0	1	01	01	H5938_008_0	10		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	300.00					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	10		Y	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	10		Y	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		31								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			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	10		Y	Select Care Drugs	4	01	1	2	6	3		111	01	111		1				30	60	100	1	2	30	60	100				30		31								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			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	9			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	9			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	9			Preferred Brand	4	11	1	1	3	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31											102.53	25	25	25				102.53	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	9			Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31											120.36	25	25	25				120.36	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	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												
H5943	002	0	1	02	01	H5943_002_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					0.00	0.00	0.00											3.00	6.00	9.00				0.00	0.00	0.00				3.00				3.00			0.10	0.00		0.10	0.00	0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5943	002	0	1	02	01	H5943_002_0	8			Generic	4	11	1	1	2	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31											6.56	25	25	25				6.56	25	25	25										25	25	25				25	25	25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5943	002	0	1	02	01	H5943_002_0	8			Preferred Brand	4	11	1	1	3	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31											101.54	25	25	25				101.54	25	25	25										25	25	25				25	25	25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5943	002	0	1	02	01	H5943_002_0	8			Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31											99.59	25	25	25				99.59	25	25	25										25	25	25				25	25	25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5943	002	0	1	02	01	H5943_002_0	8			Specialty Tier	4	11	1	1	5	1		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	5		Y	Preferred Generic	4	01	3	2	1	1	111		01	100		1	30	60	100				1	2			100				30		31	0.00	0.00	0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5945	001	0	1	01	01	H5945_001_0	5		Y	Preferred Generic	4	01	3	2	1	3	111		01	100		1	30	60	100				1	2			100				30		31	0.00	0.00	0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		3
H5945	001	0	1	01	01	H5945_001_0	5		Y	Generic	4	01	1	2	2	1	111		01	100		1	30	60	100				1	2			100				30		31	12.00	24.00	24.00																					24.00																12.00				12.00		0.40						0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5945	001	0	1	01	01	H5945_001_0	5		Y	Generic	4	01	1	2	2	3	111		01	100		1	30	60	100				1	2			100				30		31	12.00	24.00	24.00																					24.00																12.00				12.00		0.40						0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H5945	001	0	1	01	01	H5945_001_0	5		Y	Preferred Brand	4	11	1	2	3	1	111		01	100		1	30	60	100				1	2			100				30		31	35.00	70.00	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												
H5945	001	0	1	01	01	H5945_001_0	5		Y	Non-Preferred Drug	4	11	1	2	4	1	111		01	100		1	30	60	100				1	2			100				30		31	100.00	200.00	300.00																					300.00																100.00				100.00		3.33						3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5945	001	0	1	01	01	H5945_001_0	5		Y	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				83.10	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	5		Y	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												
H5945	001	0	1	01	01	H5945_001_0	5		Y	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 Drug, Specialty Tier, Select Care Drugs										1		
H5945	002	0	1	01	01	H5945_002_0	5		Y	Preferred Generic	4	01	3	2	1	1	111		01	100		1	30	60	100				1	2			100				30		31	0.00	0.00	0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5945	002	0	1	01	01	H5945_002_0	5		Y	Preferred Generic	4	01	3	2	1	3	111		01	100		1	30	60	100				1	2			100				30		31	0.00	0.00	0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		3
H5945	002	0	1	01	01	H5945_002_0	5		Y	Generic	4	01	1	2	2	1	111		01	100		1	30	60	100				1	2			100				30		31	12.00	24.00	24.00																					24.00																12.00				12.00		0.40						0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5945	002	0	1	01	01	H5945_002_0	5		Y	Generic	4	01	1	2	2	3	111		01	100		1	30	60	100				1	2			100				30		31	12.00	24.00	24.00																					24.00																12.00				12.00		0.40						0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H5945	002	0	1	01	01	H5945_002_0	5		Y	Preferred Brand	4	11	1	2	3	1	111		01	100		1	30	60	100				1	2			100				30		31	35.00	70.00	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												
H5945	002	0	1	01	01	H5945_002_0	5		Y	Non-Preferred Drug	4	11	1	2	4	1	111		01	100		1	30	60	100				1	2			100				30		31	100.00	200.00	300.00																					300.00																100.00				100.00		3.33						3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5945	002	0	1	01	01	H5945_002_0	5		Y	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				116.58	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	5		Y	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												
H5945	002	0	1	01	01	H5945_002_0	5		Y	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 Drug, Specialty Tier, Select Care Drugs										1		
H5945	008	0	1	01	01	H5945_008_0	6		Y	Preferred Generic	4	01	3	2	1	1	111		01	100		1	30	60	100				1	2			100				30		31	0.00	0.00	0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5945	008	0	1	01	01	H5945_008_0	6		Y	Preferred Generic	4	01	3	2	1	3	111		01	100		1	30	60	100				1	2			100				30		31	0.00	0.00	0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		3
H5945	008	0	1	01	01	H5945_008_0	6		Y	Generic	4	01	1	2	2	1	111		01	100		1	30	60	100				1	2			100				30		31	0.00	0.00	0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5945	008	0	1	01	01	H5945_008_0	6		Y	Generic	4	01	1	2	2	3	111		01	100		1	30	60	100				1	2			100				30		31	0.00	0.00	0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H5945	008	0	1	01	01	H5945_008_0	6		Y	Preferred Brand	4	11	1	2	3	1	111		01	100		1	30	60	100				1	2			100				30		31	20.00	40.00	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												
H5945	008	0	1	01	01	H5945_008_0	6		Y	Non-Preferred Drug	4	11	1	2	4	1	111		01	100		1	30	60	100				1	2			100				30		31	97.00	194.00	291.00																					281.00																97.00				97.00		3.23						3.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5945	008	0	1	01	01	H5945_008_0	6		Y	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				97.35	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	6		Y	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												
H5945	008	0	1	01	01	H5945_008_0	6		Y	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 Drug, Specialty Tier, Select Care Drugs										1		
H5945	009	0	1	01	01	H5945_009_0	4		N	Preferred Generic	4	01	3	1	1	1	111		01	100		1	30	60	100				1	2			100				30		31				1.13	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	4		N	Generic	4	01	1	1	2	1	111		01	100		1	30	60	100				1	2			100				30		31				10.25	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	4		N	Preferred Brand	4	11	1	1	3	1	111		01	100		1	30	60	100				1	2			100				30		31				137.55	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	4		N	Non-Preferred Drug	4	11	1	1	4	1	111		01	100		1	30	60	100				1	2			100				30		31				59.10	50	50	50																				50															50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5945	009	0	1	01	01	H5945_009_0	4		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				158.99	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	4		N	Select Care Drugs	4	01	1	1	6	1	111		01	100		1	30	60	100				1	2			100				30		31				0.08	15	15	15																				15															15			15								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5959	009	0	1	04	01	H5959_009_0	5			Preferred Generic	4	01	1	2	1	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31	0.00	0.00	0.00																			0.00	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	5			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	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	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	5			Non-Preferred Drug	4	11	1	1	4	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31				99.03	42	42	42																		42	42	42															42			42								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5959	009	0	1	04	01	H5959_009_0	5			Specialty Tier	4	11	1	1	5	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31					29	29	29																		29	29	29															29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5959	010	1	1	04	01	H5959_010_1	6		Y	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	6		Y	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	6		Y	Preferred Brand	4	11	1	2	3	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31	47.00	94.00	94.00																			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	6		Y	Non-Preferred Drug	4	11	1	1	4	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31				78.41	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	6		Y	Specialty Tier	4	11	1	1	5	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31					33	33	33																		33	33	33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5959	010	2	1	04	01	H5959_010_2	6		Y	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	6		Y	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	6		Y	Preferred Brand	4	11	1	2	3	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31	47.00	94.00	94.00																			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	6		Y	Non-Preferred Drug	4	11	1	1	4	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31				78.41	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	6		Y	Specialty Tier	4	11	1	1	5	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31					33	33	33																		33	33	33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5959	011	0	1	04	01	H5959_011_0	10		Y	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	10		Y	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	10		Y	Preferred Brand	4	11	1	2	3	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31	47.00	94.00	94.00																			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	10		Y	Non-Preferred Drug	4	11	1	1	4	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31				79.33	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	10		Y	Specialty Tier	4	11	1	1	5	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31					33	33	33																		33	33	33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5959	012	0	1	04	01	H5959_012_0	7			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	7			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	7			Preferred Brand	4	11	1	1	3	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31				50.52	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	7			Non-Preferred Drug	4	11	1	1	4	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31				96.56	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	7			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	6		N	Preferred Generic	4	01	1	2	1	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5959	013	1	1	04	01	H5959_013_1	6		N	Generic	4	01	1	2	2	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31	13.00	26.00	26.00																			13.00	26.00	26.00																13.00				13.00		0.42			0.42			0.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5959	013	1	1	04	01	H5959_013_1	6		N	Preferred Brand	4	11	1	1	3	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31				53.03	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	6		N	Non-Preferred Drug	4	11	1	1	4	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31				96.55	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	6		N	Specialty Tier	4	11	1	1	5	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31					27	27	27																		27	27	27															27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5959	013	2	1	04	01	H5959_013_2	8		N	Preferred Generic	4	01	1	2	1	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5959	013	2	1	04	01	H5959_013_2	8		N	Generic	4	01	1	2	2	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31	13.00	26.00	26.00																			13.00	26.00	26.00																13.00				13.00		0.42			0.42			0.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5959	013	2	1	04	01	H5959_013_2	8		N	Preferred Brand	4	11	1	1	3	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31				53.03	21	21	21																		21	21	21															21			21								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5959	013	2	1	04	01	H5959_013_2	8		N	Non-Preferred Drug	4	11	1	1	4	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31				96.55	45	45	45																		45	45	45															45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5959	013	2	1	04	01	H5959_013_2	8		N	Specialty Tier	4	11	1	1	5	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31					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	8		N	Preferred Generic	4	01	1	2	1	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5959	014	1	1	04	01	H5959_014_1	8		N	Generic	4	01	1	2	2	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31	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	8		N	Preferred Brand	4	11	1	2	3	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31	47.00	94.00	94.00																			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	8		N	Non-Preferred Drug	4	11	1	1	4	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31				98.97	42	42	42																		42	42	42															42			42								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5959	014	1	1	04	01	H5959_014_1	8		N	Specialty Tier	4	11	1	1	5	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31					29	29	29																		29	29	29															29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5959	014	2	1	04	01	H5959_014_2	6		N	Preferred Generic	4	01	1	2	1	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5959	014	2	1	04	01	H5959_014_2	6		N	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	6		N	Preferred Brand	4	11	1	2	3	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31	47.00	94.00	94.00																			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	6		N	Non-Preferred Drug	4	11	1	1	4	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31				98.97	42	42	42																		42	42	42															42			42								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5959	014	2	1	04	01	H5959_014_2	6		N	Specialty Tier	4	11	1	1	5	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31					29	29	29																		29	29	29															29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5959	015	0	1	04	01	H5959_015_0	7		N	Preferred Generic	4	01	1	2	1	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5959	015	0	1	04	01	H5959_015_0	7		N	Generic	4	01	1	2	2	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31	11.00	22.00	22.00																			11.00	22.00	22.00																11.00				11.00		0.35			0.35			0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5959	015	0	1	04	01	H5959_015_0	7		N	Preferred Brand	4	11	1	2	3	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31	47.00	94.00	94.00																			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	015	0	1	04	01	H5959_015_0	7		N	Non-Preferred Drug	4	11	1	1	4	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31				83.01	42	42	42																		42	42	42															42			42								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5959	015	0	1	04	01	H5959_015_0	7		N	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	016	0	1	04	01	H5959_016_0	6		N	Preferred Generic	4	01	1	2	1	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5959	016	0	1	04	01	H5959_016_0	6		N	Generic	4	01	1	2	2	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31	11.00	22.00	22.00																			11.00	22.00	22.00																11.00				11.00		0.35			0.35			0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5959	016	0	1	04	01	H5959_016_0	6		N	Preferred Brand	4	11	1	2	3	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31	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	016	0	1	04	01	H5959_016_0	6		N	Non-Preferred Drug	4	11	1	1	4	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31				85.28	42	42	42																		42	42	42															42			42								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5959	016	0	1	04	01	H5959_016_0	6		N	Specialty Tier	4	11	1	1	5	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31					27	27	27																		27	27	27															27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
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								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00				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	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								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												
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												29							29												29						29					29			29								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												
H5970	001	0	1	04	01	H5970_001_0	2		Y	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5970	001	0	1	04	01	H5970_001_0	2		Y	Preferred Generic	4	11	3	2	1	3	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H5970	001	0	1	04	01	H5970_001_0	2		Y	Generic	4	11	3	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	0.00		0.00																									20.00		60.00				0.00		0.00				0.00				0.00		0				0.67	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5970	001	0	1	04	01	H5970_001_0	2		Y	Generic	4	11	3	2	2	3	110		01		110	1	30		90				2	2				30		90	30		31	0.00		0.00																									20.00		60.00				0.00		0.00				0.00				0.00		0				0.67	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H5970	001	0	1	04	01	H5970_001_0	2		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		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	2		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	99.00		297.00																									100.00		300.00				99.00		287.00				99.00				99.00		3.30				3.33	3.30	3.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5970	001	0	1	04	01	H5970_001_0	2		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5970	015	0	1	04	01	H5970_015_0	3		Y	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5970	015	0	1	04	01	H5970_015_0	3		Y	Preferred Generic	4	11	3	2	1	3	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H5970	015	0	1	04	01	H5970_015_0	3		Y	Generic	4	11	3	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	0.00		0.00																									20.00		60.00				0.00		0.00				0.00				0.00		0				0.67	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5970	015	0	1	04	01	H5970_015_0	3		Y	Generic	4	11	3	2	2	3	110		01		110	1	30		90				2	2				30		90	30		31	0.00		0.00																									20.00		60.00				0.00		0.00				0.00				0.00		0				0.67	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H5970	015	0	1	04	01	H5970_015_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5970	015	0	1	04	01	H5970_015_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	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												
H5970	015	0	1	04	01	H5970_015_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					29																										29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5970	018	0	1	04	01	H5970_018_0	3		Y	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5970	018	0	1	04	01	H5970_018_0	3		Y	Preferred Generic	4	11	3	2	1	3	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H5970	018	0	1	04	01	H5970_018_0	3		Y	Generic	4	11	3	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	5.00		15.00																									20.00		60.00				5.00		0.00				5.00				5.00		0.17				0.67	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5970	018	0	1	04	01	H5970_018_0	3		Y	Generic	4	11	3	2	2	3	110		01		110	1	30		90				2	2				30		90	30		31	5.00		15.00																									20.00		60.00				5.00		0.00				5.00				5.00		0.17				0.67	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H5970	018	0	1	04	01	H5970_018_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5970	018	0	1	04	01	H5970_018_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	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												
H5970	018	0	1	04	01	H5970_018_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					28																										28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5970	024	1	1	04	01	H5970_024_1	2		Y	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	2.00		6.00																									10.00		30.00				2.00		0.00				2.00				2.00		0.07				0.33	0.07	0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5970	024	1	1	04	01	H5970_024_1	2		Y	Generic	4	11	3	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	9.00		27.00																									20.00		60.00				9.00		0.00				9.00				9.00		0.30				0.67	0.30	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5970	024	1	1	04	01	H5970_024_1	2		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		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	2		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		290.00				100.00				100.00		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	2		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					27																										27						27					27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5970	024	2	1	04	01	H5970_024_2	2		Y	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	2.00		6.00																									10.00		30.00				2.00		0.00				2.00				2.00		0.07				0.33	0.07	0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5970	024	2	1	04	01	H5970_024_2	2		Y	Generic	4	11	3	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	9.00		27.00																									20.00		60.00				9.00		0.00				9.00				9.00		0.30				0.67	0.30	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5970	024	2	1	04	01	H5970_024_2	2		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		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	2		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		290.00				100.00				100.00		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	2		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					27																										27						27					27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5970	025	0	1	04	01	H5970_025_0	2		Y	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5970	025	0	1	04	01	H5970_025_0	2		Y	Preferred Generic	4	11	3	2	1	3	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H5970	025	0	1	04	01	H5970_025_0	2		Y	Generic	4	11	3	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	5.00		15.00																									20.00		60.00				5.00		0.00				5.00				5.00		0.17				0.67	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5970	025	0	1	04	01	H5970_025_0	2		Y	Generic	4	11	3	2	2	3	110		01		110	1	30		90				2	2				30		90	30		31	5.00		15.00																									20.00		60.00				5.00		0.00				5.00				5.00		0.17				0.67	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H5970	025	0	1	04	01	H5970_025_0	2		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	47.00		141.00																									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												
H5970	025	0	1	04	01	H5970_025_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	100.00		300.00																									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												
H5970	025	0	1	04	01	H5970_025_0	2		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					28																										28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5970	027	0	1	04	01	H5970_027_0	2		Y	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5970	027	0	1	04	01	H5970_027_0	2		Y	Preferred Generic	4	11	3	2	1	3	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H5970	027	0	1	04	01	H5970_027_0	2		Y	Generic	4	11	3	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	5.00		15.00																									20.00		60.00				5.00		0.00				5.00				5.00		0.17				0.67	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5970	027	0	1	04	01	H5970_027_0	2		Y	Generic	4	11	3	2	2	3	110		01		110	1	30		90				2	2				30		90	30		31	5.00		15.00																									20.00		60.00				5.00		0.00				5.00				5.00		0.17				0.67	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H5970	027	0	1	04	01	H5970_027_0	2		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5970	027	0	1	04	01	H5970_027_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		290.00				100.00				100.00		3.33				3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5970	027	0	1	04	01	H5970_027_0	2		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					26																										26						26					26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5989	011	0	1	01	01	H5989_011_0	8		Y	Preferred Generic	4	11	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	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	8		Y	Generic	4	11	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	10.00	20.00	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	8		Y	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	47.00	94.00	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	8		Y	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	100.00	200.00	300.00																			100.00	200.00	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	8		Y	Specialty Tier	4	11	1	1	5	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31					26	26	26																		26	26	26															26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Supplemental Drugs												
H5989	011	0	1	01	01	H5989_011_0	8		Y	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			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Supplemental Drugs												
H5989	011	0	1	01	01	H5989_011_0	8		Y	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			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Supplemental Drugs										1		
H5991	010	0	1	01	01	H5991_010_0	11		N	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	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												
H5991	010	0	1	01	01	H5991_010_0	11		N	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	15.00	30.00	45.00																			15.00	30.00	45.00																15.00				15.00		0.50			0.50			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5991	010	0	1	01	01	H5991_010_0	11		N	Preferred Brand	4	10	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	141.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5991	010	0	1	01	01	H5991_010_0	11		N	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	100.00	200.00	300.00																			100.00	200.00	300.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5991	010	0	1	01	01	H5991_010_0	11		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31					25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5991	010	0	1	01	01	H5991_010_0	11		N	Select Care Drugs	4	01	1	2	6	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	5.00	10.00	15.00																			5.00	10.00	15.00																5.00				5.00		0.17			0.17			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6018	001	0	1	04	01	H6018_001_0	9		Y	Preferred Generic	4	11	1	2	1	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6018	001	0	1	04	01	H6018_001_0	9		Y	Preferred Generic	4	11	1	2	1	3	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H6018	001	0	1	04	01	H6018_001_0	9		Y	Generic	4	11	3	2	2	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	5.00	10.00	15.00																			5.00	10.00	12.50																5.00				5.00		0.17			0.17			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6018	001	0	1	04	01	H6018_001_0	9		Y	Generic	4	11	3	2	2	3	111		01	111		1	30	60	100				1	2	30	60	100				30		31	5.00	10.00	15.00																			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										2	3	3
H6018	001	0	1	04	01	H6018_001_0	9		Y	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	47.00	94.00	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												
H6018	001	0	1	04	01	H6018_001_0	9		Y	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	100.00	200.00	300.00																			100.00	200.00	300.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6018	001	0	1	04	01	H6018_001_0	9		Y	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												
H6019	001	0	1	01	01	H6019_001_0	5		N	Generic	4	01	3	2	1	1	110		01			1	30		90				2	2							30		31	14.00		42.00																																					14.00				14.00		0.47						0.45	Generic, Brand												
H6019	001	0	1	01	01	H6019_001_0	5		N	Brand	4	10	1	2	2	1	110		01			1	30		90				2	2							30		31	32.00		96.00																																					32.00				32.00		1.07						1.03	Generic, Brand												
H6062	001	0	1	01	01	H6062_001_0	7		N	Preferred Generic	4	11	3	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	001	0	1	01	01	H6062_001_0	7		N	Preferred Generic	4	11	3	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		3
H6062	001	0	1	01	01	H6062_001_0	7		N	Generic	4	11	3	2	2	1		110	01		110	1				30		100	1	1				30		100	30		31								15.00		45.00					10.00		20.00											15.00		45.00				10.00		20.00				15.00				15.00			0.50	0.33		0.50	0.33	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6062	001	0	1	01	01	H6062_001_0	7		N	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		N	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		N	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		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6062	003	0	1	01	01	H6062_003_0	7		N	Preferred Generic	4	11	3	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	003	0	1	01	01	H6062_003_0	7		N	Preferred Generic	4	11	3	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		3
H6062	003	0	1	01	01	H6062_003_0	7		N	Generic	4	11	3	2	2	1		110	01		110	1				30		100	1	1				30		100	30		31								15.00		45.00					10.00		20.00											15.00		45.00				10.00		20.00				15.00				15.00			0.50	0.33		0.50	0.33	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6062	003	0	1	01	01	H6062_003_0	7		N	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		N	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		N	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		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6062	005	0	1	01	01	H6062_005_0	8		Y	Preferred Generic	4	11	3	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	8		Y	Preferred Generic	4	11	3	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		3
H6062	005	0	1	01	01	H6062_005_0	8		Y	Generic	4	11	3	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	8		Y	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	8		Y	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	8		Y	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	8		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6062	006	0	1	01	01	H6062_006_0	8		Y	Preferred Generic	4	11	3	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		Y	Preferred Generic	4	11	3	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		3
H6062	006	0	1	01	01	H6062_006_0	8		Y	Generic	4	11	3	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		Y	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		Y	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		Y	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		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6062	011	0	1	01	01	H6062_011_0	7		N	Preferred Generic	4	11	3	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	011	0	1	01	01	H6062_011_0	7		N	Preferred Generic	4	11	3	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		3
H6062	011	0	1	01	01	H6062_011_0	7		N	Generic	4	11	3	2	2	1		110	01		110	1				30		100	1	1				30		100	30		31								15.00		45.00					10.00		20.00											15.00		45.00				10.00		20.00				15.00				15.00			0.50	0.33		0.50	0.33	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6062	011	0	1	01	01	H6062_011_0	7		N	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	011	0	1	01	01	H6062_011_0	7		N	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	011	0	1	01	01	H6062_011_0	7		N	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	011	0	1	01	01	H6062_011_0	7		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6067	001	1	1	01	01	H6067_001_1	9		Y	Preferred Generic	4	11	1	2	1	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	7.00	7.00	7.00																			7.00	7.00	7.00																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		Y	Generic	4	11	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	20.00	20.00	20.00																			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												
H6067	001	1	1	01	01	H6067_001_1	9		Y	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	47.00	94.00	141.00																			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		Y	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	100.00	200.00	300.00																			100.00	200.00	200.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6067	001	1	1	01	01	H6067_001_1	9		Y	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31					33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6067	001	2	1	01	01	H6067_001_2	10		Y	Preferred Generic	4	11	1	2	1	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	7.00	7.00	7.00																			7.00	7.00	7.00																7.00				7.00		0.23			0.23			0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6067	001	2	1	01	01	H6067_001_2	10		Y	Generic	4	11	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	20.00	20.00	20.00																			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												
H6067	001	2	1	01	01	H6067_001_2	10		Y	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	94.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6067	001	2	1	01	01	H6067_001_2	10		Y	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	100.00	200.00	300.00																			100.00	200.00	200.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6067	001	2	1	01	01	H6067_001_2	10		Y	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31					33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6067	002	1	1	01	01	H6067_002_1	10		Y	Preferred Generic	4	11	1	2	1	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	5.00	5.00	5.00																			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												
H6067	002	1	1	01	01	H6067_002_1	10		Y	Preferred Generic	4	11	1	2	1	3	111		01	111		1	30	60	100				1	2	30	60	100				30		31	5.00	5.00	5.00																			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		
H6067	002	1	1	01	01	H6067_002_1	10		Y	Generic	4	11	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	15.00	15.00	15.00																			15.00	15.00	15.00																15.00				15.00		0.50			0.50			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6067	002	1	1	01	01	H6067_002_1	10		Y	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	94.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6067	002	1	1	01	01	H6067_002_1	10		Y	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	100.00	200.00	300.00																			100.00	200.00	200.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6067	002	1	1	01	01	H6067_002_1	10		Y	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31					33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6067	002	2	1	01	01	H6067_002_2	11		Y	Preferred Generic	4	11	1	2	1	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	5.00	5.00	5.00																			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												
H6067	002	2	1	01	01	H6067_002_2	11		Y	Preferred Generic	4	11	1	2	1	3	111		01	111		1	30	60	100				1	2	30	60	100				30		31	5.00	5.00	5.00																			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		
H6067	002	2	1	01	01	H6067_002_2	11		Y	Generic	4	11	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	15.00	15.00	15.00																			15.00	15.00	15.00																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	11		Y	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	94.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6067	002	2	1	01	01	H6067_002_2	11		Y	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	100.00	200.00	300.00																			100.00	200.00	200.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6067	002	2	1	01	01	H6067_002_2	11		Y	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31					33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6080	001	0	1	48	05	H6080_001_0	5			Generic Drugs	4	01			1	1	110		01	100		1	30		90				2	2			90				30		31																																																					Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	1	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H6080	001	0	1	48	05	H6080_001_0	5			Brand Drugs	4	10			2	1	110		01	100		1	30		90				2	2			90				30		31																																																					Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	1	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H6080	001	0	1	48	05	H6080_001_0	5			Non-Medicare Rx/OTC Drugs	4	11			3	1	110		01	100		1	30		90				1	1			90				30		31																																																					Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	2	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H6154	001	0	1	02	01	H6154_001_0	5		Y	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00				15.00				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		Y	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					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		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	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		Y	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											100.99	50	50	50				92.02	50	50	50										50	50	50				50	50	50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6154	001	0	1	02	01	H6154_001_0	5		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												27							27												27						27					27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6154	002	0	1	02	01	H6154_002_0	4		Y	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								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	4		Y	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					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	4		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					47.00	94.00	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	4		Y	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											94.23	50	50	50				90.70	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	4		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												26							26												26						26					26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6158	001	0	1	01	01	H6158_001_0	4		Y	Preferred Generic	4	01	1	2	1	1	110		01	110		1	30		100				1	2	30		100				30		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6158	001	0	1	01	01	H6158_001_0	4		Y	Generic	4	01	1	2	2	1	110		01	110		1	30		100				1	2	30		100				30		31	8.00		16.00																			8.00		0.00																8.00				8.00		0.27			0.27			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6158	001	0	1	01	01	H6158_001_0	4		Y	Preferred Brand	4	11	1	2	3	1	110		01	110		1	30		100				1	2	30		100				30		31	47.00		94.00																			47.00		94.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6158	001	0	1	01	01	H6158_001_0	4		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01	110		1	30		100				1	2	30		100				30		31	100.00		300.00																			100.00		300.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6158	001	0	1	01	01	H6158_001_0	4		Y	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				1082.14	31																				31																	31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6158	001	0	1	01	01	H6158_001_0	4		Y	Select Care Drugs	4	01	3	2	6	1	110		01	110		1	30		100				1	2	30		100				30		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6158	001	0	1	01	01	H6158_001_0	4		Y	Select Care Drugs	4	01	3	2	6	3	110		01	110		1	30		100				1	2	30		100				30		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		3
H6158	003	0	1	01	01	H6158_003_0	4			Preferred Generic	3	01	1	2	1	1	110		01	110		1	30		100				1	2	30		100				30		31	11.00		22.00																			11.00		22.00																11.00				11.00		0.37			0.37			0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6158	003	0	1	01	01	H6158_003_0	4			Generic	3	01	1	2	2	1	110		01	110		1	30		100				1	2	30		100				30		31	20.00		40.00																			20.00		40.00																20.00				20.00		0.67			0.67			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6158	003	0	1	01	01	H6158_003_0	4			Preferred Brand	3	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	003	0	1	01	01	H6158_003_0	4			Non-Preferred Drug	3	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	003	0	1	01	01	H6158_003_0	4			Specialty Tier	3	11	1	1	5	1	010		01	010		1	30								30						30		31				635.01	25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6158	003	0	1	01	01	H6158_003_0	4			Select Care Drugs	3	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												
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								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00				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			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					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00				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												
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											93.78	47	47	47				89.79	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												
H6200	001	0	1	04	01	H6200_001_0	8		Y	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												
H6200	001	0	1	04	01	H6200_001_0	8		Y	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												
H6200	001	0	1	04	01	H6200_001_0	8		Y	Preferred Brand	4	10	1	2	3	1		111	01	100		1				30	60	90	1	2			90				30		31								47.00	94.00	141.00					45.00	90.00	135.00							112.50																47.00				47.00			1.57	1.50				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6200	001	0	1	04	01	H6200_001_0	8		Y	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												
H6200	001	0	1	04	01	H6200_001_0	8		Y	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6200	002	0	1	04	01	H6200_002_0	7		Y	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												
H6200	002	0	1	04	01	H6200_002_0	7		Y	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												
H6200	002	0	1	04	01	H6200_002_0	7		Y	Preferred Brand	4	10	1	2	3	1		111	01	100		1				30	60	90	1	2			90				30		31								47.00	94.00	141.00					45.00	90.00	135.00							112.50																47.00				47.00			1.57	1.50				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6200	002	0	1	04	01	H6200_002_0	7		Y	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												
H6200	002	0	1	04	01	H6200_002_0	7		Y	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6202	001	0	1	04	01	H6202_001_0	8		Y	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	2.00	4.00	4.00																			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, Select Care Drugs												
H6202	001	0	1	04	01	H6202_001_0	8		Y	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	8.00	16.00	22.00																			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, Select Care Drugs												
H6202	001	0	1	04	01	H6202_001_0	8		Y	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	37.00	74.00	109.00																			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, Select Care Drugs												
H6202	001	0	1	04	01	H6202_001_0	8		Y	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	100.00	194.00	290.00																			100.00	194.00	290.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6202	001	0	1	04	01	H6202_001_0	8		Y	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				908.49	28																				28																	28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6202	001	0	1	04	01	H6202_001_0	8		Y	Select Care Drugs	4	11	1	2	6	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6202	002	0	1	04	01	H6202_002_0	8		Y	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6202	002	0	1	04	01	H6202_002_0	8		Y	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	14.00																			6.00	12.00	0.00																6.00				6.00		0.20			0.20			0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6202	002	0	1	04	01	H6202_002_0	8		Y	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	37.00	74.00	109.00																			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, Select Care Drugs												
H6202	002	0	1	04	01	H6202_002_0	8		Y	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	100.00	194.00	290.00																			100.00	194.00	290.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6202	002	0	1	04	01	H6202_002_0	8		Y	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				1011.71	30																				30																	30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6202	002	0	1	04	01	H6202_002_0	8		Y	Select Care Drugs	4	11	1	2	6	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6237	007	1	1	01	01	H6237_007_1	9		Y	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	9		Y	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	9		Y	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	100	1	2	30	60	100				30		31								47.00	94.00	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	9		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	100	1	2	30	60	100				30		31								100.00	200.00	300.00					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												
H6237	007	1	1	01	01	H6237_007_1	9		Y	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											1000.89	29						1000.89	29						29																	29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6237	007	3	1	01	01	H6237_007_3	9		Y	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	9		Y	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	9		Y	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	100	1	2	30	60	100				30		31								47.00	94.00	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	9		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	100	1	2	30	60	100				30		31								100.00	200.00	300.00					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												
H6237	007	3	1	01	01	H6237_007_3	9		Y	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											1000.89	29						1000.89	29						29																	29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6237	008	1	1	01	01	H6237_008_1	8		Y	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	8		Y	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	8		Y	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	100	1	2	30	60	100				30		31								47.00	94.00	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	8		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	100	1	2	30	60	100				30		31								100.00	200.00	250.00					100.00	200.00	250.00					100.00	200.00	250.00																100.00				100.00			3.33	3.33	3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6237	008	1	1	01	01	H6237_008_1	8		Y	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											1069.92	31						1069.92	31						31																	31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6237	008	3	1	01	01	H6237_008_3	8		Y	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	8		Y	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	8		Y	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	100	1	2	30	60	100				30		31								47.00	94.00	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	8		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	100	1	2	30	60	100				30		31								100.00	200.00	250.00					100.00	200.00	250.00					100.00	200.00	250.00																100.00				100.00			3.33	3.33	3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6237	008	3	1	01	01	H6237_008_3	8		Y	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											1069.92	31						1069.92	31						31																	31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6306	005	0	1	01	01	H6306_005_0	9			Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6306	005	0	1	01	01	H6306_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	0.00	0.00	0.00																			0.00	0.00	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	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	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	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												
H6306	005	0	1	01	01	H6306_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				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	9			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	10		Y	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	2.00	4.00	6.00																			2.00	4.00	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	10		Y	Preferred Generic	4	01	1	2	1	3	111		01	111		1	30	60	90				1	2	30	60	90				30		31	2.00	4.00	6.00																			2.00	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	10		Y	Generic	4	11	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	15.00	30.00	45.00																			15.00	30.00	37.50																15.00				15.00		0.50			0.50			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6306	011	1	1	02	01	H6306_011_1	10		Y	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	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	10		Y	Non-Preferred Drug	4	11	1	1	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31				70.02	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	10		Y	Specialty Tier	4	11	1	1	5	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31					33	33	33																		33	33	33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6306	011	3	1	02	01	H6306_011_3	12		Y	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	2.00	4.00	6.00																			2.00	4.00	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	12		Y	Preferred Generic	4	01	1	2	1	3	111		01	111		1	30	60	90				1	2	30	60	90				30		31	2.00	4.00	6.00																			2.00	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	12		Y	Generic	4	11	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	15.00	30.00	45.00																			15.00	30.00	37.50																15.00				15.00		0.50			0.50			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6306	011	3	1	02	01	H6306_011_3	12		Y	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	117.50																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6306	011	3	1	02	01	H6306_011_3	12		Y	Non-Preferred Drug	4	11	1	1	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31				70.02	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	12		Y	Specialty Tier	4	11	1	1	5	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31					33	33	33																		33	33	33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6306	012	1	1	02	01	H6306_012_1	12		Y	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	5.00	10.00	15.00																			5.00	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	12		Y	Preferred Generic	4	01	1	2	1	3	111		01	111		1	30	60	90				1	2	30	60	90				30		31	5.00	10.00	15.00																			5.00	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	12		Y	Generic	4	11	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	20.00	40.00	60.00																			20.00	40.00	50.00																20.00				20.00		0.67			0.67			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6306	012	1	1	02	01	H6306_012_1	12		Y	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	117.50																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6306	012	1	1	02	01	H6306_012_1	12		Y	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	100.00	200.00	300.00																			100.00	200.00	250.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6306	012	1	1	02	01	H6306_012_1	12		Y	Specialty Tier	4	11	1	1	5	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31					30	30	30																		30	30	30															30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6306	012	5	1	02	01	H6306_012_5	12		Y	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	5.00	10.00	15.00																			5.00	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	12		Y	Preferred Generic	4	01	1	2	1	3	111		01	111		1	30	60	90				1	2	30	60	90				30		31	5.00	10.00	15.00																			5.00	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	12		Y	Generic	4	11	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	20.00	40.00	60.00																			20.00	40.00	50.00																20.00				20.00		0.67			0.67			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6306	012	5	1	02	01	H6306_012_5	12		Y	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	117.50																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6306	012	5	1	02	01	H6306_012_5	12		Y	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	100.00	200.00	300.00																			100.00	200.00	250.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6306	012	5	1	02	01	H6306_012_5	12		Y	Specialty Tier	4	11	1	1	5	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31					30	30	30																		30	30	30															30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6306	013	0	1	02	01	H6306_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	2.00	4.00	6.00																			2.00	6.00	0.00																2.00				2.00		0.07			0.07			0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6306	013	0	1	02	01	H6306_013_0	7			Preferred Generic	4	01	1	2	1	3	111		01	111		1	30	60	90				1	2	30	60	90				30		31	2.00	4.00	6.00																			2.00	6.00	0.00																2.00				2.00		0.07			0.07			0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H6306	013	0	1	02	01	H6306_013_0	7			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	20.00	0.00																8.00				8.00		0.27			0.27			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6306	013	0	1	02	01	H6306_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	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	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	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	7			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	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	6.00	0.00																2.00				2.00		0.07			0.07			0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6306	014	0	1	02	01	H6306_014_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	6.00	0.00																2.00				2.00		0.07			0.07			0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H6306	014	0	1	02	01	H6306_014_0	8			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	20.00	0.00																8.00				8.00		0.27			0.27			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6306	014	0	1	02	01	H6306_014_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	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	8			Non-Preferred Drug	4	11	1	1	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31				83.28	50	50	50																		50	50	50															50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6306	014	0	1	02	01	H6306_014_0	8			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	002	0	1	01	01	H6316_002_0	5		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								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	5		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								15.00	30.00	45.00					15.00	30.00	45.00					15.00	45.00	45.00																15.00				15.00			0.50	0.50	0.50			0.44	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6316	002	0	1	01	01	H6316_002_0	5		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								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	5		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	285.00	285.00																100.00				100.00			3.33	3.17	3.17			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6316	002	0	1	01	01	H6316_002_0	5		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												26							26						26																	26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6316	002	0	1	01	01	H6316_002_0	5		N	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								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	7		Y	Preferred Generic	4	01	1	2	1	1	111		01	100		1	30	60	90				2	2			90				30		31	0.00	0.00	0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H6322	001	0	1	01	01	H6322_001_0	7		Y	Preferred Generic	4	01	1	2	1	3	111		01	100		1	30	60	90				2	2			90				30		31	0.00	0.00	0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H6322	001	0	1	01	01	H6322_001_0	7		Y	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																					27.00																12.00				12.00		0.40						0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H6322	001	0	1	01	01	H6322_001_0	7		Y	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	7		Y	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	7		Y	Specialty Tier	4	11	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	001	0	1	01	01	H6322_001_0	7		Y	Select Care Drugs	4	11	1	2	6	1	111		01	100		1	30	60	90				2	2			90				30		31	0.00	0.00	0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H6322	001	0	1	01	01	H6322_001_0	7		Y	Select Care Drugs	4	11	1	2	6	3	111		01	100		1	30	60	90				2	2			90				30		31	0.00	0.00	0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H6322	002	0	1	01	01	H6322_002_0	7		Y	Preferred Generic	4	01	1	2	1	1	111		01	100		1	30	60	90				2	2			90				30		31	0.00	0.00	0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H6322	002	0	1	01	01	H6322_002_0	7		Y	Preferred Generic	4	01	1	2	1	3	111		01	100		1	30	60	90				2	2			90				30		31	0.00	0.00	0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H6322	002	0	1	01	01	H6322_002_0	7		Y	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																					27.00																12.00				12.00		0.40						0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H6322	002	0	1	01	01	H6322_002_0	7		Y	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	7		Y	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	7		Y	Specialty Tier	4	11	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	7		Y	Select Care Drugs	4	11	1	2	6	1	111		01	100		1	30	60	90				2	2			90				30		31	0.00	0.00	0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H6322	002	0	1	01	01	H6322_002_0	7		Y	Select Care Drugs	4	11	1	2	6	3	111		01	100		1	30	60	90				2	2			90				30		31	0.00	0.00	0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H6322	003	1	1	02	01	H6322_003_1	7		Y	Preferred Generic	4	01	1	2	1	1	111		01	100		1	30	60	90				2	2			90				30		31	0.00	0.00	0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H6322	003	1	1	02	01	H6322_003_1	7		Y	Preferred Generic	4	01	1	2	1	3	111		01	100		1	30	60	90				2	2			90				30		31	0.00	0.00	0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H6322	003	1	1	02	01	H6322_003_1	7		Y	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																					27.00																12.00				12.00		0.40						0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H6322	003	1	1	02	01	H6322_003_1	7		Y	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	7		Y	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	7		Y	Specialty Tier	4	11	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	7		Y	Select Care Drugs	4	11	1	2	6	1	111		01	100		1	30	60	90				2	2			90				30		31	0.00	0.00	0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H6322	003	1	1	02	01	H6322_003_1	7		Y	Select Care Drugs	4	11	1	2	6	3	111		01	100		1	30	60	90				2	2			90				30		31	0.00	0.00	0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H6322	003	2	1	02	01	H6322_003_2	7		Y	Preferred Generic	4	01	1	2	1	1	111		01	100		1	30	60	90				2	2			90				30		31	0.00	0.00	0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H6322	003	2	1	02	01	H6322_003_2	7		Y	Preferred Generic	4	01	1	2	1	3	111		01	100		1	30	60	90				2	2			90				30		31	0.00	0.00	0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H6322	003	2	1	02	01	H6322_003_2	7		Y	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																					27.00																12.00				12.00		0.40						0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H6322	003	2	1	02	01	H6322_003_2	7		Y	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	7		Y	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	7		Y	Specialty Tier	4	11	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	7		Y	Select Care Drugs	4	11	1	2	6	1	111		01	100		1	30	60	90				2	2			90				30		31	0.00	0.00	0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H6322	003	2	1	02	01	H6322_003_2	7		Y	Select Care Drugs	4	11	1	2	6	3	111		01	100		1	30	60	90				2	2			90				30		31	0.00	0.00	0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H6328	001	0	1	04	01	H6328_001_0	5		Y	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6328	001	0	1	04	01	H6328_001_0	5		Y	Preferred Generic	4	01	1	2	1	3	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H6328	001	0	1	04	01	H6328_001_0	5		Y	Generic	4	11	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	8.00	16.00	16.00																			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												
H6328	001	0	1	04	01	H6328_001_0	5		Y	Generic	4	11	1	2	2	3	111		01	111		1	30	60	90				1	2	30	60	90				30		31	8.00	16.00	16.00																			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										2	3	
H6328	001	0	1	04	01	H6328_001_0	5		Y	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	43.00	86.00	86.00																			43.00	86.00	86.00																43.00				43.00		1.43			1.43			1.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6328	001	0	1	04	01	H6328_001_0	5		Y	Preferred Brand	4	11	1	2	3	3	111		01	111		1	30	60	90				1	2	30	60	90				30		31	43.00	86.00	86.00																			43.00	86.00	86.00																43.00				43.00		1.43			1.43			1.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H6328	001	0	1	04	01	H6328_001_0	5		Y	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	92.00	184.00	184.00																			92.00	184.00	184.00																92.00				92.00		3.07			3.07			2.97	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6328	001	0	1	04	01	H6328_001_0	5		Y	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				1576.26	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6328	002	0	1	04	01	H6328_002_0	5		Y	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	2.00	4.00	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		Y	Preferred Generic	4	01	1	2	1	3	111		01	111		1	30	60	90				1	2	30	60	90				30		31	2.00	4.00	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		Y	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		Y	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		Y	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	45.00	90.00	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		Y	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		Y	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	194.00																			97.00	194.00	194.00																97.00				97.00		3.23			3.23			3.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6328	002	0	1	04	01	H6328_002_0	5		Y	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				1454.10	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6328	003	0	1	04	01	H6328_003_0	5		Y	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	100				1	2	30	60	100				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		Y	Preferred Generic	4	01	1	2	1	3	111		01	111		1	30	60	100				1	2	30	60	100				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		Y	Generic	4	11	1	2	2	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	14.00	28.00	28.00																			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		Y	Generic	4	11	1	2	2	3	111		01	111		1	30	60	100				1	2	30	60	100				30		31	14.00	28.00	28.00																			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		Y	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	47.00	94.00	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		Y	Preferred Brand	4	11	1	2	3	3	111		01	111		1	30	60	100				1	2	30	60	100				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		Y	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	100.00	200.00	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		Y	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				1339.16	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6348	002	0	1	04	01	H6348_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												
H6348	002	0	1	04	01	H6348_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												
H6348	002	0	1	04	01	H6348_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												
H6348	002	0	1	04	01	H6348_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											83.99	46	46	46				80.34	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	4			Specialty Tier	4	11	1	1	5	1		010	01		010	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	4			Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6348	007	0	1	04	01	H6348_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								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00				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	007	0	1	04	01	H6348_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												
H6348	007	0	1	04	01	H6348_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												
H6348	007	0	1	04	01	H6348_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											78.49	46	46	46				75.08	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	007	0	1	04	01	H6348_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												
H6348	007	0	1	04	01	H6348_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												
H6351	004	0	1	01	01	H6351_004_0	5			Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs												
H6351	004	0	1	01	01	H6351_004_0	5			Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs												
H6351	004	0	1	01	01	H6351_004_0	5			Preferred Brand	4	10	1	2	3	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31	35.00	70.00	105.00																			70.00	140.00	210.00																35.00				35.00		1.17			2.33			1.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs												
H6351	004	0	1	01	01	H6351_004_0	5			Non-Preferred Brand	4	10	1	2	4	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31	95.00	190.00	285.00																			190.00	380.00	570.00																95.00				95.00		3.17			6.33			3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs												
H6351	004	0	1	01	01	H6351_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					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	5			Select Diabetic Drugs	4	11	1	2	6	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, Select Diabetic Drugs												
H6378	001	0	1	01	01	H6378_001_0	6		N	Generic	2	01	1	2	1	1	111		01	100		1	30	60	100				1	2			100				30		31	6.75	13.50	20.25																					20.25																6.75				6.75		0.23						0.22	Generic, Brand												
H6378	001	0	1	01	01	H6378_001_0	6		N	Brand	2	11	1	1	2	1	111		01	100		1	30	60	100				1	2			100				30		31				92.28	25	25	25																				25															25			25								Generic, Brand												
H6379	001	0	1	01	01	H6379_001_0	6		Y	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	6		Y	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	6		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6379	001	0	1	01	01	H6379_001_0	6		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								100.00	200.00	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	6		Y	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	005	0	1	01	01	H6396_005_0	9		N	Preferred Generic	4	01	1	2	1	1	111		01	100		1	30	60	90				1	2			90				30		31	0.00	0.00	0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6396	005	0	1	01	01	H6396_005_0	9		N	Preferred Generic	4	01	1	2	1	3	111		01	100		1	30	60	90				1	2			90				30		31	0.00	0.00	0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H6396	005	0	1	01	01	H6396_005_0	9		N	Generic	4	01	1	1	2	1	111		01	100		1	30	60	90				1	2			90				30		31				5.59	25	25	25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6396	005	0	1	01	01	H6396_005_0	9		N	Preferred Brand	4	11	1	1	3	1	111		01	100		1	30	60	90				1	2			90				30		31				72.10	25	25	25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6396	005	0	1	01	01	H6396_005_0	9		N	Non-Preferred Drug	4	11	1	1	4	1	111		01	100		1	30	60	90				1	2			90				30		31				61.77	25	25	25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6396	005	0	1	01	01	H6396_005_0	9		N	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31				776.73	25																																					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6396	014	0	1	01	01	H6396_014_0	8		N	Preferred Generic	4	01	1	2	1	1	111		01	100		1	30	60	90				1	2			90				30		31	0.00	0.00	0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6396	014	0	1	01	01	H6396_014_0	8		N	Preferred Generic	4	01	1	2	1	3	111		01	100		1	30	60	90				1	2			90				30		31	0.00	0.00	0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H6396	014	0	1	01	01	H6396_014_0	8		N	Generic	4	01	1	1	2	1	111		01	100		1	30	60	90				1	2			90				30		31				5.51	25	25	25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6396	014	0	1	01	01	H6396_014_0	8		N	Preferred Brand	4	11	1	1	3	1	111		01	100		1	30	60	90				1	2			90				30		31				70.97	25	25	25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6396	014	0	1	01	01	H6396_014_0	8		N	Non-Preferred Drug	4	11	1	1	4	1	111		01	100		1	30	60	90				1	2			90				30		31				60.19	25	25	25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6396	014	0	1	01	01	H6396_014_0	8		N	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31				805.57	25																																					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6396	015	0	1	01	01	H6396_015_0	8		N	Preferred Generic	4	01	1	2	1	1	111		01	100		1	30	60	90				1	2			90				30		31	0.00	0.00	0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6396	015	0	1	01	01	H6396_015_0	8		N	Preferred Generic	4	01	1	2	1	3	111		01	100		1	30	60	90				1	2			90				30		31	0.00	0.00	0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H6396	015	0	1	01	01	H6396_015_0	8		N	Generic	4	01	1	1	2	1	111		01	100		1	30	60	90				1	2			90				30		31				5.76	25	25	25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6396	015	0	1	01	01	H6396_015_0	8		N	Preferred Brand	4	11	1	1	3	1	111		01	100		1	30	60	90				1	2			90				30		31				72.12	25	25	25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6396	015	0	1	01	01	H6396_015_0	8		N	Non-Preferred Drug	4	11	1	1	4	1	111		01	100		1	30	60	90				1	2			90				30		31				63.06	25	25	25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6396	015	0	1	01	01	H6396_015_0	8		N	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31				735.96	25																																					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6408	001	0	1	01	01	H6408_001_0	4		N	Preferred Generic	4	11	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								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												
H6408	001	0	1	01	01	H6408_001_0	4		N	Preferred Generic	4	11	1	2	1	3		111	01	111		1				30	60	90	1	2	30	60	90				30		31								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		
H6408	001	0	1	01	01	H6408_001_0	4		N	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					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												
H6408	001	0	1	01	01	H6408_001_0	4		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					47.00	94.00	141.00					47.00	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												
H6408	001	0	1	01	01	H6408_001_0	4		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	300.00					100.00	200.00	300.00					100.00	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												
H6408	001	0	1	01	01	H6408_001_0	4		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											830.00	33						830.00	33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6408	002	0	1	01	01	H6408_002_0	4		N	Preferred Generic	4	11	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								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												
H6408	002	0	1	01	01	H6408_002_0	4		N	Preferred Generic	4	11	1	2	1	3		111	01	111		1				30	60	90	1	2	30	60	90				30		31								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		
H6408	002	0	1	01	01	H6408_002_0	4		N	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					10.00	20.00	30.00					0.00	0.00	0.00																20.00				20.00			0.67	0.33	0.00			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6408	002	0	1	01	01	H6408_002_0	4		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					47.00	94.00	141.00					47.00	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												
H6408	002	0	1	01	01	H6408_002_0	4		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	300.00					100.00	200.00	300.00					100.00	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												
H6408	002	0	1	01	01	H6408_002_0	4		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											830.00	28						830.00	28						28																	28			28								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								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00				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			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
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								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00				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												
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								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00				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										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								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00				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	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								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												
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												29							29												29						29					29			29								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	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								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00				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	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								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												
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	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								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00				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	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								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												
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	011	0	1	01	01	H6446_011_0	4			Preferred Generic	4	11	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								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												
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	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												
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	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, 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											98.72	44	44	44				98.72	44	44	44										44	44	44				44	44	44			44			44								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			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	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		N	Preferred Generic	4	11	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								19.00	38.00	57.00					0.00	0.00	0.00											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												
H6446	013	0	1	01	01	H6446_013_0	4		N	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	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												
H6446	013	0	1	01	01	H6446_013_0	4		N	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	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, Select Care Drugs												
H6446	013	0	1	01	01	H6446_013_0	4		N	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											99.60	44	44	44				99.60	44	44	44										44	44	44				44	44	44			44			44								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6446	013	0	1	01	01	H6446_013_0	4		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							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		N	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	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		Y	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 Diabetic Drugs												
H6446	017	0	1	01	01	H6446_017_0	4		Y	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 Diabetic Drugs										2	2	3
H6446	017	0	1	01	01	H6446_017_0	4		Y	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					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 Diabetic Drugs												
H6446	017	0	1	01	01	H6446_017_0	4		Y	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					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 Diabetic Drugs										1		
H6446	017	0	1	01	01	H6446_017_0	4		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00				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		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	300.00					90.00	180.00	270.00											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		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs												
H6446	017	0	1	01	01	H6446_017_0	4		Y	Select Diabetic Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				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		Y	Select Diabetic 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 Diabetic Drugs										2	1	
H6453	005	0	1	01	01	H6453_005_0	6			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					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	6			Preferred Generic	4	01	1	2	1	3		111	01		111	1				30	60	100	1	2				30	60	100	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	6			Generic	4	01	1	2	2	1		111	01		111	1				30	60	100	1	2				30	60	100	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	6			Generic	4	01	1	2	2	3		111	01		111	1				30	60	100	1	2				30	60	100	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	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	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	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	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00				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	6			Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											1282.26	33						766.23	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6453	006	0	1	01	01	H6453_006_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					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	7			Preferred Generic	4	01	1	2	1	3		111	01		111	1				30	60	100	1	2				30	60	100	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	7			Generic	4	01	1	2	2	1		111	01		111	1				30	60	100	1	2				30	60	100	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	7			Generic	4	01	1	2	2	3		111	01		111	1				30	60	100	1	2				30	60	100	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	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					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	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	200.00	300.00				100.00	200.00	300.00				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	7			Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											989.53	33						710.76	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6453	007	1	1	01	01	H6453_007_1	5			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					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	5			Preferred Generic	4	01	1	2	1	3		111	01		111	1				30	60	100	1	2				30	60	100	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	5			Generic	4	01	1	2	2	1		111	01		111	1				30	60	100	1	2				30	60	100	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	5			Generic	4	01	1	2	2	3		111	01		111	1				30	60	100	1	2				30	60	100	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	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					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	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					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00				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	5			Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											1073.59	33						754.83	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6453	007	2	1	01	01	H6453_007_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	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	7			Preferred Generic	4	01	1	2	1	3		111	01		111	1				30	60	100	1	2				30	60	100	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	7			Generic	4	01	1	2	2	1		111	01		111	1				30	60	100	1	2				30	60	100	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	7			Generic	4	01	1	2	2	3		111	01		111	1				30	60	100	1	2				30	60	100	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	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					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	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	200.00	300.00				100.00	200.00	300.00				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	7			Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											1073.59	33						754.83	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6453	008	1	1	01	01	H6453_008_1	5			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					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	5			Preferred Generic	4	01	1	2	1	3		111	01		111	1				30	60	100	1	2				30	60	100	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	5			Generic	4	01	1	2	2	1		111	01		111	1				30	60	100	1	2				30	60	100	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	5			Generic	4	01	1	2	2	3		111	01		111	1				30	60	100	1	2				30	60	100	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	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					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	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					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00				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	5			Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											876.94	33						618.41	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6453	008	2	1	01	01	H6453_008_2	6			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					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	6			Preferred Generic	4	01	1	2	1	3		111	01		111	1				30	60	100	1	2				30	60	100	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	6			Generic	4	01	1	2	2	1		111	01		111	1				30	60	100	1	2				30	60	100	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	6			Generic	4	01	1	2	2	3		111	01		111	1				30	60	100	1	2				30	60	100	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	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	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	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	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00				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	6			Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											876.94	33						618.41	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6453	009	1	1	01	01	H6453_009_1	5			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					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	5			Preferred Generic	4	01	1	2	1	3		111	01		111	1				30	60	100	1	2				30	60	100	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	5			Generic	4	01	1	2	2	1		111	01		111	1				30	60	100	1	2				30	60	100	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	5			Generic	4	01	1	2	2	3		111	01		111	1				30	60	100	1	2				30	60	100	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	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					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	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					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00				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	5			Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											928.54	33						651.08	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6453	009	2	1	01	01	H6453_009_2	6			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					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	6			Preferred Generic	4	01	1	2	1	3		111	01		111	1				30	60	100	1	2				30	60	100	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	6			Generic	4	01	1	2	2	1		111	01		111	1				30	60	100	1	2				30	60	100	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	6			Generic	4	01	1	2	2	3		111	01		111	1				30	60	100	1	2				30	60	100	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	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	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	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	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00				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	6			Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											928.54	33						651.08	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6453	010	1	1	01	01	H6453_010_1	5			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					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	5			Preferred Generic	4	01	1	2	1	3		111	01		111	1				30	60	100	1	2				30	60	100	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	5			Generic	4	01	1	2	2	1		111	01		111	1				30	60	100	1	2				30	60	100	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	5			Generic	4	01	1	2	2	3		111	01		111	1				30	60	100	1	2				30	60	100	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	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					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	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					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00				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	5			Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											1396.89	33						644.64	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6453	010	2	1	01	01	H6453_010_2	6			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					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	6			Preferred Generic	4	01	1	2	1	3		111	01		111	1				30	60	100	1	2				30	60	100	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	6			Generic	4	01	1	2	2	1		111	01		111	1				30	60	100	1	2				30	60	100	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	6			Generic	4	01	1	2	2	3		111	01		111	1				30	60	100	1	2				30	60	100	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	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	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	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	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00				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	6			Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											1396.89	33						644.64	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6453	011	0	1	01	01	H6453_011_0	6			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					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	011	0	1	01	01	H6453_011_0	6			Preferred Generic	4	01	1	2	1	3		111	01		111	1				30	60	100	1	2				30	60	100	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	011	0	1	01	01	H6453_011_0	6			Generic	4	01	1	2	2	1		111	01		111	1				30	60	100	1	2				30	60	100	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	011	0	1	01	01	H6453_011_0	6			Generic	4	01	1	2	2	3		111	01		111	1				30	60	100	1	2				30	60	100	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	011	0	1	01	01	H6453_011_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	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	011	0	1	01	01	H6453_011_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	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00				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	011	0	1	01	01	H6453_011_0	6			Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											946.66	29						594.36	29												29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6502	002	0	1	04	01	H6502_002_0	5		Y	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	5		Y	Generic	4	11	1	2	2	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	10.00	20.00	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	5		Y	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	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	5		Y	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	100.00	200.00	300.00																			100.00	200.00	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	5		Y	Specialty Tier	4	11	1	3	5	1	010		01	010		1	30								30						30		31	100.00			1320.00	33																	100.00			33															100.00		33		100.00	33	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	7		Y	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	7		Y	Generic	4	11	1	2	2	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	10.00	20.00	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	7		Y	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	141.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6502	004	0	1	04	01	H6502_004_0	7		Y	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	100.00	200.00	300.00																			100.00	200.00	300.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6502	004	0	1	04	01	H6502_004_0	7		Y	Specialty Tier	4	11	1	3	5	1	010		01	010		1	30								30						30		31	100.00			1320.00	33																	100.00			33															100.00		33		100.00	33	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	6		Y	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	6		Y	Generic	4	11	1	2	2	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	10.00	20.00	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	6		Y	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	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	6		Y	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	100.00	200.00	300.00																			100.00	200.00	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	6		Y	Specialty Tier	4	11	1	3	5	1	010		01	010		1	30								30						30		31	100.00			1320.00	33																	100.00			33															100.00		33		100.00	33	3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6526	001	0	1	02	01	H6526_001_0	2		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6526	001	0	1	02	01	H6526_001_0	2		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H6526	001	0	1	02	01	H6526_001_0	2		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6526	001	0	1	02	01	H6526_001_0	2		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H6526	001	0	1	02	01	H6526_001_0	2		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6526	001	0	1	02	01	H6526_001_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6526	001	0	1	02	01	H6526_001_0	2		Y	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												
H6526	002	0	1	02	01	H6526_002_0	2		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6526	002	0	1	02	01	H6526_002_0	2		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H6526	002	0	1	02	01	H6526_002_0	2		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6526	002	0	1	02	01	H6526_002_0	2		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H6526	002	0	1	02	01	H6526_002_0	2		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6526	002	0	1	02	01	H6526_002_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6526	002	0	1	02	01	H6526_002_0	2		Y	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												
H6528	006	0	1	04	01	H6528_006_0	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6528	006	0	1	04	01	H6528_006_0	3		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H6528	006	0	1	04	01	H6528_006_0	3		Y	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												
H6528	006	0	1	04	01	H6528_006_0	3		Y	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
H6528	006	0	1	04	01	H6528_006_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6528	006	0	1	04	01	H6528_006_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		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												
H6528	006	0	1	04	01	H6528_006_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				312.00	28																										28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6528	031	0	1	04	01	H6528_031_0	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6528	031	0	1	04	01	H6528_031_0	3		Y	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	031	0	1	04	01	H6528_031_0	3		Y	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												
H6528	031	0	1	04	01	H6528_031_0	3		Y	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
H6528	031	0	1	04	01	H6528_031_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6528	031	0	1	04	01	H6528_031_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		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												
H6528	031	0	1	04	01	H6528_031_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				492.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6528	033	0	1	04	01	H6528_033_0	2		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6528	033	0	1	04	01	H6528_033_0	2		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H6528	033	0	1	04	01	H6528_033_0	2		Y	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												
H6528	033	0	1	04	01	H6528_033_0	2		Y	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
H6528	033	0	1	04	01	H6528_033_0	2		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6528	033	0	1	04	01	H6528_033_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6528	033	0	1	04	01	H6528_033_0	2		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				388.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6528	035	0	1	04	01	H6528_035_0	2		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6528	035	0	1	04	01	H6528_035_0	2		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H6528	035	0	1	04	01	H6528_035_0	2		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6528	035	0	1	04	01	H6528_035_0	2		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H6528	035	0	1	04	01	H6528_035_0	2		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6528	035	0	1	04	01	H6528_035_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6528	035	0	1	04	01	H6528_035_0	2		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				396.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6528	036	0	1	04	01	H6528_036_0	2		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6528	036	0	1	04	01	H6528_036_0	2		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H6528	036	0	1	04	01	H6528_036_0	2		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6528	036	0	1	04	01	H6528_036_0	2		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H6528	036	0	1	04	01	H6528_036_0	2		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6528	036	0	1	04	01	H6528_036_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6528	036	0	1	04	01	H6528_036_0	2		Y	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												
H6528	038	0	1	04	01	H6528_038_0	2		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6528	038	0	1	04	01	H6528_038_0	2		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H6528	038	0	1	04	01	H6528_038_0	2		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6528	038	0	1	04	01	H6528_038_0	2		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H6528	038	0	1	04	01	H6528_038_0	2		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6528	038	0	1	04	01	H6528_038_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6528	038	0	1	04	01	H6528_038_0	2		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				372.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6528	039	0	1	04	01	H6528_039_0	2		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6528	039	0	1	04	01	H6528_039_0	2		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H6528	039	0	1	04	01	H6528_039_0	2		Y	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												
H6528	039	0	1	04	01	H6528_039_0	2		Y	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
H6528	039	0	1	04	01	H6528_039_0	2		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6528	039	0	1	04	01	H6528_039_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6528	039	0	1	04	01	H6528_039_0	2		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				461.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6528	041	0	1	04	01	H6528_041_0	2		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6528	041	0	1	04	01	H6528_041_0	2		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H6528	041	0	1	04	01	H6528_041_0	2		Y	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												
H6528	041	0	1	04	01	H6528_041_0	2		Y	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
H6528	041	0	1	04	01	H6528_041_0	2		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6528	041	0	1	04	01	H6528_041_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6528	041	0	1	04	01	H6528_041_0	2		Y	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												
H6529	001	1	1	01	01	H6529_001_1	6		Y	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, Select Care Drugs												
H6529	001	1	1	01	01	H6529_001_1	6		Y	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, Select Care Drugs												
H6529	001	1	1	01	01	H6529_001_1	6		Y	Preferred Brand	4	11	1	2	3	1		111	10	111		1				30	60	90	1	2	30	60	90					10	31								47.00	94.00	141.00					42.00	84.00	126.00					47.00	94.00	141.00																	47.00			47.00			1.57	1.40	1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6529	001	1	1	01	01	H6529_001_1	6		Y	Non-Preferred Drug	4	11	1	2	4	1		111	10	111		1				30	60	90	1	2	30	60	90					10	31								100.00	200.00	300.00					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, Select Care Drugs												
H6529	001	1	1	01	01	H6529_001_1	6		Y	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, Select Care Drugs												
H6529	001	1	1	01	01	H6529_001_1	6		Y	Select Care Drugs	4	11	1	2	6	1		111	10	111		1				30	60	90	1	2	30	60	90					10	31								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																	0.00			0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6529	001	2	1	01	01	H6529_001_2	6		Y	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, Select Care Drugs												
H6529	001	2	1	01	01	H6529_001_2	6		Y	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, Select Care Drugs												
H6529	001	2	1	01	01	H6529_001_2	6		Y	Preferred Brand	4	11	1	2	3	1		111	10	111		1				30	60	90	1	2	30	60	90					10	31								47.00	94.00	141.00					42.00	84.00	126.00					47.00	94.00	141.00																	47.00			47.00			1.57	1.40	1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6529	001	2	1	01	01	H6529_001_2	6		Y	Non-Preferred Drug	4	11	1	2	4	1		111	10	111		1				30	60	90	1	2	30	60	90					10	31								100.00	200.00	300.00					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, Select Care Drugs												
H6529	001	2	1	01	01	H6529_001_2	6		Y	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, Select Care Drugs												
H6529	001	2	1	01	01	H6529_001_2	6		Y	Select Care Drugs	4	11	1	2	6	1		111	10	111		1				30	60	90	1	2	30	60	90					10	31								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																	0.00			0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6529	002	0	1	01	01	H6529_002_0	8		Y	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, Select Care Drugs												
H6529	002	0	1	01	01	H6529_002_0	8		Y	Generic	4	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					8.00	16.00	0.00																	15.00			15.00			0.50	0.17	0.27			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6529	002	0	1	01	01	H6529_002_0	8		Y	Preferred Brand	4	11	1	2	3	1		111	10	111		1				30	60	90	1	2	30	60	90					10	31								47.00	94.00	141.00					37.00	74.00	111.00					47.00	94.00	141.00																	47.00			47.00			1.57	1.23	1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6529	002	0	1	01	01	H6529_002_0	8		Y	Non-Preferred Drug	4	11	1	2	4	1		111	10	111		1				30	60	90	1	2	30	60	90					10	31								100.00	200.00	300.00					90.00	180.00	270.00					100.00	200.00	300.00																	100.00			100.00			3.33	3.00	3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6529	002	0	1	01	01	H6529_002_0	8		Y	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, Select Care Drugs												
H6529	002	0	1	01	01	H6529_002_0	8		Y	Select Care Drugs	4	11	1	2	6	1		111	10	111		1				30	60	90	1	2	30	60	90					10	31								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																	0.00			0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6545	001	0	1	04	01	H6545_001_0	10		Y	Preferred Generic	4	11	1	2	1	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6545	001	0	1	04	01	H6545_001_0	10		Y	Preferred Generic	4	11	1	2	1	3	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H6545	001	0	1	04	01	H6545_001_0	10		Y	Generic	4	11	3	2	2	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	5.00	10.00	15.00																			5.00	10.00	12.50																5.00				5.00		0.17			0.17			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6545	001	0	1	04	01	H6545_001_0	10		Y	Generic	4	11	3	2	2	3	111		01	111		1	30	60	100				1	2	30	60	100				30		31	5.00	10.00	15.00																			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										2	2	2
H6545	001	0	1	04	01	H6545_001_0	10		Y	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	47.00	94.00	141.00																			47.00	94.00	117.50																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6545	001	0	1	04	01	H6545_001_0	10		Y	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	100.00	200.00	300.00																			100.00	200.00	300.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6545	001	0	1	04	01	H6545_001_0	10		Y	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												
H6550	003	0	1	01	01	H6550_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												
H6550	003	0	1	01	01	H6550_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												
H6550	003	0	1	01	01	H6550_003_0	4			Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											47.00	94.00	141.00				37.00	74.00	74.00				47.00				47.00			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	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												
H6550	003	0	1	01	01	H6550_003_0	4			Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6550	003	0	1	01	01	H6550_003_0	4			Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	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	4			Preferred Generic	3	11	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								19.00	38.00	57.00					0.00	0.00	0.00											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												
H6550	006	0	1	01	01	H6550_006_0	4			Generic	3	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					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												
H6550	006	0	1	01	01	H6550_006_0	4			Preferred Brand	3	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	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, Select Care Drugs												
H6550	006	0	1	01	01	H6550_006_0	4			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	45	45	45				98.69	45	45	45										45	45	45				45	45	45			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6550	006	0	1	01	01	H6550_006_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, Select Care Drugs												
H6550	006	0	1	01	01	H6550_006_0	4			Select Care Drugs	3	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			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	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												
H6550	007	0	1	01	01	H6550_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												
H6550	007	0	1	01	01	H6550_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												
H6550	007	0	1	01	01	H6550_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												
H6550	007	0	1	01	01	H6550_007_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												
H6550	007	0	1	01	01	H6550_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												
H6586	001	0	1	04	01	H6586_001_0	9		Y	Preferred Generic	4	11	1	2	1	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6586	001	0	1	04	01	H6586_001_0	9		Y	Preferred Generic	4	11	1	2	1	3	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H6586	001	0	1	04	01	H6586_001_0	9		Y	Generic	4	11	3	2	2	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	10.00	20.00	30.00																			10.00	20.00	25.00																10.00				10.00		0.33			0.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6586	001	0	1	04	01	H6586_001_0	9		Y	Generic	4	11	3	2	2	3	111		01	111		1	30	60	100				1	2	30	60	100				30		31	10.00	20.00	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										2	3	3
H6586	001	0	1	04	01	H6586_001_0	9		Y	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	47.00	94.00	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												
H6586	001	0	1	04	01	H6586_001_0	9		Y	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	100.00	200.00	300.00																			100.00	200.00	300.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6586	001	0	1	04	01	H6586_001_0	9		Y	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												
H6586	002	0	1	04	01	H6586_002_0	9		Y	Preferred Generic	4	11	1	2	1	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6586	002	0	1	04	01	H6586_002_0	9		Y	Preferred Generic	4	11	1	2	1	3	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H6586	002	0	1	04	01	H6586_002_0	9		Y	Generic	4	11	3	2	2	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	10.00	20.00	30.00																			10.00	20.00	25.00																10.00				10.00		0.33			0.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6586	002	0	1	04	01	H6586_002_0	9		Y	Generic	4	11	3	2	2	3	111		01	111		1	30	60	100				1	2	30	60	100				30		31	10.00	20.00	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										2	3	3
H6586	002	0	1	04	01	H6586_002_0	9		Y	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	47.00	94.00	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												
H6586	002	0	1	04	01	H6586_002_0	9		Y	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	100.00	200.00	300.00																			100.00	200.00	300.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6586	002	0	1	04	01	H6586_002_0	9		Y	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												
H6586	003	0	1	04	01	H6586_003_0	9		Y	Preferred Generic	4	11	1	2	1	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6586	003	0	1	04	01	H6586_003_0	9		Y	Preferred Generic	4	11	1	2	1	3	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H6586	003	0	1	04	01	H6586_003_0	9		Y	Generic	4	11	3	2	2	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6586	003	0	1	04	01	H6586_003_0	9		Y	Generic	4	11	3	2	2	3	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	3
H6586	003	0	1	04	01	H6586_003_0	9		Y	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	47.00	94.00	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												
H6586	003	0	1	04	01	H6586_003_0	9		Y	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	100.00	200.00	300.00																			100.00	200.00	300.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6586	003	0	1	04	01	H6586_003_0	9		Y	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												
H6594	001	0	1	04	01	H6594_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												
H6594	001	0	1	04	01	H6594_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												
H6594	001	0	1	04	01	H6594_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												
H6594	001	0	1	04	01	H6594_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											79.80	45	45	45				76.26	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	4			Specialty Tier	4	11	1	1	5	1		010	01		010	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	4			Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			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	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												
H6594	002	0	1	04	01	H6594_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												
H6594	002	0	1	04	01	H6594_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												
H6594	002	0	1	04	01	H6594_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											93.91	50	50	50				90.15	48	48	48										50	50	50				48	48	48			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6594	002	0	1	04	01	H6594_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												
H6594	002	0	1	04	01	H6594_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												
H6594	002	0	1	04	01	H6594_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	
H6594	003	0	1	04	01	H6594_003_0	4			Preferred Generic	3	11	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								19.00	38.00	57.00					0.00	0.00	0.00											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												
H6594	003	0	1	04	01	H6594_003_0	4			Generic	3	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					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												
H6594	003	0	1	04	01	H6594_003_0	4			Preferred Brand	3	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	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, Select Care Drugs												
H6594	003	0	1	04	01	H6594_003_0	4			Non-Preferred Drug	3	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											99.44	46	46	46				99.44	46	46	46										46	46	46				46	46	46			46			46								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6594	003	0	1	04	01	H6594_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, Select Care Drugs												
H6594	003	0	1	04	01	H6594_003_0	4			Select Care Drugs	3	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6594	004	0	1	04	01	H6594_004_0	4			Preferred Generic	4	11	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								19.00	38.00	57.00					0.00	0.00	0.00											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												
H6594	004	0	1	04	01	H6594_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	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												
H6594	004	0	1	04	01	H6594_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	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, Select Care Drugs												
H6594	004	0	1	04	01	H6594_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											99.18	47	47	47				99.18	47	47	47										47	47	47				47	47	47			47			47								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6594	004	0	1	04	01	H6594_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												
H6594	004	0	1	04	01	H6594_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												
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								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00				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												
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											78.11	45	45	45				74.64	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												29							29												29						29					29			29								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	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, 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								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												
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	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, 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											94.20	50	50	50				94.20	50	50	50										50	50	50				50	50	50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
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			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	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	3		Y	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	001	0	1	01	01	H6622_001_0	3		Y	Preferred Generic	4	11	3	2	1	3	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H6622	001	0	1	01	01	H6622_001_0	3		Y	Generic	4	11	3	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	0.00		0.00																									20.00		60.00				0.00		0.00				0.00				0.00		0				0.67	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	001	0	1	01	01	H6622_001_0	3		Y	Generic	4	11	3	2	2	3	110		01		110	1	30		90				2	2				30		90	30		31	0.00		0.00																									20.00		60.00				0.00		0.00				0.00				0.00		0				0.67	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H6622	001	0	1	01	01	H6622_001_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		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	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		290.00				100.00				100.00		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	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	004	0	1	01	01	H6622_004_0	4		Y	Preferred Generic	4	11	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	004	0	1	01	01	H6622_004_0	4		Y	Generic	4	11	1	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	0.00		0.00																									20.00		60.00				0.00		0.00				0.00				0.00		0				0.67	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	004	0	1	01	01	H6622_004_0	4		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	45.00		135.00																									47.00		141.00				45.00		125.00				45.00				45.00		1.50				1.57	1.50	1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	004	0	1	01	01	H6622_004_0	4		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	95.00		285.00																									100.00		300.00				95.00		275.00				95.00				95.00		3.17				3.33	3.17	3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	004	0	1	01	01	H6622_004_0	4		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	005	0	1	01	01	H6622_005_0	4		Y	Preferred Generic	4	11	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	005	0	1	01	01	H6622_005_0	4		Y	Generic	4	11	1	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	0.00		0.00																									20.00		60.00				0.00		0.00				0.00				0.00		0				0.67	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	005	0	1	01	01	H6622_005_0	4		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	45.00		135.00																									47.00		141.00				45.00		125.00				45.00				45.00		1.50				1.57	1.50	1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	005	0	1	01	01	H6622_005_0	4		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	95.00		285.00																									100.00		300.00				95.00		275.00				95.00				95.00		3.17				3.33	3.17	3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	005	0	1	01	01	H6622_005_0	4		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	007	0	1	01	01	H6622_007_0	2		Y	Preferred Generic	4	11	1	2	1	1	110		01		110	1	30		100				1	2				30		100	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	007	0	1	01	01	H6622_007_0	2		Y	Preferred Generic	4	11	1	2	1	3	110		01		110	1	30		100				1	2				30		100	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H6622	007	0	1	01	01	H6622_007_0	2		Y	Generic	4	11	1	2	2	1	110		01		110	1	30		100				2	2				30		100	30		31	0.00		0.00																									20.00		60.00				0.00		0.00				0.00				0.00		0				0.67	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	007	0	1	01	01	H6622_007_0	2		Y	Generic	4	11	1	2	2	3	110		01		110	1	30		100				2	2				30		100	30		31	0.00		0.00																									20.00		60.00				0.00		0.00				0.00				0.00		0				0.67	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H6622	007	0	1	01	01	H6622_007_0	2		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		100				2	2				30		100	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												
H6622	007	0	1	01	01	H6622_007_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		100				2	2				30		100	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												
H6622	007	0	1	01	01	H6622_007_0	2		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					29																										29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	008	0	1	01	01	H6622_008_0	2		N	Preferred Generic	4	11	1	2	1	1	110		01		110	1	30		100				1	2				30		100	30		31	6.00		18.00																									10.00		30.00				6.00		0.00				6.00				6.00		0.20				0.33	0.20	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	008	0	1	01	01	H6622_008_0	2		N	Generic	4	11	1	2	2	1	110		01		110	1	30		100				2	2				30		100	30		31	20.00		60.00																									20.00		60.00				20.00		0.00				20.00				20.00		0.67				0.67	0.67	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	008	0	1	01	01	H6622_008_0	2		N	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		100				2	2				30		100	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												
H6622	008	0	1	01	01	H6622_008_0	2		N	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		100				2	2				30		100	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												
H6622	008	0	1	01	01	H6622_008_0	2		N	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	010	0	1	02	01	H6622_010_0	4		Y	Preferred Generic	4	11	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	010	0	1	02	01	H6622_010_0	4		Y	Generic	4	11	1	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	0.00		0.00																									20.00		60.00				0.00		0.00				0.00				0.00		0				0.67	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	010	0	1	02	01	H6622_010_0	4		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	45.00		135.00																									47.00		141.00				45.00		125.00				45.00				45.00		1.50				1.57	1.50	1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	010	0	1	02	01	H6622_010_0	4		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	95.00		285.00																									100.00		300.00				95.00		275.00				95.00				95.00		3.17				3.33	3.17	3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	010	0	1	02	01	H6622_010_0	4		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	013	0	1	02	01	H6622_013_0	5		Y	Preferred Generic	4	11	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	013	0	1	02	01	H6622_013_0	5		Y	Preferred Generic	4	11	1	2	1	3	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H6622	013	0	1	02	01	H6622_013_0	5		Y	Generic	4	11	1	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	0.00		0.00																									20.00		60.00				0.00		0.00				0.00				0.00		0				0.67	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	013	0	1	02	01	H6622_013_0	5		Y	Generic	4	11	1	2	2	3	110		01		110	1	30		90				2	2				30		90	30		31	0.00		0.00																									20.00		60.00				0.00		0.00				0.00				0.00		0				0.67	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H6622	013	0	1	02	01	H6622_013_0	5		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	013	0	1	02	01	H6622_013_0	5		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		290.00				100.00				100.00		3.33				3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	013	0	1	02	01	H6622_013_0	5		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	014	0	1	02	01	H6622_014_0	4		Y	Preferred Generic	4	11	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	014	0	1	02	01	H6622_014_0	4		Y	Preferred Generic	4	11	1	2	1	3	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H6622	014	0	1	02	01	H6622_014_0	4		Y	Generic	4	11	1	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	0.00		0.00																									20.00		60.00				0.00		0.00				0.00				0.00		0				0.67	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	014	0	1	02	01	H6622_014_0	4		Y	Generic	4	11	1	2	2	3	110		01		110	1	30		90				2	2				30		90	30		31	0.00		0.00																									20.00		60.00				0.00		0.00				0.00				0.00		0				0.67	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H6622	014	0	1	02	01	H6622_014_0	4		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	014	0	1	02	01	H6622_014_0	4		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		290.00				100.00				100.00		3.33				3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	014	0	1	02	01	H6622_014_0	4		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	017	0	1	01	01	H6622_017_0	5		Y	Preferred Generic	4	11	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	7.00		21.00																									10.00		30.00				7.00		0.00				7.00				7.00		0.23				0.33	0.23	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6622	017	0	1	01	01	H6622_017_0	5		Y	Generic	4	11	1	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	17.00		51.00																									20.00		60.00				17.00		0.00				17.00				17.00		0.57				0.67	0.57	0.55	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6622	017	0	1	01	01	H6622_017_0	5		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				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												
H6622	017	0	1	01	01	H6622_017_0	5		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		290.00				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												
H6622	017	0	1	01	01	H6622_017_0	5		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					29																										29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6622	017	0	1	01	01	H6622_017_0	5		Y	Select Care Drugs	4	11	1	2	6	1	110		01		110	1	30		90				1	2				30		90	30		31	7.00		21.00																									11.00		33.00				7.00		0.00				7.00				7.00		0.23				0.37	0.23	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6622	019	0	1	01	01	H6622_019_0	4		Y	Preferred Generic	4	11	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	1.00		3.00																									10.00		30.00				1.00		0.00				1.00				1.00		0.03				0.33	0.03	0.03	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	019	0	1	01	01	H6622_019_0	4		Y	Generic	4	11	1	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	4.00		12.00																									20.00		60.00				4.00		0.00				4.00				4.00		0.13				0.67	0.13	0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	019	0	1	01	01	H6622_019_0	4		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		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	4		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	97.00		291.00																									100.00		300.00				97.00		281.00				97.00				97.00		3.23				3.33	3.23	3.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	019	0	1	01	01	H6622_019_0	4		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					31																										31						31					31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	021	1	1	02	01	H6622_021_1	4		Y	Preferred Generic	4	11	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	021	1	1	02	01	H6622_021_1	4		Y	Preferred Generic	4	11	1	2	1	3	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H6622	021	1	1	02	01	H6622_021_1	4		Y	Generic	4	11	1	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	0.00		0.00																									20.00		60.00				0.00		0.00				0.00				0.00		0				0.67	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	021	1	1	02	01	H6622_021_1	4		Y	Generic	4	11	1	2	2	3	110		01		110	1	30		90				2	2				30		90	30		31	0.00		0.00																									20.00		60.00				0.00		0.00				0.00				0.00		0				0.67	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H6622	021	1	1	02	01	H6622_021_1	4		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	47.00		141.00																									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												
H6622	021	1	1	02	01	H6622_021_1	4		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	97.00		291.00																									100.00		300.00				97.00		281.00				97.00				97.00		3.23				3.33	3.23	3.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	021	1	1	02	01	H6622_021_1	4		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	021	2	1	02	01	H6622_021_2	5		Y	Preferred Generic	4	11	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	021	2	1	02	01	H6622_021_2	5		Y	Preferred Generic	4	11	1	2	1	3	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H6622	021	2	1	02	01	H6622_021_2	5		Y	Generic	4	11	1	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	0.00		0.00																									20.00		60.00				0.00		0.00				0.00				0.00		0				0.67	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	021	2	1	02	01	H6622_021_2	5		Y	Generic	4	11	1	2	2	3	110		01		110	1	30		90				2	2				30		90	30		31	0.00		0.00																									20.00		60.00				0.00		0.00				0.00				0.00		0				0.67	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H6622	021	2	1	02	01	H6622_021_2	5		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	47.00		141.00																									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												
H6622	021	2	1	02	01	H6622_021_2	5		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	97.00		291.00																									100.00		300.00				97.00		281.00				97.00				97.00		3.23				3.33	3.23	3.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	021	2	1	02	01	H6622_021_2	5		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	022	0	1	02	01	H6622_022_0	4		Y	Preferred Generic	4	11	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	022	0	1	02	01	H6622_022_0	4		Y	Preferred Generic	4	11	1	2	1	3	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H6622	022	0	1	02	01	H6622_022_0	4		Y	Generic	4	11	1	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	0.00		0.00																									20.00		60.00				0.00		0.00				0.00				0.00		0				0.67	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	022	0	1	02	01	H6622_022_0	4		Y	Generic	4	11	1	2	2	3	110		01		110	1	30		90				2	2				30		90	30		31	0.00		0.00																									20.00		60.00				0.00		0.00				0.00				0.00		0				0.67	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H6622	022	0	1	02	01	H6622_022_0	4		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	022	0	1	02	01	H6622_022_0	4		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		290.00				100.00				100.00		3.33				3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	022	0	1	02	01	H6622_022_0	4		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	023	0	1	02	01	H6622_023_0	4		Y	Preferred Generic	4	11	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0				0	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	023	0	1	02	01	H6622_023_0	4		Y	Preferred Generic	4	11	1	2	1	3	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0				0	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H6622	023	0	1	02	01	H6622_023_0	4		Y	Generic	4	11	1	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	0.00		0.00																									20.00		60.00				0.00		0.00				0.00				0.00		0				0.67	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	023	0	1	02	01	H6622_023_0	4		Y	Generic	4	11	1	2	2	3	110		01		110	1	30		90				2	2				30		90	30		31	0.00		0.00																									20.00		60.00				0.00		0.00				0.00				0.00		0				0.67	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H6622	023	0	1	02	01	H6622_023_0	4		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	023	0	1	02	01	H6622_023_0	4		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		290.00				100.00				100.00		3.33				3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	023	0	1	02	01	H6622_023_0	4		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	025	0	1	02	01	H6622_025_0	4		Y	Preferred Generic	4	11	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	025	0	1	02	01	H6622_025_0	4		Y	Generic	4	11	1	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	0.00		0.00																									20.00		60.00				0.00		0.00				0.00				0.00		0				0.67	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	025	0	1	02	01	H6622_025_0	4		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	45.00		135.00																									47.00		141.00				45.00		125.00				45.00				45.00		1.50				1.57	1.50	1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	025	0	1	02	01	H6622_025_0	4		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	95.00		285.00																									100.00		300.00				95.00		275.00				95.00				95.00		3.17				3.33	3.17	3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	025	0	1	02	01	H6622_025_0	4		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	026	0	1	02	01	H6622_026_0	3		Y	Preferred Generic	4	11	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	026	0	1	02	01	H6622_026_0	3		Y	Generic	4	11	1	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	0.00		0.00																									20.00		60.00				0.00		0.00				0.00				0.00		0				0.67	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	026	0	1	02	01	H6622_026_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	45.00		135.00																									47.00		141.00				45.00		125.00				45.00				45.00		1.50				1.57	1.50	1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	026	0	1	02	01	H6622_026_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	95.00		285.00																									100.00		300.00				95.00		275.00				95.00				95.00		3.17				3.33	3.17	3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	026	0	1	02	01	H6622_026_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	028	0	1	01	01	H6622_028_0	5		Y	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		100				1	2				30		100	30		31	2.00		6.00																									10.00		30.00				2.00		0.00				2.00				2.00		0.07				0.33	0.07	0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	028	0	1	01	01	H6622_028_0	5		Y	Generic	4	11	3	2	2	1	110		01		110	1	30		100				2	2				30		100	30		31	8.00		24.00																									20.00		60.00				8.00		0.00				8.00				8.00		0.27				0.67	0.27	0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	028	0	1	01	01	H6622_028_0	5		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		100				2	2				30		100	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												
H6622	028	0	1	01	01	H6622_028_0	5		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		100				2	2				30		100	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												
H6622	028	0	1	01	01	H6622_028_0	5		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	029	0	1	01	01	H6622_029_0	4		Y	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		100				1	2				30		100	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	029	0	1	01	01	H6622_029_0	4		Y	Preferred Generic	4	11	3	2	1	3	110		01		110	1	30		100				1	2				30		100	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	3
H6622	029	0	1	01	01	H6622_029_0	4		Y	Generic	4	11	1	2	2	1	110		01		110	1	30		100				2	2				30		100	30		31	5.00		15.00																									20.00		60.00				5.00		0.00				5.00				5.00		0.17				0.67	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	029	0	1	01	01	H6622_029_0	4		Y	Generic	4	11	1	2	2	3	110		01		110	1	30		100				2	2				30		100	30		31	5.00		15.00																									20.00		60.00				5.00		0.00				5.00				5.00		0.17				0.67	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H6622	029	0	1	01	01	H6622_029_0	4		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		100				2	2				30		100	30		31	40.00		120.00																									47.00		141.00				40.00		110.00				40.00				40.00		1.33				1.57	1.33	1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	029	0	1	01	01	H6622_029_0	4		Y	Preferred Brand	4	11	1	2	3	3	110		01		110	1	30		100				2	2				30		100	30		31	40.00		120.00																									47.00		141.00				40.00		110.00				40.00				40.00		1.33				1.57	1.33	1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H6622	029	0	1	01	01	H6622_029_0	4		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		100				2	2				30		100	30		31	80.00		240.00																									100.00		300.00				80.00		230.00				80.00				80.00		2.67				3.33	2.67	2.58	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	029	0	1	01	01	H6622_029_0	4		Y	Non-Preferred Drug	4	11	1	2	4	3	110		01		110	1	30		100				2	2				30		100	30		31	80.00		240.00																									100.00		300.00				80.00		230.00				80.00				80.00		2.67				3.33	2.67	2.58	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H6622	029	0	1	01	01	H6622_029_0	4		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	029	0	1	01	01	H6622_029_0	4		Y	Specialty Tier	4	11	1	1	5	3	010		01		010	1	30											30			30		31					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	5		Y	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		100				1	2				30		100	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	030	0	1	01	01	H6622_030_0	5		Y	Preferred Generic	4	11	3	2	1	3	110		01		110	1	30		100				1	2				30		100	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	2	3
H6622	030	0	1	01	01	H6622_030_0	5		Y	Generic	4	11	1	2	2	1	110		01		110	1	30		100				2	2				30		100	30		31	2.00		6.00																									20.00		60.00				2.00		0.00				2.00				2.00		0.07				0.67	0.07	0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	030	0	1	01	01	H6622_030_0	5		Y	Generic	4	11	1	2	2	3	110		01		110	1	30		100				2	2				30		100	30		31	2.00		6.00																									20.00		60.00				2.00		0.00				2.00				2.00		0.07				0.67	0.07	0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H6622	030	0	1	01	01	H6622_030_0	5		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		100				2	2				30		100	30		31	40.00		120.00																									47.00		141.00				40.00		110.00				40.00				40.00		1.33				1.57	1.33	1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	030	0	1	01	01	H6622_030_0	5		Y	Preferred Brand	4	11	1	2	3	3	110		01		110	1	30		100				2	2				30		100	30		31	40.00		120.00																									47.00		141.00				40.00		110.00				40.00				40.00		1.33				1.57	1.33	1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H6622	030	0	1	01	01	H6622_030_0	5		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		100				2	2				30		100	30		31	80.00		240.00																									100.00		300.00				80.00		230.00				80.00				80.00		2.67				3.33	2.67	2.58	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	030	0	1	01	01	H6622_030_0	5		Y	Non-Preferred Drug	4	11	1	2	4	3	110		01		110	1	30		100				2	2				30		100	30		31	80.00		240.00																									100.00		300.00				80.00		230.00				80.00				80.00		2.67				3.33	2.67	2.58	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H6622	030	0	1	01	01	H6622_030_0	5		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	030	0	1	01	01	H6622_030_0	5		Y	Specialty Tier	4	11	1	1	5	3	010		01		010	1	30											30			30		31					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	3		Y	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	032	0	1	01	01	H6622_032_0	3		Y	Preferred Generic	4	11	3	2	1	3	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H6622	032	0	1	01	01	H6622_032_0	3		Y	Generic	4	11	3	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	0.00		0.00																									20.00		60.00				0.00		0.00				0.00				0.00		0				0.67	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	032	0	1	01	01	H6622_032_0	3		Y	Generic	4	11	3	2	2	3	110		01		110	1	30		90				2	2				30		90	30		31	0.00		0.00																									20.00		60.00				0.00		0.00				0.00				0.00		0				0.67	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H6622	032	0	1	01	01	H6622_032_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	032	0	1	01	01	H6622_032_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	99.00		297.00																									100.00		300.00				99.00		287.00				99.00				99.00		3.30				3.33	3.30	3.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	032	0	1	01	01	H6622_032_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	033	0	1	01	01	H6622_033_0	3		Y	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	033	0	1	01	01	H6622_033_0	3		Y	Preferred Generic	4	11	3	2	1	3	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H6622	033	0	1	01	01	H6622_033_0	3		Y	Generic	4	11	3	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	0.00		0.00																									20.00		60.00				0.00		0.00				0.00				0.00		0				0.67	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	033	0	1	01	01	H6622_033_0	3		Y	Generic	4	11	3	2	2	3	110		01		110	1	30		90				2	2				30		90	30		31	0.00		0.00																									20.00		60.00				0.00		0.00				0.00				0.00		0				0.67	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H6622	033	0	1	01	01	H6622_033_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	033	0	1	01	01	H6622_033_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	99.00		297.00																									100.00		300.00				99.00		287.00				99.00				99.00		3.30				3.33	3.30	3.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	033	0	1	01	01	H6622_033_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	034	0	1	01	01	H6622_034_0	3		Y	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	034	0	1	01	01	H6622_034_0	3		Y	Preferred Generic	4	11	3	2	1	3	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H6622	034	0	1	01	01	H6622_034_0	3		Y	Generic	4	11	3	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	0.00		0.00																									20.00		60.00				0.00		0.00				0.00				0.00		0				0.67	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	034	0	1	01	01	H6622_034_0	3		Y	Generic	4	11	3	2	2	3	110		01		110	1	30		90				2	2				30		90	30		31	0.00		0.00																									20.00		60.00				0.00		0.00				0.00				0.00		0				0.67	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H6622	034	0	1	01	01	H6622_034_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		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	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		290.00				100.00				100.00		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	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					29																										29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	035	0	1	01	01	H6622_035_0	4		Y	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	035	0	1	01	01	H6622_035_0	4		Y	Preferred Generic	4	11	3	2	1	3	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H6622	035	0	1	01	01	H6622_035_0	4		Y	Generic	4	11	3	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	0.00		0.00																									20.00		60.00				0.00		0.00				0.00				0.00		0				0.67	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	035	0	1	01	01	H6622_035_0	4		Y	Generic	4	11	3	2	2	3	110		01		110	1	30		90				2	2				30		90	30		31	0.00		0.00																									20.00		60.00				0.00		0.00				0.00				0.00		0				0.67	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H6622	035	0	1	01	01	H6622_035_0	4		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	035	0	1	01	01	H6622_035_0	4		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		290.00				100.00				100.00		3.33				3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	035	0	1	01	01	H6622_035_0	4		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	036	0	1	01	01	H6622_036_0	3		Y	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	036	0	1	01	01	H6622_036_0	3		Y	Preferred Generic	4	11	3	2	1	3	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H6622	036	0	1	01	01	H6622_036_0	3		Y	Generic	4	11	3	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	0.00		0.00																									20.00		60.00				0.00		0.00				0.00				0.00		0				0.67	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	036	0	1	01	01	H6622_036_0	3		Y	Generic	4	11	3	2	2	3	110		01		110	1	30		90				2	2				30		90	30		31	0.00		0.00																									20.00		60.00				0.00		0.00				0.00				0.00		0				0.67	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H6622	036	0	1	01	01	H6622_036_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		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	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		290.00				100.00				100.00		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	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	037	0	1	01	01	H6622_037_0	3		Y	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	037	0	1	01	01	H6622_037_0	3		Y	Preferred Generic	4	11	3	2	1	3	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H6622	037	0	1	01	01	H6622_037_0	3		Y	Generic	4	11	3	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	0.00		0.00																									20.00		60.00				0.00		0.00				0.00				0.00		0				0.67	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	037	0	1	01	01	H6622_037_0	3		Y	Generic	4	11	3	2	2	3	110		01		110	1	30		90				2	2				30		90	30		31	0.00		0.00																									20.00		60.00				0.00		0.00				0.00				0.00		0				0.67	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H6622	037	0	1	01	01	H6622_037_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		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	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		290.00				100.00				100.00		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	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	047	0	1	01	01	H6622_047_0	3		Y	Preferred Generic	4	11	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	047	0	1	01	01	H6622_047_0	3		Y	Generic	4	11	1	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	5.00		15.00																									20.00		60.00				5.00		0.00				5.00				5.00		0.17				0.67	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	047	0	1	01	01	H6622_047_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	42.00		126.00																									47.00		141.00				42.00		116.00				42.00				42.00		1.40				1.57	1.40	1.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	047	0	1	01	01	H6622_047_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	90.00		270.00																									100.00		300.00				90.00		260.00				90.00				90.00		3				3.33	3	2.90	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	047	0	1	01	01	H6622_047_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	049	0	1	01	01	H6622_049_0	3		N	Preferred Generic	3	11	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	5.00		15.00																									10.00		30.00				5.00		0.00				5.00				5.00		0.17				0.33	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	049	0	1	01	01	H6622_049_0	3		N	Generic	3	11	1	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	20.00		60.00																									20.00		60.00				20.00		0.00				20.00				20.00		0.67				0.67	0.67	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	049	0	1	01	01	H6622_049_0	3		N	Preferred Brand	3	11	1	1	3	1	110		01		110	1	30		90				2	2				30		90	30		31				53.00	21		21																								21		21				21		21			21			21								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	049	0	1	01	01	H6622_049_0	3		N	Non-Preferred Drug	3	11	1	1	4	1	110		01		110	1	30		90				2	2				30		90	30		31				66.00	25		25																								25		25				25		25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	049	0	1	01	01	H6622_049_0	3		N	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												
H6622	052	0	1	01	01	H6622_052_0	3		Y	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	052	0	1	01	01	H6622_052_0	3		Y	Preferred Generic	4	11	3	2	1	3	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H6622	052	0	1	01	01	H6622_052_0	3		Y	Generic	4	11	3	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	5.00		15.00																									20.00		60.00				5.00		0.00				5.00				5.00		0.17				0.67	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	052	0	1	01	01	H6622_052_0	3		Y	Generic	4	11	3	2	2	3	110		01		110	1	30		90				2	2				30		90	30		31	5.00		15.00																									20.00		60.00				5.00		0.00				5.00				5.00		0.17				0.67	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H6622	052	0	1	01	01	H6622_052_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	052	0	1	01	01	H6622_052_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		290.00				100.00				100.00		3.33				3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	052	0	1	01	01	H6622_052_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	054	0	1	01	01	H6622_054_0	3		Y	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	054	0	1	01	01	H6622_054_0	3		Y	Preferred Generic	4	11	3	2	1	3	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H6622	054	0	1	01	01	H6622_054_0	3		Y	Generic	4	11	3	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	0.00		0.00																									20.00		60.00				0.00		0.00				0.00				0.00		0				0.67	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	054	0	1	01	01	H6622_054_0	3		Y	Generic	4	11	3	2	2	3	110		01		110	1	30		90				2	2				30		90	30		31	0.00		0.00																									20.00		60.00				0.00		0.00				0.00				0.00		0				0.67	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H6622	054	0	1	01	01	H6622_054_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	054	0	1	01	01	H6622_054_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		290.00				100.00				100.00		3.33				3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	054	0	1	01	01	H6622_054_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	055	0	1	01	01	H6622_055_0	4		Y	Preferred Generic	4	11	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	055	0	1	01	01	H6622_055_0	4		Y	Preferred Generic	4	11	1	2	1	3	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H6622	055	0	1	01	01	H6622_055_0	4		Y	Generic	4	11	1	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	5.00		15.00																									20.00		60.00				5.00		0.00				5.00				5.00		0.17				0.67	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	055	0	1	01	01	H6622_055_0	4		Y	Generic	4	11	1	2	2	3	110		01		110	1	30		90				2	2				30		90	30		31	5.00		15.00																									20.00		60.00				5.00		0.00				5.00				5.00		0.17				0.67	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H6622	055	0	1	01	01	H6622_055_0	4		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	055	0	1	01	01	H6622_055_0	4		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	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												
H6622	055	0	1	01	01	H6622_055_0	4		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	056	0	1	01	01	H6622_056_0	4		Y	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		100				1	2				30		100	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	056	0	1	01	01	H6622_056_0	4		Y	Preferred Generic	4	11	3	2	1	3	110		01		110	1	30		100				1	2				30		100	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H6622	056	0	1	01	01	H6622_056_0	4		Y	Generic	4	11	3	2	2	1	110		01		110	1	30		100				2	2				30		100	30		31	0.00		0.00																									20.00		60.00				0.00		0.00				0.00				0.00		0				0.67	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	056	0	1	01	01	H6622_056_0	4		Y	Generic	4	11	3	2	2	3	110		01		110	1	30		100				2	2				30		100	30		31	0.00		0.00																									20.00		60.00				0.00		0.00				0.00				0.00		0				0.67	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H6622	056	0	1	01	01	H6622_056_0	4		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		100				2	2				30		100	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												
H6622	056	0	1	01	01	H6622_056_0	4		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		100				2	2				30		100	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												
H6622	056	0	1	01	01	H6622_056_0	4		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	057	0	1	02	01	H6622_057_0	3		Y	Preferred Generic	4	11	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	057	0	1	02	01	H6622_057_0	3		Y	Generic	4	11	1	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	0.00		0.00																									20.00		60.00				0.00		0.00				0.00				0.00		0				0.67	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	057	0	1	02	01	H6622_057_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	45.00		135.00																									47.00		141.00				45.00		125.00				45.00				45.00		1.50				1.57	1.50	1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	057	0	1	02	01	H6622_057_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	95.00		285.00																									100.00		300.00				95.00		275.00				95.00				95.00		3.17				3.33	3.17	3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	057	0	1	02	01	H6622_057_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	059	0	1	01	01	H6622_059_0	3		Y	Preferred Generic	4	11	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	059	0	1	01	01	H6622_059_0	3		Y	Generic	4	11	1	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	5.00		15.00																									20.00		60.00				5.00		0.00				5.00				5.00		0.17				0.67	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	059	0	1	01	01	H6622_059_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		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	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	99.00		297.00																									100.00		300.00				99.00		287.00				99.00				99.00		3.30				3.33	3.30	3.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	059	0	1	01	01	H6622_059_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	060	0	1	02	01	H6622_060_0	4		Y	Preferred Generic	4	11	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	060	0	1	02	01	H6622_060_0	4		Y	Generic	4	11	1	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	0.00		0.00																									20.00		60.00				0.00		0.00				0.00				0.00		0				0.67	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	060	0	1	02	01	H6622_060_0	4		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	060	0	1	02	01	H6622_060_0	4		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	97.00		291.00																									100.00		300.00				97.00		281.00				97.00				97.00		3.23				3.33	3.23	3.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	060	0	1	02	01	H6622_060_0	4		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	061	0	1	02	01	H6622_061_0	3		Y	Preferred Generic	4	11	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	061	0	1	02	01	H6622_061_0	3		Y	Generic	4	11	1	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	0.00		0.00																									20.00		60.00				0.00		0.00				0.00				0.00		0				0.67	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	061	0	1	02	01	H6622_061_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	45.00		135.00																									47.00		141.00				45.00		125.00				45.00				45.00		1.50				1.57	1.50	1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	061	0	1	02	01	H6622_061_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	95.00		285.00																									100.00		300.00				95.00		275.00				95.00				95.00		3.17				3.33	3.17	3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	061	0	1	02	01	H6622_061_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	062	0	1	02	01	H6622_062_0	4		Y	Preferred Generic	4	11	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	062	0	1	02	01	H6622_062_0	4		Y	Generic	4	11	1	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	6.00		18.00																									20.00		60.00				6.00		0.00				6.00				6.00		0.20				0.67	0.20	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	062	0	1	02	01	H6622_062_0	4		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	062	0	1	02	01	H6622_062_0	4		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		290.00				100.00				100.00		3.33				3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	062	0	1	02	01	H6622_062_0	4		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					31																										31						31					31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	063	0	1	01	01	H6622_063_0	3		Y	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	063	0	1	01	01	H6622_063_0	3		Y	Preferred Generic	4	11	3	2	1	3	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H6622	063	0	1	01	01	H6622_063_0	3		Y	Generic	4	11	3	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	5.00		15.00																									20.00		60.00				5.00		0.00				5.00				5.00		0.17				0.67	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	063	0	1	01	01	H6622_063_0	3		Y	Generic	4	11	3	2	2	3	110		01		110	1	30		90				2	2				30		90	30		31	5.00		15.00																									20.00		60.00				5.00		0.00				5.00				5.00		0.17				0.67	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H6622	063	0	1	01	01	H6622_063_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	063	0	1	01	01	H6622_063_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		290.00				100.00				100.00		3.33				3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	063	0	1	01	01	H6622_063_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					29																										29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	066	0	1	01	01	H6622_066_0	3		Y	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	066	0	1	01	01	H6622_066_0	3		Y	Preferred Generic	4	11	3	2	1	3	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H6622	066	0	1	01	01	H6622_066_0	3		Y	Generic	4	11	3	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	0.00		0.00																									20.00		60.00				0.00		0.00				0.00				0.00		0				0.67	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	066	0	1	01	01	H6622_066_0	3		Y	Generic	4	11	3	2	2	3	110		01		110	1	30		90				2	2				30		90	30		31	0.00		0.00																									20.00		60.00				0.00		0.00				0.00				0.00		0				0.67	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H6622	066	0	1	01	01	H6622_066_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	066	0	1	01	01	H6622_066_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		290.00				100.00				100.00		3.33				3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	066	0	1	01	01	H6622_066_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	071	0	1	01	01	H6622_071_0	4		Y	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6622	071	0	1	01	01	H6622_071_0	4		Y	Preferred Generic	4	11	3	2	1	3	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		3
H6622	071	0	1	01	01	H6622_071_0	4		Y	Generic	4	11	3	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	0.00		0.00																									20.00		60.00				0.00		0.00				0.00				0.00		0				0.67	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6622	071	0	1	01	01	H6622_071_0	4		Y	Generic	4	11	3	2	2	3	110		01		110	1	30		90				2	2				30		90	30		31	0.00		0.00																									20.00		60.00				0.00		0.00				0.00				0.00		0				0.67	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		3
H6622	071	0	1	01	01	H6622_071_0	4		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				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												
H6622	071	0	1	01	01	H6622_071_0	4		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	99.00		297.00																									100.00		300.00				99.00		287.00				99.00				99.00		3.30				3.33	3.30	3.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6622	071	0	1	01	01	H6622_071_0	4		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6622	071	0	1	01	01	H6622_071_0	4		Y	Select Care Drugs	4	11	1	2	6	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0				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	3		Y	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	073	0	1	02	01	H6622_073_0	3		Y	Preferred Generic	4	11	3	2	1	3	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H6622	073	0	1	02	01	H6622_073_0	3		Y	Generic	4	11	3	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	5.00		15.00																									20.00		60.00				5.00		0.00				5.00				5.00		0.17				0.67	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	073	0	1	02	01	H6622_073_0	3		Y	Generic	4	11	3	2	2	3	110		01		110	1	30		90				2	2				30		90	30		31	5.00		15.00																									20.00		60.00				5.00		0.00				5.00				5.00		0.17				0.67	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H6622	073	0	1	02	01	H6622_073_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		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	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		290.00				100.00				100.00		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	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					27																										27						27					27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	074	1	1	01	01	H6622_074_1	4		Y	Preferred Generic	4	11	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	2.00		6.00																									10.00		30.00				2.00		0.00				2.00				2.00		0.07				0.33	0.07	0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	074	1	1	01	01	H6622_074_1	4		Y	Generic	4	11	1	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	8.00		24.00																									20.00		60.00				8.00		0.00				8.00				8.00		0.27				0.67	0.27	0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	074	1	1	01	01	H6622_074_1	4		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	47.00		141.00																									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												
H6622	074	1	1	01	01	H6622_074_1	4		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	99.00		297.00																									100.00		300.00				99.00		287.00				99.00				99.00		3.30				3.33	3.30	3.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	074	1	1	01	01	H6622_074_1	4		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					29																										29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	074	2	1	01	01	H6622_074_2	4		Y	Preferred Generic	4	11	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	2.00		6.00																									10.00		30.00				2.00		0.00				2.00				2.00		0.07				0.33	0.07	0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	074	2	1	01	01	H6622_074_2	4		Y	Generic	4	11	1	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	8.00		24.00																									20.00		60.00				8.00		0.00				8.00				8.00		0.27				0.67	0.27	0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	074	2	1	01	01	H6622_074_2	4		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		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		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	99.00		297.00																									100.00		300.00				99.00		287.00				99.00				99.00		3.30				3.33	3.30	3.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	074	2	1	01	01	H6622_074_2	4		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					29																										29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	075	0	1	01	01	H6622_075_0	4		Y	Preferred Generic	4	11	1	2	1	1	110		01		110	1	30		100				1	2				30		100	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	075	0	1	01	01	H6622_075_0	4		Y	Preferred Generic	4	11	1	2	1	3	110		01		110	1	30		100				1	2				30		100	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H6622	075	0	1	01	01	H6622_075_0	4		Y	Generic	4	11	1	2	2	1	110		01		110	1	30		100				2	2				30		100	30		31	5.00		15.00																									20.00		60.00				5.00		0.00				5.00				5.00		0.17				0.67	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	075	0	1	01	01	H6622_075_0	4		Y	Generic	4	11	1	2	2	3	110		01		110	1	30		100				2	2				30		100	30		31	5.00		15.00																									20.00		60.00				5.00		0.00				5.00				5.00		0.17				0.67	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H6622	075	0	1	01	01	H6622_075_0	4		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		100				2	2				30		100	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												
H6622	075	0	1	01	01	H6622_075_0	4		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		100				2	2				30		100	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												
H6622	075	0	1	01	01	H6622_075_0	4		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	076	0	1	02	01	H6622_076_0	3		Y	Preferred Generic	4	11	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	2.00		6.00																									10.00		30.00				2.00		0.00				2.00				2.00		0.07				0.33	0.07	0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	076	0	1	02	01	H6622_076_0	3		Y	Generic	4	11	1	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	12.00		36.00																									20.00		60.00				12.00		0.00				12.00				12.00		0.40				0.67	0.40	0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	076	0	1	02	01	H6622_076_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	076	0	1	02	01	H6622_076_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		290.00				100.00				100.00		3.33				3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	076	0	1	02	01	H6622_076_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					29																										29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	077	0	1	02	01	H6622_077_0	3		Y	Preferred Generic	4	11	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	2.00		6.00																									10.00		30.00				2.00		0.00				2.00				2.00		0.07				0.33	0.07	0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	077	0	1	02	01	H6622_077_0	3		Y	Generic	4	11	1	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	12.00		36.00																									20.00		60.00				12.00		0.00				12.00				12.00		0.40				0.67	0.40	0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	077	0	1	02	01	H6622_077_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	077	0	1	02	01	H6622_077_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		290.00				100.00				100.00		3.33				3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	077	0	1	02	01	H6622_077_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					29																										29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	081	0	1	01	01	H6622_081_0	4		Y	Preferred Generic	4	11	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	081	0	1	01	01	H6622_081_0	4		Y	Generic	4	11	1	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	0.00		0.00																									20.00		60.00				0.00		0.00				0.00				0.00		0				0.67	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	081	0	1	01	01	H6622_081_0	4		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	45.00		135.00																									47.00		141.00				45.00		125.00				45.00				45.00		1.50				1.57	1.50	1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	081	0	1	01	01	H6622_081_0	4		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	95.00		285.00																									100.00		300.00				95.00		275.00				95.00				95.00		3.17				3.33	3.17	3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	081	0	1	01	01	H6622_081_0	4		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	082	0	1	01	01	H6622_082_0	4		Y	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		100				1	2				30		100	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	082	0	1	01	01	H6622_082_0	4		Y	Generic	4	11	3	2	2	1	110		01		110	1	30		100				2	2				30		100	30		31	0.00		0.00																									20.00		60.00				0.00		0.00				0.00				0.00		0				0.67	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	082	0	1	01	01	H6622_082_0	4		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		100				2	2				30		100	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												
H6622	082	0	1	01	01	H6622_082_0	4		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		100				2	2				30		100	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												
H6622	082	0	1	01	01	H6622_082_0	4		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6672	003	0	1	01	01	H6672_003_0	5		Y	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								5.00	10.00	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		Y	Generic	4	01	3	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	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		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	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		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	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		Y	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	005	0	1	01	01	H6672_005_0	5		Y	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												
H6672	005	0	1	01	01	H6672_005_0	5		Y	Generic	4	01	3	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		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	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		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								100.00	200.00	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		Y	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	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												
H6678	001	0	1	01	01	H6678_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					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	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												
H6678	001	0	1	01	01	H6678_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												
H6678	001	0	1	01	01	H6678_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												
H6678	001	0	1	01	01	H6678_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												
H6678	002	0	1	01	01	H6678_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								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00				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	5			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	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												
H6678	002	0	1	01	01	H6678_002_0	5			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	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												
H6678	002	0	1	01	01	H6678_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												
H6678	002	0	1	01	01	H6678_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												
H6678	002	0	1	01	01	H6678_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												
H6678	002	0	1	01	01	H6678_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	
H6678	003	0	1	01	01	H6678_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								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00				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	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					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	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												
H6678	003	0	1	01	01	H6678_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												
H6678	003	0	1	01	01	H6678_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												
H6678	003	0	1	01	01	H6678_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												
H6678	004	0	1	01	01	H6678_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												
H6678	004	0	1	01	01	H6678_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								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00				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	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												
H6678	004	0	1	01	01	H6678_004_0	5			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	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												
H6678	004	0	1	01	01	H6678_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												
H6678	004	0	1	01	01	H6678_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												
H6678	004	0	1	01	01	H6678_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												
H6678	004	0	1	01	01	H6678_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	
H6706	001	0	1	02	01	H6706_001_0	2		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6706	001	0	1	02	01	H6706_001_0	2		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H6706	001	0	1	02	01	H6706_001_0	2		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6706	001	0	1	02	01	H6706_001_0	2		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H6706	001	0	1	02	01	H6706_001_0	2		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6706	001	0	1	02	01	H6706_001_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6706	001	0	1	02	01	H6706_001_0	2		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				567.00	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	14			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	14			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	14			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				0.00		0.00				12.00				12.00			0.40	0.17		0.37	0.00	0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6723	001	1	1	01	01	H6723_001_1	14			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				0.00		0.00				12.00				12.00			0.40	0.17		0.37	0.00	0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H6723	001	1	1	01	01	H6723_001_1	14			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	14			Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											71.09	50		50				68.18	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	14			Specialty Tier	4	11	1	1	5	1		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	14			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	14			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	14			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				0.00		0.00				12.00				12.00			0.40	0.17		0.37	0.00	0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6723	001	2	1	01	01	H6723_001_2	14			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				0.00		0.00				12.00				12.00			0.40	0.17		0.37	0.00	0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H6723	001	2	1	01	01	H6723_001_2	14			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	14			Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											71.09	50		50				68.18	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	14			Specialty Tier	4	11	1	1	5	1		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	15			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	15			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	15			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				0.00		0.00				12.00				12.00			0.40	0.17		0.37	0.00	0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6723	001	3	1	01	01	H6723_001_3	15			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				0.00		0.00				12.00				12.00			0.40	0.17		0.37	0.00	0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H6723	001	3	1	01	01	H6723_001_3	15			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	15			Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											71.09	50		50				68.18	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	15			Specialty Tier	4	11	1	1	5	1		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	14			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	14			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	14			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	14			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	14			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	14			Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											71.63	50		50				73.91	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	14			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	14			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	14			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	14			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	14			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	14			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	14			Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											71.63	50		50				73.91	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	14			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	14			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	14			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	14			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	14			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	14			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	14			Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											71.63	50		50				73.91	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	14			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	15			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	15			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	15			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	15			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	15			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	15			Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											62.31	50		50				68.79	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	15			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	14			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	14			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	14			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	14			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	14			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	14			Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											62.31	50		50				68.79	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	14			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	15			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	15			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	15			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	15			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	15			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	15			Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											62.31	50		50				68.79	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	15			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	15			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	15			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	15			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	15			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	15			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	15			Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											66.33	50		50				70.26	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	15			Specialty Tier	4	11	1	1	5	1		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	15			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	15			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	15			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	15			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	15			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	15			Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											66.33	50		50				70.26	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	15			Specialty Tier	4	11	1	1	5	1		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	14			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				0.00		0.00				12.00				12.00			0.40	0.13		0.37	0.00	0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6723	006	1	1	01	01	H6723_006_1	14			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				0.00		0.00				12.00				12.00			0.40	0.13		0.37	0.00	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	14			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				0.00		0.00				16.00				16.00			0.53	0.27		0.50	0.00	0.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6723	006	1	1	01	01	H6723_006_1	14			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				0.00		0.00				16.00				16.00			0.53	0.27		0.50	0.00	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	14			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	14			Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											61.84	50		50				64.86	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	14			Specialty Tier	4	11	1	1	5	1		010	01		010	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	14			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	14			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	14			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				0.00		0.00				12.00				12.00			0.40	0.13		0.37	0.00	0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6723	006	2	1	01	01	H6723_006_2	14			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				0.00		0.00				12.00				12.00			0.40	0.13		0.37	0.00	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	14			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				0.00		0.00				16.00				16.00			0.53	0.27		0.50	0.00	0.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6723	006	2	1	01	01	H6723_006_2	14			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				0.00		0.00				16.00				16.00			0.53	0.27		0.50	0.00	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	14			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	14			Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											61.84	50		50				64.86	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	14			Specialty Tier	4	11	1	1	5	1		010	01		010	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	14			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	14			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	14			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				0.00		0.00				12.00				12.00			0.40	0.13		0.37	0.00	0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6723	006	3	1	01	01	H6723_006_3	14			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				0.00		0.00				12.00				12.00			0.40	0.13		0.37	0.00	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	14			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				0.00		0.00				16.00				16.00			0.53	0.27		0.50	0.00	0.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6723	006	3	1	01	01	H6723_006_3	14			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				0.00		0.00				16.00				16.00			0.53	0.27		0.50	0.00	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	14			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	14			Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											61.84	50		50				64.86	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	14			Specialty Tier	4	11	1	1	5	1		010	01		010	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	14			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	14			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	31		100				1	2			100				31		34	5.00		10.00																					10.00																5.00				5.00		0.16						0.15	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	31		100				1	2			100				31		34	20.00		40.00																					40.00																20.00				20.00		0.65						0.59	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	31		100				1	2			100				31		34	45.00		90.00																					90.00																45.00				45.00		1.45						1.32	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	31		100				1	2			100				31		34	95.00		190.00																					190.00																95.00				95.00		3.06						2.79	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	31														31		34				791.66	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	31		100				1	2			100				31		34	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6743	007	0	1	04	01	H6743_007_0	5			Preferred Generic	4	01	1	2	1	1	110		01	100		1	31		100				1	2			100				31		34	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6743	007	0	1	04	01	H6743_007_0	5			Generic	4	01	1	2	2	1	110		01	100		1	31		100				1	2			100				31		34	8.00		16.00																					16.00																8.00				8.00		0.26						0.24	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	31		100				1	2			100				31		34	47.00		94.00																					94.00																47.00				47.00		1.52						1.38	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	31		100				1	2			100				31		34	100.00		200.00																					200.00																100.00				100.00		3.23						2.94	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	31														31		34				737.02	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	31		100				1	2			100				31		34	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6743	023	1	1	04	01	H6743_023_1	5			Preferred Generic	4	01	1	2	1	1	110		01	100		1	31		100				1	2			100				31		34	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6743	023	1	1	04	01	H6743_023_1	5			Generic	4	01	1	2	2	1	110		01	100		1	31		100				1	2			100				31		34	8.00		16.00																					16.00																8.00				8.00		0.26						0.24	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6743	023	1	1	04	01	H6743_023_1	5			Preferred Brand	4	10	1	2	3	1	110		01	100		1	31		100				1	2			100				31		34	47.00		94.00																					94.00																47.00				47.00		1.52						1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6743	023	1	1	04	01	H6743_023_1	5			Non-Preferred Drug	4	11	1	2	4	1	110		01	100		1	31		100				1	2			100				31		34	100.00		200.00																					200.00																100.00				100.00		3.23						2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6743	023	1	1	04	01	H6743_023_1	5			Specialty Tier	4	11	1	1	5	1	010		01			1	31														31		34				1113.89	33																																					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6743	023	1	1	04	01	H6743_023_1	5			Select Care Drugs	4	11	1	2	6	1	110		01	100		1	31		100				1	2			100				31		34	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6743	023	2	1	04	01	H6743_023_2	5			Preferred Generic	4	01	1	2	1	1	110		01	100		1	31		100				1	2			100				31		34	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6743	023	2	1	04	01	H6743_023_2	5			Generic	4	01	1	2	2	1	110		01	100		1	31		100				1	2			100				31		34	8.00		16.00																					16.00																8.00				8.00		0.26						0.24	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6743	023	2	1	04	01	H6743_023_2	5			Preferred Brand	4	10	1	2	3	1	110		01	100		1	31		100				1	2			100				31		34	47.00		94.00																					94.00																47.00				47.00		1.52						1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6743	023	2	1	04	01	H6743_023_2	5			Non-Preferred Drug	4	11	1	2	4	1	110		01	100		1	31		100				1	2			100				31		34	100.00		200.00																					200.00																100.00				100.00		3.23						2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6743	023	2	1	04	01	H6743_023_2	5			Specialty Tier	4	11	1	1	5	1	010		01			1	31														31		34				1113.89	33																																					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6743	023	2	1	04	01	H6743_023_2	5			Select Care Drugs	4	11	1	2	6	1	110		01	100		1	31		100				1	2			100				31		34	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6743	023	3	1	04	01	H6743_023_3	5			Preferred Generic	4	01	1	2	1	1	110		01	100		1	31		100				1	2			100				31		34	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6743	023	3	1	04	01	H6743_023_3	5			Generic	4	01	1	2	2	1	110		01	100		1	31		100				1	2			100				31		34	8.00		16.00																					16.00																8.00				8.00		0.26						0.24	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6743	023	3	1	04	01	H6743_023_3	5			Preferred Brand	4	10	1	2	3	1	110		01	100		1	31		100				1	2			100				31		34	47.00		94.00																					94.00																47.00				47.00		1.52						1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6743	023	3	1	04	01	H6743_023_3	5			Non-Preferred Drug	4	11	1	2	4	1	110		01	100		1	31		100				1	2			100				31		34	100.00		200.00																					200.00																100.00				100.00		3.23						2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6743	023	3	1	04	01	H6743_023_3	5			Specialty Tier	4	11	1	1	5	1	010		01			1	31														31		34				1113.89	33																																					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6743	023	3	1	04	01	H6743_023_3	5			Select Care Drugs	4	11	1	2	6	1	110		01	100		1	31		100				1	2			100				31		34	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6743	025	0	1	04	01	H6743_025_0	5			Preferred Generic	4	01	1	2	1	1	110		01	100		1	31		100				1	2			100				31		34	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6743	025	0	1	04	01	H6743_025_0	5			Generic	4	01	1	2	2	1	110		01	100		1	31		100				1	2			100				31		34	8.00		16.00																					16.00																8.00				8.00		0.26						0.24	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6743	025	0	1	04	01	H6743_025_0	5			Preferred Brand	4	10	1	2	3	1	110		01	100		1	31		100				1	2			100				31		34	47.00		94.00																					94.00																47.00				47.00		1.52						1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6743	025	0	1	04	01	H6743_025_0	5			Non-Preferred Drug	4	11	1	2	4	1	110		01	100		1	31		100				1	2			100				31		34	100.00		200.00																					200.00																100.00				100.00		3.23						2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6743	025	0	1	04	01	H6743_025_0	5			Specialty Tier	4	11	1	1	5	1	010		01			1	31														31		34				1006.60	30																																					30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6743	025	0	1	04	01	H6743_025_0	5			Select Care Drugs	4	11	1	2	6	1	110		01	100		1	31		100				1	2			100				31		34	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6750	005	0	1	01	01	H6750_005_0	5		Y	Preferred Generic	4	01	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					0.00	0.00	0.00																5.00				0.00			0.17	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H6750	005	0	1	01	01	H6750_005_0	5		Y	Generic	4	01	3	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								20.00	40.00	60.00					10.00	20.00	30.00					10.00	20.00	20.00																20.00				10.00			0.67	0.33	0.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H6750	005	0	1	01	01	H6750_005_0	5		Y	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					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												
H6750	005	0	1	01	01	H6750_005_0	5		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	300.00					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												
H6750	005	0	1	01	01	H6750_005_0	5		Y	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												25							25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H6750	005	0	1	01	01	H6750_005_0	5		Y	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												
H6750	005	0	1	01	01	H6750_005_0	5		Y	Vaccines	4	11	1	2	6	3		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										1		
H6750	012	1	1	01	01	H6750_012_1	5		Y	Preferred Generic	4	01	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					0.00	0.00	0.00																5.00				0.00			0.17	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H6750	012	1	1	01	01	H6750_012_1	5		Y	Generic	4	01	3	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								20.00	40.00	60.00					8.00	16.00	24.00					8.00	16.00	16.00																20.00				8.00			0.67	0.27	0.27			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H6750	012	1	1	01	01	H6750_012_1	5		Y	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					47.00	94.00	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												
H6750	012	1	1	01	01	H6750_012_1	5		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	300.00					100.00	200.00	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												
H6750	012	1	1	01	01	H6750_012_1	5		Y	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												28							28						28																	28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H6750	012	1	1	01	01	H6750_012_1	5		Y	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												
H6750	012	1	1	01	01	H6750_012_1	5		Y	Vaccines	4	11	1	2	6	3		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										1		
H6750	012	2	1	01	01	H6750_012_2	5		Y	Preferred Generic	4	01	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					0.00	0.00	0.00																5.00				0.00			0.17	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H6750	012	2	1	01	01	H6750_012_2	5		Y	Generic	4	01	3	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								20.00	40.00	60.00					8.00	16.00	24.00					8.00	16.00	16.00																20.00				8.00			0.67	0.27	0.27			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H6750	012	2	1	01	01	H6750_012_2	5		Y	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								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												
H6750	012	2	1	01	01	H6750_012_2	5		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								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												
H6750	012	2	1	01	01	H6750_012_2	5		Y	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												28							28						28																	28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H6750	012	2	1	01	01	H6750_012_2	5		Y	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												
H6750	012	2	1	01	01	H6750_012_2	5		Y	Vaccines	4	11	1	2	6	3		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										1		
H6750	013	0	1	01	01	H6750_013_0	5		Y	Preferred Generic	4	01	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					0.00	0.00	0.00																5.00				0.00			0.17	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H6750	013	0	1	01	01	H6750_013_0	5		Y	Generic	4	01	3	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								20.00	40.00	60.00					8.00	16.00	24.00					8.00	16.00	16.00																20.00				8.00			0.67	0.27	0.27			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H6750	013	0	1	01	01	H6750_013_0	5		Y	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					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												
H6750	013	0	1	01	01	H6750_013_0	5		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	300.00					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												
H6750	013	0	1	01	01	H6750_013_0	5		Y	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												28							28						28																	28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H6750	013	0	1	01	01	H6750_013_0	5		Y	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												
H6750	013	0	1	01	01	H6750_013_0	5		Y	Vaccines	4	11	1	2	6	3		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										1		
H6750	014	0	1	02	01	H6750_014_0	6		Y	Preferred Generic	4	01	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					0.00	0.00	0.00																5.00				0.00			0.17	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H6750	014	0	1	02	01	H6750_014_0	6		Y	Generic	4	01	3	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								20.00	40.00	60.00					8.00	16.00	24.00					8.00	16.00	16.00																20.00				8.00			0.67	0.27	0.27			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H6750	014	0	1	02	01	H6750_014_0	6		Y	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					47.00	94.00	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												
H6750	014	0	1	02	01	H6750_014_0	6		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	300.00					100.00	200.00	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												
H6750	014	0	1	02	01	H6750_014_0	6		Y	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												28							28						28																	28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H6750	014	0	1	02	01	H6750_014_0	6		Y	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												
H6750	014	0	1	02	01	H6750_014_0	6		Y	Vaccines	4	11	1	2	6	3		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										1		
H6813	001	0	1	04	01	H6813_001_0	10		N	Preferred Generic	4	11	1	2	1	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6813	001	0	1	04	01	H6813_001_0	10		N	Preferred Generic	4	11	1	2	1	3	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H6813	001	0	1	04	01	H6813_001_0	10		N	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												
H6813	001	0	1	04	01	H6813_001_0	10		N	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																			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										2	2	2
H6813	001	0	1	04	01	H6813_001_0	10		N	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	47.00	94.00	141.00																			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												
H6813	001	0	1	04	01	H6813_001_0	10		N	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												
H6813	001	0	1	04	01	H6813_001_0	10		N	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												
H6813	002	0	1	04	01	H6813_002_0	9		Y	Preferred Generic	4	11	1	2	1	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6813	002	0	1	04	01	H6813_002_0	9		Y	Preferred Generic	4	11	1	2	1	3	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H6813	002	0	1	04	01	H6813_002_0	9		Y	Generic	4	11	3	2	2	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6813	002	0	1	04	01	H6813_002_0	9		Y	Generic	4	11	3	2	2	3	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	3
H6813	002	0	1	04	01	H6813_002_0	9		Y	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	47.00	94.00	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												
H6813	002	0	1	04	01	H6813_002_0	9		Y	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	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												
H6813	002	0	1	04	01	H6813_002_0	9		Y	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												
H6815	037	0	1	01	01	H6815_037_0	4			Preferred Generic	3	11	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								19.00	38.00	57.00					0.00	0.00	0.00											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												
H6815	037	0	1	01	01	H6815_037_0	4			Generic	3	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					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												
H6815	037	0	1	01	01	H6815_037_0	4			Preferred Brand	3	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	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, Select Care Drugs												
H6815	037	0	1	01	01	H6815_037_0	4			Non-Preferred Drug	3	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											98.87	49	49	49				98.87	49	49	49										49	49	49				49	49	49			49			49								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	3	11	1	1	5	1		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												
H6815	037	0	1	01	01	H6815_037_0	4			Select Care Drugs	3	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred 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								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00				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												
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								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00				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
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								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												
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	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												
H6830	001	0	1	04	01	H6830_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												
H6830	001	0	1	04	01	H6830_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												
H6830	001	0	1	04	01	H6830_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												
H6830	001	0	1	04	01	H6830_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												
H6830	001	0	1	04	01	H6830_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												
H6830	002	0	1	04	01	H6830_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								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00				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	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												
H6830	002	0	1	04	01	H6830_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												
H6830	002	0	1	04	01	H6830_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												
H6830	002	0	1	04	01	H6830_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												
H6830	002	0	1	04	01	H6830_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												
H6832	001	0	1	01	01	H6832_001_0	4		Y	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	4		Y	Generic	4	01	1	2	2	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	15.00	30.00	45.00																			15.00	30.00	45.00																	15.00			15.00		0.50			0.50			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6832	001	0	1	01	01	H6832_001_0	4		Y	Preferred Brand	4	10	1	2	3	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	45.00	90.00	135.00																			45.00	90.00	135.00																	45.00			45.00		1.50			1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6832	001	0	1	01	01	H6832_001_0	4		Y	Non-Preferred Brand	4	10	1	2	4	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	95.00	190.00	285.00																			95.00	190.00	285.00																	95.00			95.00		3.17			3.17			3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6832	001	0	1	01	01	H6832_001_0	4		Y	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	4		Y	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	4		Y	Generic	4	01	1	2	2	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	15.00	30.00	45.00																			15.00	30.00	45.00																	15.00			15.00		0.50			0.50			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6832	002	0	1	01	01	H6832_002_0	4		Y	Preferred Brand	4	10	1	2	3	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	45.00	90.00	135.00																			45.00	90.00	135.00																	45.00			45.00		1.50			1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6832	002	0	1	01	01	H6832_002_0	4		Y	Non-Preferred Brand	4	10	1	2	4	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	95.00	190.00	285.00																			95.00	190.00	285.00																	95.00			95.00		3.17			3.17			3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6832	002	0	1	01	01	H6832_002_0	4		Y	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	003	0	1	01	01	H6832_003_0	6		Y	Preferred Generic	4	01	1	2	1	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	2.00	4.00	6.00																			2.00	4.00	6.00																	2.00			2.00		0.07			0.07			0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H6832	003	0	1	01	01	H6832_003_0	6		Y	Generic	4	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																			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												
H6832	003	0	1	01	01	H6832_003_0	6		Y	Preferred Brand	4	10	1	2	3	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	45.00	90.00	135.00																			45.00	90.00	135.00																	45.00			45.00		1.50			1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H6832	003	0	1	01	01	H6832_003_0	6		Y	Non-Preferred Brand	4	10	1	2	4	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	95.00	190.00	285.00																			95.00	190.00	285.00																	95.00			95.00		3.17			3.17			3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H6832	003	0	1	01	01	H6832_003_0	6		Y	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, Select Care Drugs												
H6832	003	0	1	01	01	H6832_003_0	6		Y	Select Care Drugs	4	11	1	2	6	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 Brand, Specialty Tier, Select Care Drugs												
H6847	001	0	1	02	01	H6847_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												
H6847	001	0	1	02	01	H6847_001_0	5			Generic	4	01	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	6.00																3.00				3.00		0.10			0.10			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6847	001	0	1	02	01	H6847_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	74.00																37.00				37.00		1.23			1.23			1.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6847	001	0	1	02	01	H6847_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												
H6847	001	0	1	02	01	H6847_001_0	5			Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				250.00	29																				29																	29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6851	002	0	1	01	01	H6851_002_0	13			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												
H6851	002	0	1	01	01	H6851_002_0	13			Generic	4	01	1	2	2	1	110		01	110		1	30		90				1	2	30		90				30		31	12.00		30.00																			11.00		28.00																12.00				12.00		0.40			0.37			0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6851	002	0	1	01	01	H6851_002_0	13			Preferred Brand	4	10	1	2	3	1	110		01	110		1	30		90				1	2	30		90				30		31	47.00		132.00																			45.00		130.00																47.00				47.00		1.57			1.50			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6851	002	0	1	01	01	H6851_002_0	13			Non-Preferred Drug	4	11	1	2	4	1	110		01	110		1	30		90				1	2	30		90				30		31	100.00		280.00																			97.00		275.00																100.00				100.00		3.33			3.23			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6851	002	0	1	01	01	H6851_002_0	13			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												
H6851	003	0	1	01	01	H6851_003_0	13			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												
H6851	003	0	1	01	01	H6851_003_0	13			Generic	4	01	1	2	2	1	110		01	110		1	30		90				1	2	30		90				30		31	12.00		30.00																			11.00		28.00																12.00				12.00		0.40			0.37			0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6851	003	0	1	01	01	H6851_003_0	13			Preferred Brand	4	10	1	2	3	1	110		01	110		1	30		90				1	2	30		90				30		31	47.00		132.00																			45.00		130.00																47.00				47.00		1.57			1.50			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6851	003	0	1	01	01	H6851_003_0	13			Non-Preferred Drug	4	11	1	2	4	1	110		01	110		1	30		90				1	2	30		90				30		31	100.00		280.00																			97.00		275.00																100.00				100.00		3.33			3.23			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6851	003	0	1	01	01	H6851_003_0	13			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												
H6852	001	0	1	01	01	H6852_001_0	10		Y	Preferred Generic	4	11	1	2	1	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6852	001	0	1	01	01	H6852_001_0	10		Y	Preferred Generic	4	11	1	2	1	3	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H6852	001	0	1	01	01	H6852_001_0	10		Y	Generic	4	11	3	2	2	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6852	001	0	1	01	01	H6852_001_0	10		Y	Generic	4	11	3	2	2	3	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	3
H6852	001	0	1	01	01	H6852_001_0	10		Y	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	47.00	94.00	141.00																			47.00	94.00	117.50																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6852	001	0	1	01	01	H6852_001_0	10		Y	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	100.00	200.00	300.00																			100.00	200.00	300.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6852	001	0	1	01	01	H6852_001_0	10		Y	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												
H6852	002	0	1	01	01	H6852_002_0	11		N	Preferred Generic	4	11	1	2	1	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6852	002	0	1	01	01	H6852_002_0	11		N	Preferred Generic	4	11	1	2	1	3	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H6852	002	0	1	01	01	H6852_002_0	11		N	Generic	4	11	3	2	2	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	7.00	14.00	21.00																			7.00	14.00	17.50																7.00				7.00		0.23			0.23			0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6852	002	0	1	01	01	H6852_002_0	11		N	Generic	4	11	3	2	2	3	111		01	111		1	30	60	100				1	2	30	60	100				30		31	7.00	14.00	21.00																			7.00	14.00	17.50																7.00				7.00		0.23			0.23			0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	2	2
H6852	002	0	1	01	01	H6852_002_0	11		N	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	47.00	94.00	141.00																			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												
H6852	002	0	1	01	01	H6852_002_0	11		N	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	100.00	200.00	300.00																			100.00	200.00	300.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6852	002	0	1	01	01	H6852_002_0	11		N	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												
H6870	001	0	1	48	05	H6870_001_0	4			Generic Drugs	4	01			1	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31																																																					Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	1	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H6870	001	0	1	48	05	H6870_001_0	4			Brand Drugs	4	10			2	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31																																																					Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	1	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H6870	001	0	1	48	05	H6870_001_0	4			Non-Medicare Rx/OTC Drugs	4	11			3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31																																																					Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	2	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H6874	001	0	1	04	01	H6874_001_0	9		Y	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	9		Y	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	9		Y	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		29	31								47.00	94.00	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	9		Y	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		29	31											81.76	50	50	50				81.76	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	9		Y	Specialty Tier	4	11	1	1	5	1		111	10		111	1				30	60	90	1	2				30	60	90		29	31											2721.51	29	29	29				2721.51	29	29	29										29	29	29				29	29	29				29		29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6874	002	0	1	04	01	H6874_002_0	7		Y	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	7		Y	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	7		Y	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		29	31								47.00	94.00	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	7		Y	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		29	31											86.08	50	50	50				86.08	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	7		Y	Specialty Tier	4	11	1	1	5	1		111	10		111	1				30	60	90	1	2				30	60	90		29	31											2134.49	29	29	29				2134.49	29	29	29										29	29	29				29	29	29				29		29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6898	001	0	1	04	01	H6898_001_0	9		Y	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								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, Select Care Drugs												
H6898	001	0	1	04	01	H6898_001_0	9		Y	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, Select Care Drugs												
H6898	001	0	1	04	01	H6898_001_0	9		Y	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	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, Select Care Drugs												
H6898	001	0	1	04	01	H6898_001_0	9		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	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, Select Care Drugs												
H6898	001	0	1	04	01	H6898_001_0	9		Y	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											1110.17	29						1110.17	29						29																	29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6898	001	0	1	04	01	H6898_001_0	9		Y	Select Care Drugs	4	11	1	2	6	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6898	002	0	1	04	01	H6898_002_0	9		Y	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								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, Select Care Drugs												
H6898	002	0	1	04	01	H6898_002_0	9		Y	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								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, Select Care Drugs												
H6898	002	0	1	04	01	H6898_002_0	9		Y	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								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, Select Care Drugs												
H6898	002	0	1	04	01	H6898_002_0	9		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	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, Select Care Drugs												
H6898	002	0	1	04	01	H6898_002_0	9		Y	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											1071.94	30						1071.94	30						30																	30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6898	002	0	1	04	01	H6898_002_0	9		Y	Select Care Drugs	4	11	1	2	6	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6910	001	0	1	01	01	H6910_001_0	5		Y	Preferred Generic	4	11	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								10.00	20.00	30.00					0.00	0.00	0.00					0.00	0.00	0.00																10.00				10.00			0.33	0.00	0.00			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6910	001	0	1	01	01	H6910_001_0	5		Y	Preferred Generic	4	11	1	2	1	3		111	01	111		1				30	60	90	1	2	30	60	90				30		31								10.00	20.00	30.00					0.00	0.00	0.00					0.00	0.00	0.00																10.00				10.00			0.33	0.00	0.00			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H6910	001	0	1	01	01	H6910_001_0	5		Y	Generic	4	11	3	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		31								20.00	40.00	60.00					6.00	12.00	18.00					0.00	0.00	0.00																20.00				20.00			0.67	0.20	0.00			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6910	001	0	1	01	01	H6910_001_0	5		Y	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					31.00	62.00	93.00					31.00	62.00	62.00																47.00				47.00			1.57	1.03	1.03			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6910	001	0	1	01	01	H6910_001_0	5		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	300.00					90.00	180.00	270.00					90.00	180.00	180.00																100.00				100.00			3.33	3.00	3.00			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6910	001	0	1	01	01	H6910_001_0	5		Y	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											830.00	33						830.00	33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6910	003	0	1	01	01	H6910_003_0	5		Y	Preferred Generic	4	11	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								10.00	20.00	30.00					0.00	0.00	0.00					0.00	0.00	0.00																10.00				10.00			0.33	0.00	0.00			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6910	003	0	1	01	01	H6910_003_0	5		Y	Preferred Generic	4	11	1	2	1	3		111	01	111		1				30	60	90	1	2	30	60	90				30		31								10.00	20.00	30.00					0.00	0.00	0.00					0.00	0.00	0.00																10.00				10.00			0.33	0.00	0.00			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H6910	003	0	1	01	01	H6910_003_0	5		Y	Generic	4	11	3	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		31								20.00	40.00	60.00					6.00	12.00	18.00					0.00	0.00	0.00																20.00				20.00			0.67	0.20	0.00			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6910	003	0	1	01	01	H6910_003_0	5		Y	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					31.00	62.00	93.00					31.00	62.00	62.00																47.00				47.00			1.57	1.03	1.03			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6910	003	0	1	01	01	H6910_003_0	5		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	300.00					90.00	180.00	270.00					90.00	180.00	180.00																100.00				100.00			3.33	3.00	3.00			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6910	003	0	1	01	01	H6910_003_0	5		Y	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											830.00	33						830.00	33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6910	005	0	1	01	01	H6910_005_0	5		N	Preferred Generic	4	11	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								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	005	0	1	01	01	H6910_005_0	5		N	Preferred Generic	4	11	1	2	1	3		111	01	111		1				30	60	90	1	2	30	60	90				30		31								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	005	0	1	01	01	H6910_005_0	5		N	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					10.00	20.00	30.00					0.00	0.00	0.00																20.00				20.00			0.67	0.33	0.00			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6910	005	0	1	01	01	H6910_005_0	5		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					47.00	94.00	141.00					47.00	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												
H6910	005	0	1	01	01	H6910_005_0	5		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	300.00					100.00	200.00	300.00					100.00	200.00	200.00																100.00				100.00			3.33	3.33	3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6910	005	0	1	01	01	H6910_005_0	5		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											830.00	28						830.00	28						28																	28			28								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	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H6936	003	0	1	01	01	H6936_003_0	10			Generic	4	01	1	2	2	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	7.00	7.00	7.00																			7.00	7.00	7.00																7.00				7.00		0.23			0.23			0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H6936	003	0	1	01	01	H6936_003_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	141.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H6936	003	0	1	01	01	H6936_003_0	10			Non-Preferred Brand	4	10	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	100.00	200.00	300.00																			100.00	200.00	300.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
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					33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H6936	003	0	1	01	01	H6936_003_0	10			Vaccines	4	11	1	2	6	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H6936	005	0	1	01	01	H6936_005_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 Brand, Specialty Tier, Vaccines												
H6936	005	0	1	01	01	H6936_005_0	10			Generic	4	01	1	2	2	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	7.00	7.00	7.00																			7.00	7.00	7.00																7.00				7.00		0.23			0.23			0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H6936	005	0	1	01	01	H6936_005_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	141.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H6936	005	0	1	01	01	H6936_005_0	10			Non-Preferred Brand	4	10	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	100.00	200.00	300.00																			100.00	200.00	300.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
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					33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H6936	005	0	1	01	01	H6936_005_0	10			Vaccines	4	11	1	2	6	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H6936	006	0	1	01	01	H6936_006_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 Brand, Specialty Tier, Vaccines												
H6936	006	0	1	01	01	H6936_006_0	10			Generic	4	01	1	2	2	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	7.00	7.00	7.00																			7.00	7.00	7.00																7.00				7.00		0.23			0.23			0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H6936	006	0	1	01	01	H6936_006_0	10			Preferred Brand	4	10	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	141.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H6936	006	0	1	01	01	H6936_006_0	10			Non-Preferred Brand	4	10	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	100.00	200.00	300.00																			100.00	200.00	300.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H6936	006	0	1	01	01	H6936_006_0	10			Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31					33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H6936	006	0	1	01	01	H6936_006_0	10			Vaccines	4	11	1	2	6	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H6975	003	0	1	01	01	H6975_003_0	4			Preferred Generic	4	11	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								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												
H6975	003	0	1	01	01	H6975_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					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												
H6975	003	0	1	01	01	H6975_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	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, Select Care Drugs												
H6975	003	0	1	01	01	H6975_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											99.18	43	43	43				99.18	43	43	43										43	43	43				43	43	43			43			43								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6975	003	0	1	01	01	H6975_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												
H6975	003	0	1	01	01	H6975_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												
H6975	005	0	1	01	01	H6975_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												
H6975	005	0	1	01	01	H6975_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					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00				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	4			Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											47.00	94.00	141.00				37.00	74.00	74.00				47.00				47.00			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	4			Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											88.71	50	50	50				85.16	48	48	48										50	50	50				48	48	48			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6975	005	0	1	01	01	H6975_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												
H6975	005	0	1	01	01	H6975_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												
H6988	001	0	1	01	01	H6988_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												
H6988	001	0	1	01	01	H6988_001_0	8			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	8			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	8			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	8			Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31				672.58	25																																					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7006	003	0	1	04	01	H7006_003_0	5			Preferred Generic	4	01	1	2	1	1	110		01	100		1	31		100				1	2			100				31		34	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7006	003	0	1	04	01	H7006_003_0	5			Generic	4	01	1	2	2	1	110		01	100		1	31		100				1	2			100				31		34	8.00		16.00																					16.00																8.00				8.00		0.26						0.24	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	31		100				1	2			100				31		34	47.00		94.00																					94.00																47.00				47.00		1.52						1.38	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	31		100				1	2			100				31		34	100.00		200.00																					200.00																100.00				100.00		3.23						2.94	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	31														31		34				1152.15	33																																					33			33								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	31		100				1	2			100				31		34	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7006	007	0	1	04	01	H7006_007_0	6			Preferred Generic	4	01	1	2	1	1	110		01	100		1	31		100				1	2			100				31		34	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7006	007	0	1	04	01	H7006_007_0	6			Generic	4	01	1	2	2	1	110		01	100		1	31		100				1	2			100				31		34	8.00		16.00																					16.00																8.00				8.00		0.26						0.24	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7006	007	0	1	04	01	H7006_007_0	6			Preferred Brand	4	10	1	2	3	1	110		01	100		1	31		100				1	2			100				31		34	47.00		94.00																					94.00																47.00				47.00		1.52						1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7006	007	0	1	04	01	H7006_007_0	6			Non-Preferred Drug	4	11	1	2	4	1	110		01	100		1	31		100				1	2			100				31		34	100.00		200.00																					200.00																100.00				100.00		3.23						2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7006	007	0	1	04	01	H7006_007_0	6			Specialty Tier	4	11	1	1	5	1	010		01			1	31														31		34				896.12	30																																					30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7006	007	0	1	04	01	H7006_007_0	6			Select Care Drugs	4	11	1	2	6	1	110		01	100		1	31		100				1	2			100				31		34	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7006	010	0	1	04	01	H7006_010_0	5			Preferred Generic	4	01	1	2	1	1	110		01	100		1	31		100				1	2			100				31		34	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7006	010	0	1	04	01	H7006_010_0	5			Generic	4	01	1	2	2	1	110		01	100		1	31		100				1	2			100				31		34	12.00		24.00																					24.00																12.00				12.00		0.39						0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7006	010	0	1	04	01	H7006_010_0	5			Preferred Brand	4	10	1	2	3	1	110		01	100		1	31		100				1	2			100				31		34	35.00		105.00																					105.00																35.00				35.00		1.13						1.03	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7006	010	0	1	04	01	H7006_010_0	5			Non-Preferred Drug	4	11	1	2	4	1	110		01	100		1	31		100				1	2			100				31		34	100.00		300.00																					300.00																100.00				100.00		3.23						2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7006	010	0	1	04	01	H7006_010_0	5			Specialty Tier	4	11	1	1	5	1	010		01			1	31														31		34				910.30	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	5			Select Care Drugs	4	11	1	2	6	1	110		01	100		1	31		100				1	2			100				31		34	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7006	011	0	1	04	01	H7006_011_0	5			Preferred Generic	4	01	1	2	1	1	110		01	100		1	31		100				1	2			100				31		34	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7006	011	0	1	04	01	H7006_011_0	5			Generic	4	01	1	2	2	1	110		01	100		1	31		100				1	2			100				31		34	12.00		24.00																					24.00																12.00				12.00		0.39						0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7006	011	0	1	04	01	H7006_011_0	5			Preferred Brand	4	10	1	2	3	1	110		01	100		1	31		100				1	2			100				31		34	35.00		105.00																					105.00																35.00				35.00		1.13						1.03	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7006	011	0	1	04	01	H7006_011_0	5			Non-Preferred Drug	4	11	1	2	4	1	110		01	100		1	31		100				1	2			100				31		34	100.00		300.00																					300.00																100.00				100.00		3.23						2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7006	011	0	1	04	01	H7006_011_0	5			Specialty Tier	4	11	1	1	5	1	010		01			1	31														31		34				863.98	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	5			Select Care Drugs	4	11	1	2	6	1	110		01	100		1	31		100				1	2			100				31		34	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7020	004	0	1	01	01	H7020_004_0	4		Y	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00				10.00				10.00			0.33	0.00		0.33	0.00	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7020	004	0	1	01	01	H7020_004_0	4		Y	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00				20.00				20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7020	004	0	1	01	01	H7020_004_0	4		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00				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		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7020	004	0	1	01	01	H7020_004_0	4		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											766.53	33						827.31	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		Y	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00				15.00				15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7020	006	0	1	01	01	H7020_006_0	4		Y	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					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												
H7020	006	0	1	01	01	H7020_006_0	4		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00				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		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7020	006	0	1	01	01	H7020_006_0	4		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											729.78	33						722.54	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		Y	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00				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		Y	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								15.00	30.00	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		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00				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		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								100.00	200.00	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		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											715.25	33						749.43	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7028	001	0	1	04	01	H7028_001_0	9		Y	Preferred Generic	4	11	1	2	1	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7028	001	0	1	04	01	H7028_001_0	9		Y	Preferred Generic	4	11	1	2	1	3	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H7028	001	0	1	04	01	H7028_001_0	9		Y	Generic	4	11	3	2	2	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7028	001	0	1	04	01	H7028_001_0	9		Y	Generic	4	11	3	2	2	3	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	3
H7028	001	0	1	04	01	H7028_001_0	9		Y	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	47.00	94.00	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												
H7028	001	0	1	04	01	H7028_001_0	9		Y	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	100.00	200.00	300.00																			100.00	200.00	300.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7028	001	0	1	04	01	H7028_001_0	9		Y	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												
H7028	002	0	1	04	01	H7028_002_0	10		N	Preferred Generic	4	11	1	2	1	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7028	002	0	1	04	01	H7028_002_0	10		N	Preferred Generic	4	11	1	2	1	3	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H7028	002	0	1	04	01	H7028_002_0	10		N	Generic	4	11	3	2	2	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	2.00	4.00	6.00																			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												
H7028	002	0	1	04	01	H7028_002_0	10		N	Generic	4	11	3	2	2	3	111		01	111		1	30	60	100				1	2	30	60	100				30		31	2.00	4.00	6.00																			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										2	2	2
H7028	002	0	1	04	01	H7028_002_0	10		N	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	47.00	94.00	141.00																			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												
H7028	002	0	1	04	01	H7028_002_0	10		N	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	100.00	200.00	300.00																			100.00	200.00	300.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7028	002	0	1	04	01	H7028_002_0	10		N	Specialty Tier	4	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												
H7063	001	0	1	04	01	H7063_001_0	6		N	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	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	6		N	Preferred Generic	4	01	1	2	1	3	111		01	111		1	30	60	90				1	2	30	60	90				30		31	3.00	6.00	6.00																			3.00	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	6		N	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	5.00	10.00	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	6		N	Generic	4	01	1	2	2	3	111		01	111		1	30	60	90				1	2	30	60	90				30		31	5.00	10.00	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	6		N	Preferred Brand	4	10	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	45.00	90.00	135.00																			45.00	90.00	135.00																45.00				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	6		N	Non-Preferred Drug	4	10	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	100.00	200.00	300.00																			100.00	200.00	300.00																100.00				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	6		N	Specialty Tier	4	10	1	1	5	1	010		01	010		1	30								30						30		31					33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7063	002	0	1	04	01	H7063_002_0	6		Y	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	3.00	6.00	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	6		Y	Preferred Generic	4	01	1	2	1	3	111		01	111		1	30	60	90				1	2	30	60	90				30		31	3.00	6.00	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	6		Y	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	6		Y	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	6		Y	Preferred Brand	4	10	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	45.00	90.00	135.00																			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	6		Y	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	6		Y	Specialty Tier	4	10	1	1	5	1	010		01	010		1	30								30						30		31					33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7063	006	0	1	04	01	H7063_006_0	6		N	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	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	6		N	Preferred Generic	4	01	1	2	1	3	111		01	111		1	30	60	90				1	2	30	60	90				30		31	3.00	6.00	6.00																			3.00	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	6		N	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	5.00	10.00	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	6		N	Generic	4	01	1	2	2	3	111		01	111		1	30	60	90				1	2	30	60	90				30		31	5.00	10.00	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	6		N	Preferred Brand	4	10	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	45.00	90.00	135.00																			45.00	90.00	135.00																45.00				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	6		N	Non-Preferred Drug	4	10	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	100.00	200.00	300.00																			100.00	200.00	300.00																100.00				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	6		N	Specialty Tier	4	10	1	1	5	1	010		01	010		1	30								30						30		31					33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7063	007	0	1	04	01	H7063_007_0	6		Y	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	3.00	6.00	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	6		Y	Preferred Generic	4	01	1	2	1	3	111		01	111		1	30	60	90				1	2	30	60	90				30		31	3.00	6.00	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	6		Y	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	6		Y	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	6		Y	Preferred Brand	4	10	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	45.00	90.00	135.00																			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	6		Y	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	6		Y	Specialty Tier	4	10	1	1	5	1	010		01	010		1	30								30						30		31					33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7063	012	0	1	04	01	H7063_012_0	8		N	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	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	8		N	Preferred Generic	4	01	1	2	1	3	111		01	111		1	30	60	90				1	2	30	60	90				30		31	3.00	6.00	6.00																			3.00	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	8		N	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	5.00	10.00	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	8		N	Generic	4	01	1	2	2	3	111		01	111		1	30	60	90				1	2	30	60	90				30		31	5.00	10.00	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	8		N	Preferred Brand	4	10	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	45.00	90.00	135.00																			45.00	90.00	135.00																45.00				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	8		N	Non-Preferred Drug	4	10	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	100.00	200.00	300.00																			100.00	200.00	300.00																100.00				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	8		N	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	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, Select Care Drugs												
H7074	001	0	1	04	01	H7074_001_0	5			Generic	4	01	1	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	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	5			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	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	5			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	300.00																			100.00	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	5			Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				863.36	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	5			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	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	5			Select Care Drugs	4	01	1	2	6	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, Select Care Drugs										1		
H7076	015	0	1	01	01	H7076_015_0	8		N	Preferred Generic	4	01	1	2	1	1	111		01	100		1	30	60	90				1	2			90				30		31	0.00	0.00	0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7076	015	0	1	01	01	H7076_015_0	8		N	Preferred Generic	4	01	1	2	1	3	111		01	100		1	30	60	90				1	2			90				30		31	0.00	0.00	0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H7076	015	0	1	01	01	H7076_015_0	8		N	Generic	4	01	1	1	2	1	111		01	100		1	30	60	90				1	2			90				30		31				5.87	25	25	25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7076	015	0	1	01	01	H7076_015_0	8		N	Preferred Brand	4	11	1	1	3	1	111		01	100		1	30	60	90				1	2			90				30		31				76.25	25	25	25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7076	015	0	1	01	01	H7076_015_0	8		N	Non-Preferred Drug	4	11	1	1	4	1	111		01	100		1	30	60	90				1	2			90				30		31				61.92	25	25	25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7076	015	0	1	01	01	H7076_015_0	8		N	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31				766.33	25																																					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7076	016	0	1	01	01	H7076_016_0	8		N	Preferred Generic	4	01	1	2	1	1	111		01	100		1	30	60	90				1	2			90				30		31	0.00	0.00	0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7076	016	0	1	01	01	H7076_016_0	8		N	Preferred Generic	4	01	1	2	1	3	111		01	100		1	30	60	90				1	2			90				30		31	0.00	0.00	0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H7076	016	0	1	01	01	H7076_016_0	8		N	Generic	4	01	1	1	2	1	111		01	100		1	30	60	90				1	2			90				30		31				5.77	25	25	25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7076	016	0	1	01	01	H7076_016_0	8		N	Preferred Brand	4	11	1	1	3	1	111		01	100		1	30	60	90				1	2			90				30		31				69.97	25	25	25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7076	016	0	1	01	01	H7076_016_0	8		N	Non-Preferred Drug	4	11	1	1	4	1	111		01	100		1	30	60	90				1	2			90				30		31				55.84	25	25	25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7076	016	0	1	01	01	H7076_016_0	8		N	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31				734.63	25																																					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7093	002	0	1	04	01	H7093_002_0	6		Y	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	6		Y	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	6		Y	Preferred Brand	4	11	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	6		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				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	6		Y	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7093	002	0	1	04	01	H7093_002_0	6		Y	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				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	6		Y	Select Care Drugs	4	01	1	2	6	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				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	5		Y	Preferred Generic	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	5		Y	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	5		Y	Preferred Brand	4	10	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	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	5		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	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	5		Y	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7115	001	0	1	01	01	H7115_001_0	5		Y	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	5		Y	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	5		Y	Preferred Generic	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	5		Y	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	5		Y	Preferred Brand	4	10	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	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	5		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	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	5		Y	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7115	003	0	1	01	01	H7115_003_0	5		Y	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	5		Y	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	5		Y	Preferred Generic	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	5		Y	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	5		Y	Preferred Brand	4	10	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	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	5		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	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	5		Y	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7115	004	0	1	01	01	H7115_004_0	5		Y	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	5		Y	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	7		N	Preferred Generic	4	11	1	2	1	1		111	01		100	1				30	60	90	1	2						90	30		31								15.00	30.00	45.00					8.00	12.00	16.00													21.00						16.00				15.00				8.00			0.50	0.27				0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7123	001	0	1	01	01	H7123_001_0	7		N	Preferred Generic	4	11	1	2	1	3		111	01		100	1				30	60	90	1	2						90	30		31								20.00	40.00	60.00					15.00	22.50	30.00													35.00						30.00				20.00				15.00			0.67	0.50				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H7123	001	0	1	01	01	H7123_001_0	7		N	Generic	4	11	1	2	2	1		111	01		100	1				30	60	90	1	2						90	30		31								20.00	40.00	60.00					15.00	22.50	30.00													35.00						30.00				20.00				15.00			0.67	0.50				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7123	001	0	1	01	01	H7123_001_0	7		N	Preferred Brand	4	11	1	2	3	1		111	01		100	1				30	60	90	1	2						90	30		31								45.00	90.00	135.00					25.00	37.50	50.00													55.00						50.00				45.00				25.00			1.50	0.83				0.81	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7123	001	0	1	01	01	H7123_001_0	7		N	Non-Preferred Drug	4	11	1	1	4	1		111	01		100	1				30	60	90	1	2						90	30		31											59.33	49	49	49				67.61	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	7		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											509.76	25						562.63	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7147	001	0	1	01	01	H7147_001_0	10		Y	Preferred Generic	4	11	1	2	1	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7147	001	0	1	01	01	H7147_001_0	10		Y	Preferred Generic	4	11	1	2	1	3	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H7147	001	0	1	01	01	H7147_001_0	10		Y	Generic	4	11	3	2	2	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	2.00	4.00	6.00																			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												
H7147	001	0	1	01	01	H7147_001_0	10		Y	Generic	4	11	3	2	2	3	111		01	111		1	30	60	100				1	2	30	60	100				30		31	2.00	4.00	6.00																			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										2	3	3
H7147	001	0	1	01	01	H7147_001_0	10		Y	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	47.00	94.00	141.00																			47.00	94.00	117.50																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7147	001	0	1	01	01	H7147_001_0	10		Y	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	95.00	190.00	285.00																			95.00	190.00	285.00																95.00				95.00		3.17			3.17			3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7147	001	0	1	01	01	H7147_001_0	10		Y	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												
H7147	004	0	1	01	01	H7147_004_0	10		Y	Preferred Generic	4	11	1	2	1	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7147	004	0	1	01	01	H7147_004_0	10		Y	Preferred Generic	4	11	1	2	1	3	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H7147	004	0	1	01	01	H7147_004_0	10		Y	Generic	4	11	3	2	2	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7147	004	0	1	01	01	H7147_004_0	10		Y	Generic	4	11	3	2	2	3	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	3
H7147	004	0	1	01	01	H7147_004_0	10		Y	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	47.00	94.00	141.00																			47.00	94.00	117.50																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7147	004	0	1	01	01	H7147_004_0	10		Y	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	95.00	190.00	285.00																			95.00	190.00	285.00																95.00				95.00		3.17			3.17			3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7147	004	0	1	01	01	H7147_004_0	10		Y	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												
H7147	005	0	1	01	01	H7147_005_0	11		N	Preferred Generic	4	11	1	2	1	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7147	005	0	1	01	01	H7147_005_0	11		N	Preferred Generic	4	11	1	2	1	3	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H7147	005	0	1	01	01	H7147_005_0	11		N	Generic	4	11	3	2	2	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	9.00	18.00	27.00																			9.00	18.00	22.50																9.00				9.00		0.30			0.30			0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7147	005	0	1	01	01	H7147_005_0	11		N	Generic	4	11	3	2	2	3	111		01	111		1	30	60	100				1	2	30	60	100				30		31	9.00	18.00	27.00																			9.00	18.00	22.50																9.00				9.00		0.30			0.30			0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	2	2
H7147	005	0	1	01	01	H7147_005_0	11		N	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	47.00	94.00	141.00																			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												
H7147	005	0	1	01	01	H7147_005_0	11		N	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	95.00	190.00	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												
H7147	005	0	1	01	01	H7147_005_0	11		N	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												
H7149	001	0	1	02	01	H7149_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												
H7149	001	0	1	02	01	H7149_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		
H7149	001	0	1	02	01	H7149_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												
H7149	001	0	1	02	01	H7149_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		
H7149	001	0	1	02	01	H7149_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												
H7149	001	0	1	02	01	H7149_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												
H7149	001	0	1	02	01	H7149_001_0	3			Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											729.38	33						526.25	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7151	001	0	1	01	01	H7151_001_0	13		Y	Preferred Generic	4	11	1	2	1	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7151	001	0	1	01	01	H7151_001_0	13		Y	Preferred Generic	4	11	1	2	1	3	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H7151	001	0	1	01	01	H7151_001_0	13		Y	Generic	4	11	3	2	2	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7151	001	0	1	01	01	H7151_001_0	13		Y	Generic	4	11	3	2	2	3	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	2	2
H7151	001	0	1	01	01	H7151_001_0	13		Y	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	47.00	94.00	141.00																			47.00	94.00	117.50																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7151	001	0	1	01	01	H7151_001_0	13		Y	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	100.00	200.00	300.00																			100.00	200.00	300.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7151	001	0	1	01	01	H7151_001_0	13		Y	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												
H7151	003	0	1	01	01	H7151_003_0	11		Y	Preferred Generic	4	11	1	2	1	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7151	003	0	1	01	01	H7151_003_0	11		Y	Preferred Generic	4	11	1	2	1	3	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H7151	003	0	1	01	01	H7151_003_0	11		Y	Generic	4	11	3	2	2	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	10.00	20.00	30.00																			10.00	20.00	25.00																10.00				10.00		0.33			0.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7151	003	0	1	01	01	H7151_003_0	11		Y	Generic	4	11	3	2	2	3	111		01	111		1	30	60	100				1	2	30	60	100				30		31	10.00	20.00	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										2	2	2
H7151	003	0	1	01	01	H7151_003_0	11		Y	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	47.00	94.00	141.00																			47.00	94.00	117.50																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7151	003	0	1	01	01	H7151_003_0	11		Y	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	100.00	200.00	300.00																			100.00	200.00	300.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7151	003	0	1	01	01	H7151_003_0	11		Y	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												
H7163	002	0	1	02	01	H7163_002_0	10		Y	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	10		Y	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	10		Y	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	10		Y	Preferred Brand	4	10	1	2	3	1		110	01		100	1				31		100	1	2						100	31		31								47.00		141.00					47.00		141.00													141.00						141.00				47.00				47.00			1.52	1.52				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7163	002	0	1	02	01	H7163_002_0	10		Y	Non-Preferred Brand	4	10	1	2	4	1		110	01		100	1				31		100	1	2						100	31		31								100.00		300.00					100.00		300.00													300.00						300.00				100.00				100.00			3.23	3.23				3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7163	002	0	1	02	01	H7163_002_0	10		Y	Specialty Tier	4	10	1	1	5	1		010	01		010	1				31								31			31		31											945.73	25						687.14	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7163	004	0	1	02	01	H7163_004_0	10		Y	Preferred Generic	4	01	1	2	1	1		110	01		110	1				31		100	1	2				31		100	31		31								5.00		15.00					0.00		0.00											5.00		15.00				0.00		0.00				5.00				5.00			0.16	0.00		0.16	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7163	004	0	1	02	01	H7163_004_0	10		Y	Preferred Generic	4	01	1	2	1	3		110	01		110	1				31		100	1	2				31		100	31		31								5.00		15.00					0.00		0.00											5.00		15.00				0.00		0.00				5.00				5.00			0.16	0.00		0.16	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H7163	004	0	1	02	01	H7163_004_0	10		Y	Generic	4	01	1	2	2	1		110	01		100	1				31		100	1	2						100	31		31								14.00		42.00					14.00		42.00													42.00						42.00				14.00				14.00			0.45	0.45				0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7163	004	0	1	02	01	H7163_004_0	10		Y	Preferred Brand	4	10	1	2	3	1		110	01		100	1				31		100	1	2						100	31		31								47.00		141.00					47.00		141.00													141.00						141.00				47.00				47.00			1.52	1.52				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7163	004	0	1	02	01	H7163_004_0	10		Y	Non-Preferred Brand	4	10	1	2	4	1		110	01		100	1				31		100	1	2						100	31		31								100.00		300.00					100.00		300.00													300.00						300.00				100.00				100.00			3.23	3.23				3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7163	004	0	1	02	01	H7163_004_0	10		Y	Specialty Tier	4	10	1	1	5	1		010	01		010	1				31								31			31		31											1426.46	25						682.55	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7163	005	0	1	02	01	H7163_005_0	10		Y	Preferred Generic	4	01	1	2	1	1		110	01		110	1				31		100	1	2				31		100	31		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.32	0.00		0.32	0.00	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7163	005	0	1	02	01	H7163_005_0	10		Y	Preferred Generic	4	01	1	2	1	3		110	01		110	1				31		100	1	2				31		100	31		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.32	0.00		0.32	0.00	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H7163	005	0	1	02	01	H7163_005_0	10		Y	Generic	4	01	1	2	2	1		110	01		100	1				31		100	1	2						100	31		31								20.00		60.00					20.00		60.00													60.00						60.00				20.00				20.00			0.65	0.65				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7163	005	0	1	02	01	H7163_005_0	10		Y	Preferred Brand	4	10	1	2	3	1		110	01		100	1				31		100	1	2						100	31		31								47.00		141.00					47.00		141.00													141.00						141.00				47.00				47.00			1.52	1.52				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7163	005	0	1	02	01	H7163_005_0	10		Y	Non-Preferred Brand	4	10	1	2	4	1		110	01		100	1				31		100	1	2						100	31		31								100.00		300.00					100.00		300.00													300.00						300.00				100.00				100.00			3.23	3.23				3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7163	005	0	1	02	01	H7163_005_0	10		Y	Specialty Tier	4	10	1	1	5	1		010	01		010	1				31								31			31		31											1164.43	25						596.28	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7165	001	0	1	01	01	H7165_001_0	7		Y	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	2	2	30	60	90				30		31								5.00	10.00	15.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				0.00			0.17	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7165	001	0	1	01	01	H7165_001_0	7		Y	Preferred Generic	4	01	1	2	1	3		111	01	111		1				30	60	90	2	2	30	60	90				30		31								5.00	10.00	15.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				0.00			0.17	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H7165	001	0	1	01	01	H7165_001_0	7		Y	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		31								15.00	30.00	45.00					10.00	20.00	30.00					10.00	20.00	0.00																15.00				10.00			0.50	0.33	0.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7165	001	0	1	01	01	H7165_001_0	7		Y	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		31								47.00	94.00	141.00					42.00	84.00	126.00					42.00	84.00	105.00																47.00				42.00			1.57	1.40	1.40			1.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7165	001	0	1	01	01	H7165_001_0	7		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		31								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, Select Care Drugs												
H7165	001	0	1	01	01	H7165_001_0	7		Y	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								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7165	001	0	1	01	01	H7165_001_0	7		Y	Select Care Drugs	4	01	1	2	6	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					0.00	0.00	0.00																5.00				0.00			0.17	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7165	001	0	1	01	01	H7165_001_0	7		Y	Select Care Drugs	4	01	1	2	6	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					0.00	0.00	0.00																5.00				0.00			0.17	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H7165	002	0	1	01	01	H7165_002_0	7		Y	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	2	2	30	60	90				30		31								5.00	10.00	15.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				0.00			0.17	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7165	002	0	1	01	01	H7165_002_0	7		Y	Preferred Generic	4	01	1	2	1	3		111	01	111		1				30	60	90	2	2	30	60	90				30		31								5.00	10.00	15.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				0.00			0.17	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H7165	002	0	1	01	01	H7165_002_0	7		Y	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		31								15.00	30.00	45.00					10.00	20.00	30.00					10.00	20.00	0.00																15.00				10.00			0.50	0.33	0.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7165	002	0	1	01	01	H7165_002_0	7		Y	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		31								47.00	94.00	141.00					42.00	84.00	126.00					42.00	84.00	105.00																47.00				42.00			1.57	1.40	1.40			1.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7165	002	0	1	01	01	H7165_002_0	7		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		31								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, Select Care Drugs												
H7165	002	0	1	01	01	H7165_002_0	7		Y	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								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7165	002	0	1	01	01	H7165_002_0	7		Y	Select Care Drugs	4	01	1	2	6	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					0.00	0.00	0.00																5.00				0.00			0.17	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7165	002	0	1	01	01	H7165_002_0	7		Y	Select Care Drugs	4	01	1	2	6	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					0.00	0.00	0.00																5.00				0.00			0.17	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H7169	001	0	1	04	01	H7169_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								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												
H7169	001	0	1	04	01	H7169_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												
H7169	001	0	1	04	01	H7169_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												
H7169	001	0	1	04	01	H7169_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											79.36	45	45	45				75.83	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	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												
H7169	001	0	1	04	01	H7169_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												
H7172	001	0	1	48	05	H7172_001_0	5			Generic Drugs	4	01			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	5			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	5			Non-Medicare Rx/OTC Drugs	4	11			3	1	111		10			1	30	60	90				1	2								29	31																																																					Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	2	0.00	0.00	0.00	0.00			0.00	0.00			
H7175	001	0	1	04	01	H7175_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												
H7175	001	0	1	04	01	H7175_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					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00				15.00				15.00			0.5	0.00		0.5	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7175	001	0	1	04	01	H7175_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												
H7175	001	0	1	04	01	H7175_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											78.91	50	50	50				75.76	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	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												
H7175	001	0	1	04	01	H7175_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												
H7175	003	0	1	04	01	H7175_003_0	4			Preferred Generic	4	11	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								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												
H7175	003	0	1	04	01	H7175_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					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												
H7175	003	0	1	04	01	H7175_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	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, Select Care Drugs												
H7175	003	0	1	04	01	H7175_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											98.20	43	43	43				98.20	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	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												
H7175	003	0	1	04	01	H7175_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												
H7175	004	0	1	04	01	H7175_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												
H7175	004	0	1	04	01	H7175_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					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00				15.00				15.00			0.5	0.00		0.5	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7175	004	0	1	04	01	H7175_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												
H7175	004	0	1	04	01	H7175_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											80.21	45	45	45				80.21	45	45	45										45	45	45				45	45	45			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7175	004	0	1	04	01	H7175_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												
H7175	004	0	1	04	01	H7175_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												
H7175	004	0	1	04	01	H7175_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	
H7175	006	0	1	04	01	H7175_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												
H7175	006	0	1	04	01	H7175_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					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00				15.00				15.00			0.5	0.00		0.5	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7175	006	0	1	04	01	H7175_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												
H7175	006	0	1	04	01	H7175_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											90.12	50	50	50				86.52	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	006	0	1	04	01	H7175_006_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												
H7175	006	0	1	04	01	H7175_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												
H7199	001	0	1	04	01	H7199_001_0	9		Y	Preferred Generic	4	11	1	2	1	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7199	001	0	1	04	01	H7199_001_0	9		Y	Preferred Generic	4	11	1	2	1	3	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H7199	001	0	1	04	01	H7199_001_0	9		Y	Generic	4	11	3	2	2	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7199	001	0	1	04	01	H7199_001_0	9		Y	Generic	4	11	3	2	2	3	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	3
H7199	001	0	1	04	01	H7199_001_0	9		Y	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	47.00	94.00	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												
H7199	001	0	1	04	01	H7199_001_0	9		Y	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	100.00	200.00	300.00																			100.00	200.00	300.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7199	001	0	1	04	01	H7199_001_0	9		Y	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												
H7199	002	0	1	04	01	H7199_002_0	9		Y	Preferred Generic	4	11	1	2	1	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7199	002	0	1	04	01	H7199_002_0	9		Y	Preferred Generic	4	11	1	2	1	3	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H7199	002	0	1	04	01	H7199_002_0	9		Y	Generic	4	11	3	2	2	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	5.00	10.00	15.00																			5.00	10.00	12.50																5.00				5.00		0.17			0.17			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7199	002	0	1	04	01	H7199_002_0	9		Y	Generic	4	11	3	2	2	3	111		01	111		1	30	60	100				1	2	30	60	100				30		31	5.00	10.00	15.00																			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										2	3	3
H7199	002	0	1	04	01	H7199_002_0	9		Y	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	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												
H7199	002	0	1	04	01	H7199_002_0	9		Y	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	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												
H7199	002	0	1	04	01	H7199_002_0	9		Y	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												
H7220	004	0	1	02	01	H7220_004_0	4		Y	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					3.00	6.00	9.00					6.00	12.00	18.00																6.00				6.00			0.20	0.10	0.20			0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H7220	004	0	1	02	01	H7220_004_0	4		Y	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	30.00	45.00																15.00				15.00			0.50	0.50	0.50			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H7220	004	0	1	02	01	H7220_004_0	4		Y	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	100	2	2	30	60	100				30		31								47.00	94.00	141.00					37.00	74.00	111.00					47.00	94.00	141.00																47.00				47.00			1.57	1.23	1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H7220	004	0	1	02	01	H7220_004_0	4		Y	Non-Preferred Brand	4	11	1	2	4	1		111	01	111		1				30	60	100	2	2	30	60	100				30		31								100.00	200.00	300.00					100.00	200.00	300.00					100.00	200.00	300.00																100.00				100.00			3.33	3.33	3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H7220	004	0	1	02	01	H7220_004_0	4		Y	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H7220	004	0	1	02	01	H7220_004_0	4		Y	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		31								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H7220	009	1	1	01	01	H7220_009_1	4		Y	Preferred Generic	4	11	1	2	1	1		111	01	111		1				30	60	100	1	2	30	60	100				30		31								3.00	6.00	9.00					0.00	0.00	0.00					3.00	6.00	0.00																3.00				3.00			0.10	0.00	0.10			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H7220	009	1	1	01	01	H7220_009_1	4		Y	Generic	4	01	1	2	2	1		111	01	111		1				30	60	100	2	2	30	60	100				30		31								12.00	24.00	36.00					12.00	24.00	36.00					12.00	24.00	0.00																12.00				12.00			0.40	0.40	0.40			0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H7220	009	1	1	01	01	H7220_009_1	4		Y	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	100	2	2	30	60	100				30		31								47.00	94.00	141.00					37.00	74.00	111.00					47.00	94.00	141.00																47.00				47.00			1.57	1.23	1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H7220	009	1	1	01	01	H7220_009_1	4		Y	Non-Preferred Brand	4	11	1	2	4	1		111	01	111		1				30	60	100	2	2	30	60	100				30		31								100.00	200.00	300.00					100.00	200.00	300.00					100.00	200.00	300.00																100.00				100.00			3.33	3.33	3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H7220	009	1	1	01	01	H7220_009_1	4		Y	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H7220	009	1	1	01	01	H7220_009_1	4		Y	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		31								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H7220	009	2	1	01	01	H7220_009_2	4		Y	Preferred Generic	4	11	1	2	1	1		111	01	111		1				30	60	100	1	2	30	60	100				30		31								3.00	6.00	9.00					0.00	0.00	0.00					3.00	6.00	0.00																3.00				3.00			0.10	0.00	0.10			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H7220	009	2	1	01	01	H7220_009_2	4		Y	Generic	4	01	1	2	2	1		111	01	111		1				30	60	100	2	2	30	60	100				30		31								12.00	24.00	36.00					12.00	24.00	36.00					12.00	24.00	0.00																12.00				12.00			0.40	0.40	0.40			0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H7220	009	2	1	01	01	H7220_009_2	4		Y	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	100	2	2	30	60	100				30		31								47.00	94.00	141.00					37.00	74.00	111.00					47.00	94.00	141.00																47.00				47.00			1.57	1.23	1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H7220	009	2	1	01	01	H7220_009_2	4		Y	Non-Preferred Brand	4	11	1	2	4	1		111	01	111		1				30	60	100	2	2	30	60	100				30		31								100.00	200.00	300.00					100.00	200.00	300.00					100.00	200.00	300.00																100.00				100.00			3.33	3.33	3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H7220	009	2	1	01	01	H7220_009_2	4		Y	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H7220	009	2	1	01	01	H7220_009_2	4		Y	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		31								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H7220	009	3	1	01	01	H7220_009_3	4		Y	Preferred Generic	4	11	1	2	1	1		111	01	111		1				30	60	100	1	2	30	60	100				30		31								3.00	6.00	9.00					0.00	0.00	0.00					3.00	6.00	0.00																3.00				3.00			0.10	0.00	0.10			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H7220	009	3	1	01	01	H7220_009_3	4		Y	Generic	4	01	1	2	2	1		111	01	111		1				30	60	100	2	2	30	60	100				30		31								12.00	24.00	36.00					12.00	24.00	36.00					12.00	24.00	0.00																12.00				12.00			0.40	0.40	0.40			0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H7220	009	3	1	01	01	H7220_009_3	4		Y	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	100	2	2	30	60	100				30		31								47.00	94.00	141.00					37.00	74.00	111.00					47.00	94.00	141.00																47.00				47.00			1.57	1.23	1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H7220	009	3	1	01	01	H7220_009_3	4		Y	Non-Preferred Brand	4	11	1	2	4	1		111	01	111		1				30	60	100	2	2	30	60	100				30		31								100.00	200.00	300.00					100.00	200.00	300.00					100.00	200.00	300.00																100.00				100.00			3.33	3.33	3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H7220	009	3	1	01	01	H7220_009_3	4		Y	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H7220	009	3	1	01	01	H7220_009_3	4		Y	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		31								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			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	4		Y	Preferred Generic	4	11	1	2	1	1		111	01	111		1				30	60	100	1	2	30	60	100				30		31								3.00	6.00	9.00					0.00	0.00	0.00					3.00	6.00	0.00																3.00				3.00			0.10	0.00	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	4		Y	Generic	4	01	1	2	2	1		111	01	111		1				30	60	100	2	2	30	60	100				30		31								12.00	24.00	36.00					12.00	24.00	36.00					12.00	24.00	0.00																12.00				12.00			0.40	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	4		Y	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	100	2	2	30	60	100				30		31								47.00	94.00	141.00					37.00	74.00	111.00					47.00	94.00	141.00																47.00				47.00			1.57	1.23	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	4		Y	Non-Preferred Brand	4	11	1	2	4	1		111	01	111		1				30	60	100	2	2	30	60	100				30		31								100.00	200.00	300.00					100.00	200.00	300.00					100.00	200.00	300.00																100.00				100.00			3.33	3.33	3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H7220	010	0	1	01	01	H7220_010_0	4		Y	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H7220	010	0	1	01	01	H7220_010_0	4		Y	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		31								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			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	4		Y	Preferred Generic	4	11	1	2	1	1		111	01	111		1				30	60	100	1	2	30	60	100				30		31								3.00	6.00	9.00					0.00	0.00	0.00					3.00	6.00	0.00																3.00				3.00			0.10	0.00	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	4		Y	Generic	4	01	1	2	2	1		111	01	111		1				30	60	100	2	2	30	60	100				30		31								12.00	24.00	36.00					12.00	24.00	36.00					12.00	24.00	0.00																12.00				12.00			0.40	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	4		Y	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	100	2	2	30	60	100				30		31								47.00	94.00	141.00					37.00	74.00	111.00					47.00	94.00	141.00																47.00				47.00			1.57	1.23	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	4		Y	Non-Preferred Brand	4	11	1	2	4	1		111	01	111		1				30	60	100	2	2	30	60	100				30		31								100.00	200.00	300.00					100.00	200.00	300.00					100.00	200.00	300.00																100.00				100.00			3.33	3.33	3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H7220	011	0	1	02	01	H7220_011_0	4		Y	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H7220	011	0	1	02	01	H7220_011_0	4		Y	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		31								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H7220	012	0	1	01	01	H7220_012_0	4		Y	Preferred Generic	4	11	1	2	1	1		111	01	111		1				30	60	100	1	2	30	60	100				30		31								3.00	6.00	9.00					0.00	0.00	0.00					3.00	6.00	0.00																3.00				3.00			0.10	0.00	0.10			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H7220	012	0	1	01	01	H7220_012_0	4		Y	Generic	4	01	1	2	2	1		111	01	111		1				30	60	100	2	2	30	60	100				30		31								12.00	24.00	36.00					12.00	24.00	36.00					12.00	24.00	0.00																12.00				12.00			0.40	0.40	0.40			0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H7220	012	0	1	01	01	H7220_012_0	4		Y	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	100	2	2	30	60	100				30		31								47.00	94.00	141.00					37.00	74.00	111.00					47.00	94.00	141.00																47.00				47.00			1.57	1.23	1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H7220	012	0	1	01	01	H7220_012_0	4		Y	Non-Preferred Brand	4	11	1	2	4	1		111	01	111		1				30	60	100	2	2	30	60	100				30		31								100.00	200.00	300.00					100.00	200.00	300.00					100.00	200.00	300.00																100.00				100.00			3.33	3.33	3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H7220	012	0	1	01	01	H7220_012_0	4		Y	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H7220	012	0	1	01	01	H7220_012_0	4		Y	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		31								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			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	6		Y	Preferred Generic	4	11	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	4.00	8.00	12.00																			4.00	8.00	0.00																4.00				4.00		0.13			0.13			0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7245	001	0	1	01	01	H7245_001_0	6		Y	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												
H7245	001	0	1	01	01	H7245_001_0	6		Y	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	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												
H7245	001	0	1	01	01	H7245_001_0	6		Y	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	100.00	200.00	300.00																			100.00	200.00	300.00																100.00				100.00		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	6		Y	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												
H7245	002	0	1	01	01	H7245_002_0	6		Y	Preferred Generic	4	11	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	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												
H7245	002	0	1	01	01	H7245_002_0	6		Y	Generic	4	11	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	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												
H7245	002	0	1	01	01	H7245_002_0	6		Y	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	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												
H7245	002	0	1	01	01	H7245_002_0	6		Y	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	100.00	200.00	300.00																			100.00	200.00	300.00																100.00				100.00		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	6		Y	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												
H7245	005	0	1	01	01	H7245_005_0	6		Y	Preferred Generic	4	11	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	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												
H7245	005	0	1	01	01	H7245_005_0	6		Y	Generic	4	11	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	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												
H7245	005	0	1	01	01	H7245_005_0	6		Y	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	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												
H7245	005	0	1	01	01	H7245_005_0	6		Y	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	100.00	200.00	300.00																			100.00	200.00	300.00																100.00				100.00		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	6		Y	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												
H7273	001	0	1	04	01	H7273_001_0	9		Y	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												
H7273	001	0	1	04	01	H7273_001_0	9		Y	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		
H7273	001	0	1	04	01	H7273_001_0	9		Y	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	9		Y	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	9		Y	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	9		Y	Specialty Tier	4	11	1	1	5	1	010		01			1	31														31		31				872.16	33																																					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7273	002	0	1	04	01	H7273_002_0	9		Y	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												
H7273	002	0	1	04	01	H7273_002_0	9		Y	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		
H7273	002	0	1	04	01	H7273_002_0	9		Y	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	9		Y	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	9		Y	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	9		Y	Specialty Tier	4	11	1	1	5	1	010		01			1	31														31		31				1024.77	33																																					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7273	005	0	1	04	01	H7273_005_0	9		Y	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												
H7273	005	0	1	04	01	H7273_005_0	9		Y	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		
H7273	005	0	1	04	01	H7273_005_0	9		Y	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	9		Y	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	9		Y	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	9		Y	Specialty Tier	4	11	1	1	5	1	010		01			1	31														31		31				834.48	33																																					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7284	001	0	1	04	01	H7284_001_0	3		Y	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	2.00		6.00																									10.00		30.00				2.00		0.00				2.00				2.00		0.07				0.33	0.07	0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7284	001	0	1	04	01	H7284_001_0	3		Y	Preferred Generic	4	11	3	2	1	3	110		01		110	1	30		90				1	2				30		90	30		31	2.00		6.00																									10.00		30.00				2.00		0.00				2.00				2.00		0.07				0.33	0.07	0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H7284	001	0	1	04	01	H7284_001_0	3		Y	Generic	4	11	3	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	10.00		30.00																									20.00		60.00				10.00		0.00				10.00				10.00		0.33				0.67	0.33	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7284	001	0	1	04	01	H7284_001_0	3		Y	Generic	4	11	3	2	2	3	110		01		110	1	30		90				2	2				30		90	30		31	10.00		30.00																									20.00		60.00				10.00		0.00				10.00				10.00		0.33				0.67	0.33	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H7284	001	0	1	04	01	H7284_001_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7284	001	0	1	04	01	H7284_001_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	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												
H7284	001	0	1	04	01	H7284_001_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7284	003	0	1	04	01	H7284_003_0	4		N	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	17.00		51.00																									17.00		51.00				17.00		0.00				17.00				17.00		0.57				0.57	0.57	0.55	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7284	003	0	1	04	01	H7284_003_0	4		N	Generic	4	11	3	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	18.00		54.00																									20.00		60.00				18.00		0.00				18.00				18.00		0.60				0.67	0.60	0.58	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7284	003	0	1	04	01	H7284_003_0	4		N	Preferred Brand	4	11	1	1	3	1	110		01		110	1	30		90				2	2				30		90	30		31				41.00	18		18																								18		18				18		18			18			18								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7284	003	0	1	04	01	H7284_003_0	4		N	Non-Preferred Drug	4	11	1	1	4	1	110		01		110	1	30		90				2	2				30		90	30		31				95.00	35		35																								35		35				35		35			35			35								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7284	003	0	1	04	01	H7284_003_0	4		N	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7284	006	0	1	04	01	H7284_006_0	4		Y	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7284	006	0	1	04	01	H7284_006_0	4		Y	Preferred Generic	4	11	3	2	1	3	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H7284	006	0	1	04	01	H7284_006_0	4		Y	Generic	4	11	3	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	0.00		0.00																									20.00		60.00				0.00		0.00				0.00				0.00		0				0.67	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7284	006	0	1	04	01	H7284_006_0	4		Y	Generic	4	11	3	2	2	3	110		01		110	1	30		90				2	2				30		90	30		31	0.00		0.00																									20.00		60.00				0.00		0.00				0.00				0.00		0				0.67	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H7284	006	0	1	04	01	H7284_006_0	4		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		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		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	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												
H7284	006	0	1	04	01	H7284_006_0	4		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7284	007	0	1	04	01	H7284_007_0	3		Y	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7284	007	0	1	04	01	H7284_007_0	3		Y	Generic	4	11	3	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	0.00		0.00																									20.00		60.00				0.00		0.00				0.00				0.00		0				0.67	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7284	007	0	1	04	01	H7284_007_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	30.00		90.00																									47.00		141.00				30.00		80.00				30.00				30.00		1				1.57	1	0.97	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7284	007	0	1	04	01	H7284_007_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	95.00		285.00																									100.00		300.00				95.00		275.00				95.00				95.00		3.17				3.33	3.17	3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7284	007	0	1	04	01	H7284_007_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					30																										30						30					30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7284	008	0	1	04	01	H7284_008_0	3		Y	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7284	008	0	1	04	01	H7284_008_0	3		Y	Generic	4	11	3	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	5.00		15.00																									20.00		60.00				5.00		0.00				5.00				5.00		0.17				0.67	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7284	008	0	1	04	01	H7284_008_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		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	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		290.00				100.00				100.00		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	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					30																										30						30					30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7284	009	0	1	04	01	H7284_009_0	5		Y	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7284	009	0	1	04	01	H7284_009_0	5		Y	Preferred Generic	4	11	3	2	1	3	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H7284	009	0	1	04	01	H7284_009_0	5		Y	Generic	4	11	3	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	0.00		0.00																									20.00		60.00				0.00		0.00				0.00				0.00		0				0.67	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7284	009	0	1	04	01	H7284_009_0	5		Y	Generic	4	11	3	2	2	3	110		01		110	1	30		90				2	2				30		90	30		31	0.00		0.00																									20.00		60.00				0.00		0.00				0.00				0.00		0				0.67	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H7284	009	0	1	04	01	H7284_009_0	5		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		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	5		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		290.00				100.00				100.00		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	5		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7301	002	0	1	04	01	H7301_002_0	5			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	5			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	5			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	5			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	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					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00					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	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					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	5			Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1029.71	33						561.17	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7301	006	0	1	04	01	H7301_006_0	3			Preferred Generic	4	01	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	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
H7301	006	0	1	04	01	H7301_006_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												
H7301	006	0	1	04	01	H7301_006_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
H7301	006	0	1	04	01	H7301_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					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00					47.00			47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7301	006	0	1	04	01	H7301_006_0	3			Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	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	3			Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											985.52	33						440.01	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											904.99	33						586.99	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											765.33	33						460.03	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7301	011	0	1	04	01	H7301_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												
H7301	011	0	1	04	01	H7301_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		
H7301	011	0	1	04	01	H7301_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					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					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	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		
H7301	011	0	1	04	01	H7301_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												
H7301	011	0	1	04	01	H7301_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												
H7301	011	0	1	04	01	H7301_011_0	3			Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											938.94	33						556.87	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7301	012	0	1	04	01	H7301_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												
H7301	012	0	1	04	01	H7301_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		
H7301	012	0	1	04	01	H7301_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					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					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	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		
H7301	012	0	1	04	01	H7301_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												
H7301	012	0	1	04	01	H7301_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												
H7301	012	0	1	04	01	H7301_012_0	3			Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											938.94	33						556.87	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
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								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00				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	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								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00				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
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								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												
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											95.91	49	49	49				91.99	47	47	47										49	49	49				47	47	47			49			49								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		Y	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												
H7323	003	0	1	04	01	H7323_003_0	4		Y	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
H7323	003	0	1	04	01	H7323_003_0	4		Y	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					3.00	6.00	9.00											10.00	20.00	30.00				3.00	6.00	0.00				10.00				10.00			0.33	0.1		0.33	0.1	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7323	003	0	1	04	01	H7323_003_0	4		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								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		Y	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											88.38	50	50	50				84.84	48	48	48										50	50	50				48	48	48			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7323	003	0	1	04	01	H7323_003_0	4		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												29							29												29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7323	003	0	1	04	01	H7323_003_0	4		Y	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			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		Y	Select Care Drugs	4	11	1	2	6	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			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	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								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00				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			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					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00				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												
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											89.81	50	50	50				86.22	48	48	48										50	50	50				48	48	48			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
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								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00				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	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								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00				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
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								10.00	20.00	30.00					3.00	6.00	9.00											10.00	20.00	30.00				3.00	6.00	0.00				10.00				10.00			0.33	0.1		0.33	0.1	0.32	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											88.31	45	45	45				84.39	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	
H7323	009	0	1	04	01	H7323_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												
H7323	009	0	1	04	01	H7323_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								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00				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
H7323	009	0	1	04	01	H7323_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					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												
H7323	009	0	1	04	01	H7323_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												
H7323	009	0	1	04	01	H7323_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											95.35	50	50	50				91.53	48	48	48										50	50	50				48	48	48			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7323	009	0	1	04	01	H7323_009_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	009	0	1	04	01	H7323_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												
H7323	009	0	1	04	01	H7323_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	
H7323	010	0	1	04	01	H7323_010_0	5		N	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												
H7323	010	0	1	04	01	H7323_010_0	5		N	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
H7323	010	0	1	04	01	H7323_010_0	5		N	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					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	010	0	1	04	01	H7323_010_0	5		N	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								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	010	0	1	04	01	H7323_010_0	5		N	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											90.43	50	50	50				86.81	48	48	48										50	50	50				48	48	48			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7323	010	0	1	04	01	H7323_010_0	5		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												30							30												30						30					30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7323	010	0	1	04	01	H7323_010_0	5		N	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7323	010	0	1	04	01	H7323_010_0	5		N	Select Care Drugs	4	11	1	2	6	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			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	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												
H7326	001	0	1	04	01	H7326_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												
H7326	001	0	1	04	01	H7326_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												
H7326	001	0	1	04	01	H7326_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												
H7326	001	0	1	04	01	H7326_001_0	4			Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												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	4			Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			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	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	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								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00				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	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	
H7326	007	0	1	04	01	H7326_007_0	4			Preferred Generic	4	11	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								19.00	38.00	57.00					0.00	0.00	0.00											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												
H7326	007	0	1	04	01	H7326_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	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												
H7326	007	0	1	04	01	H7326_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	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, Select Care Drugs												
H7326	007	0	1	04	01	H7326_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											97.74	45	45	45				97.74	45	45	45										45	45	45				45	45	45			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7326	007	0	1	04	01	H7326_007_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												
H7326	007	0	1	04	01	H7326_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												
H7330	001	0	1	01	01	H7330_001_0	8		Y	Preferred Generic	4	11	1	2	1	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7330	001	0	1	01	01	H7330_001_0	8		Y	Preferred Generic	4	11	1	2	1	3	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H7330	001	0	1	01	01	H7330_001_0	8		Y	Generic	4	11	3	2	2	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	5.00	10.00	15.00																			0.00	0.00	0.00																5.00				5.00		0.17			0.00			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7330	001	0	1	01	01	H7330_001_0	8		Y	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	47.00	94.00	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												
H7330	001	0	1	01	01	H7330_001_0	8		Y	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	100.00	200.00	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												
H7330	001	0	1	01	01	H7330_001_0	8		Y	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31					33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7330	002	0	1	02	01	H7330_002_0	8		Y	Preferred Generic	4	11	1	2	1	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7330	002	0	1	02	01	H7330_002_0	8		Y	Preferred Generic	4	11	1	2	1	3	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H7330	002	0	1	02	01	H7330_002_0	8		Y	Generic	4	11	3	2	2	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	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												
H7330	002	0	1	02	01	H7330_002_0	8		Y	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	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												
H7330	002	0	1	02	01	H7330_002_0	8		Y	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	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												
H7330	002	0	1	02	01	H7330_002_0	8		Y	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31					33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7330	003	0	1	01	01	H7330_003_0	8		Y	Preferred Generic	4	11	1	2	1	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7330	003	0	1	01	01	H7330_003_0	8		Y	Preferred Generic	4	11	1	2	1	3	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H7330	003	0	1	01	01	H7330_003_0	8		Y	Generic	4	11	3	2	2	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	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												
H7330	003	0	1	01	01	H7330_003_0	8		Y	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	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												
H7330	003	0	1	01	01	H7330_003_0	8		Y	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	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												
H7330	003	0	1	01	01	H7330_003_0	8		Y	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31					33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7330	004	0	1	02	01	H7330_004_0	8		Y	Preferred Generic	4	11	1	2	1	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7330	004	0	1	02	01	H7330_004_0	8		Y	Preferred Generic	4	11	1	2	1	3	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H7330	004	0	1	02	01	H7330_004_0	8		Y	Generic	4	11	3	2	2	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	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												
H7330	004	0	1	02	01	H7330_004_0	8		Y	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	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												
H7330	004	0	1	02	01	H7330_004_0	8		Y	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	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												
H7330	004	0	1	02	01	H7330_004_0	8		Y	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31					33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7330	005	0	1	01	01	H7330_005_0	9		Y	Preferred Generic	4	11	1	2	1	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7330	005	0	1	01	01	H7330_005_0	9		Y	Preferred Generic	4	11	1	2	1	3	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H7330	005	0	1	01	01	H7330_005_0	9		Y	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																			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												
H7330	005	0	1	01	01	H7330_005_0	9		Y	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	47.00	94.00	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												
H7330	005	0	1	01	01	H7330_005_0	9		Y	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	100.00	200.00	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												
H7330	005	0	1	01	01	H7330_005_0	9		Y	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31					33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7360	001	0	1	04	01	H7360_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												
H7360	001	0	1	04	01	H7360_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												
H7360	001	0	1	04	01	H7360_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												
H7360	001	0	1	04	01	H7360_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											75.49	45	45	45				72.14	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	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												
H7360	001	0	1	04	01	H7360_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												
H7389	001	0	1	01	01	H7389_001_0	5		Y	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												
H7389	001	0	1	01	01	H7389_001_0	5		Y	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
H7389	001	0	1	01	01	H7389_001_0	5		Y	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					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		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7389	001	0	1	01	01	H7389_001_0	5		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7389	001	0	1	01	01	H7389_001_0	5		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											768.39	33						847.44	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		Y	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												
H7389	002	0	1	01	01	H7389_002_0	4		Y	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
H7389	002	0	1	01	01	H7389_002_0	4		Y	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00				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		Y	Generic	4	01	1	2	2	3		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00				20.00				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		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7389	002	0	1	01	01	H7389_002_0	4		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7389	002	0	1	01	01	H7389_002_0	4		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											768.44	33						847.40	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		Y	Preferred Generic	4	01	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	003	0	1	01	01	H7389_003_0	4		Y	Preferred Generic	4	01	1	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00				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	003	0	1	01	01	H7389_003_0	4		Y	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00				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	003	0	1	01	01	H7389_003_0	4		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7389	003	0	1	01	01	H7389_003_0	4		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7389	003	0	1	01	01	H7389_003_0	4		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											785.83	33						723.90	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		Y	Preferred Generic	4	01	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	004	0	1	01	01	H7389_004_0	4		Y	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00				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	004	0	1	01	01	H7389_004_0	4		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7389	004	0	1	01	01	H7389_004_0	4		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7389	004	0	1	01	01	H7389_004_0	4		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											785.83	33						723.09	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7389	005	0	1	01	01	H7389_005_0	5			Preferred Generic	3	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								19.00	38.00	57.00					3.00	6.00	9.00											19.00	38.00	57.00				0.00	0.00	0.00				19.00				19.00			0.63	0.10		0.63	0.00	0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7389	005	0	1	01	01	H7389_005_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					19.00	38.00	57.00											20.00	40.00	60.00				19.00	38.00	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												
H7389	005	0	1	01	01	H7389_005_0	5			Preferred Brand	3	11	1	1	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											46.51	17	17	17				44.25	17	17	17										17	17	17				17	17	17			17			17								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7389	005	0	1	01	01	H7389_005_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											98.72	47	47	47				97.20	47	47	47										47	47	47				47	47	47			47			47								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7389	005	0	1	01	01	H7389_005_0	5			Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31											557.66	25						419.19	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7399	001	0	1	01	01	H7399_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												
H7399	001	0	1	01	01	H7399_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					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	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												
H7399	001	0	1	01	01	H7399_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												
H7399	001	0	1	01	01	H7399_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												
H7399	001	0	1	01	01	H7399_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												
H7399	002	0	1	01	01	H7399_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								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00				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	6			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	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					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	6			Generic	4	11	1	2	2	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								7.00	14.00	21.00					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	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												
H7399	002	0	1	01	01	H7399_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												
H7399	002	0	1	01	01	H7399_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												
H7399	002	0	1	01	01	H7399_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												
H7399	002	0	1	01	01	H7399_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	
H7404	001	0	1	04	01	H7404_001_0	4		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7404	001	0	1	04	01	H7404_001_0	4		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H7404	001	0	1	04	01	H7404_001_0	4		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7404	001	0	1	04	01	H7404_001_0	4		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H7404	001	0	1	04	01	H7404_001_0	4		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		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	4		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7404	001	0	1	04	01	H7404_001_0	4		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				424.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7404	002	0	1	04	01	H7404_002_0	4		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7404	002	0	1	04	01	H7404_002_0	4		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H7404	002	0	1	04	01	H7404_002_0	4		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7404	002	0	1	04	01	H7404_002_0	4		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H7404	002	0	1	04	01	H7404_002_0	4		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7404	002	0	1	04	01	H7404_002_0	4		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7404	002	0	1	04	01	H7404_002_0	4		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				278.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7404	005	0	1	04	01	H7404_005_0	4		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7404	005	0	1	04	01	H7404_005_0	4		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H7404	005	0	1	04	01	H7404_005_0	4		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	14.00		42.00																											42.00						0.00				14.00				14.00		0.46						0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7404	005	0	1	04	01	H7404_005_0	4		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	14.00		42.00																											42.00						0.00				14.00				14.00		0.46						0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H7404	005	0	1	04	01	H7404_005_0	4		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7404	005	0	1	04	01	H7404_005_0	4		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		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	4		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				154.00	26																										26						26					26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7404	006	0	1	04	01	H7404_006_0	4		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7404	006	0	1	04	01	H7404_006_0	4		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H7404	006	0	1	04	01	H7404_006_0	4		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	14.00		42.00																											42.00						0.00				14.00				14.00		0.46						0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7404	006	0	1	04	01	H7404_006_0	4		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	14.00		42.00																											42.00						0.00				14.00				14.00		0.46						0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H7404	006	0	1	04	01	H7404_006_0	4		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7404	006	0	1	04	01	H7404_006_0	4		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7404	006	0	1	04	01	H7404_006_0	4		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				234.00	28																										28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7404	011	0	1	04	01	H7404_011_0	4		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7404	011	0	1	04	01	H7404_011_0	4		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H7404	011	0	1	04	01	H7404_011_0	4		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	14.00		42.00																											42.00						0.00				14.00				14.00		0.46						0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7404	011	0	1	04	01	H7404_011_0	4		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	14.00		42.00																											42.00						0.00				14.00				14.00		0.46						0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H7404	011	0	1	04	01	H7404_011_0	4		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7404	011	0	1	04	01	H7404_011_0	4		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7404	011	0	1	04	01	H7404_011_0	4		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				210.00	28																										28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7404	012	0	1	04	01	H7404_012_0	4		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7404	012	0	1	04	01	H7404_012_0	4		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H7404	012	0	1	04	01	H7404_012_0	4		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7404	012	0	1	04	01	H7404_012_0	4		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H7404	012	0	1	04	01	H7404_012_0	4		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7404	012	0	1	04	01	H7404_012_0	4		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7404	012	0	1	04	01	H7404_012_0	4		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				338.00	30																										30						30					30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7404	014	0	1	04	01	H7404_014_0	4		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7404	014	0	1	04	01	H7404_014_0	4		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H7404	014	0	1	04	01	H7404_014_0	4		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	8.00		24.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7404	014	0	1	04	01	H7404_014_0	4		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	8.00		24.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H7404	014	0	1	04	01	H7404_014_0	4		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7404	014	0	1	04	01	H7404_014_0	4		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7404	014	0	1	04	01	H7404_014_0	4		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				478.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7404	018	0	1	04	01	H7404_018_0	2		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7404	018	0	1	04	01	H7404_018_0	2		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H7404	018	0	1	04	01	H7404_018_0	2		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7404	018	0	1	04	01	H7404_018_0	2		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H7404	018	0	1	04	01	H7404_018_0	2		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7404	018	0	1	04	01	H7404_018_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7404	018	0	1	04	01	H7404_018_0	2		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				492.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7404	020	0	1	04	01	H7404_020_0	2		Y	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		100	2	2						100	30		31								10.00		30.00					0.00		0.00													30.00						0.00				10.00				10.00			0.33	0.00				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7404	020	0	1	04	01	H7404_020_0	2		Y	Preferred Generic	4	01	1	2	1	3		110	01		100	1				30		100	2	2						100	30		31								10.00		30.00					0.00		0.00													30.00						0.00				10.00				10.00			0.33	0.00				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H7404	020	0	1	04	01	H7404_020_0	2		Y	Generic	4	01	3	2	2	1		110	01		100	1				30		100	2	2						100	30		31								15.00		45.00					0.00		0.00													45.00						0.00				15.00				15.00			0.50	0.00				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7404	020	0	1	04	01	H7404_020_0	2		Y	Generic	4	01	3	2	2	3		110	01		100	1				30		100	2	2						100	30		31								15.00		45.00					0.00		0.00													45.00						0.00				15.00				15.00			0.50	0.00				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H7404	020	0	1	04	01	H7404_020_0	2		Y	Preferred Brand	4	11	1	2	3	1		110	01		100	1				30		100	2	2						100	30		31								47.00		141.00					47.00		131.00													141.00						131.00				47.00				47.00			1.56	1.56				1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7404	020	0	1	04	01	H7404_020_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1		110	01		100	1				30		100	2	2						100	30		31								100.00		300.00					100.00		290.00													300.00						290.00				100.00				100.00			3.33	3.33				3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7404	020	0	1	04	01	H7404_020_0	2		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											351.00	30						331.00	30												30						30					30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7404	021	0	1	04	01	H7404_021_0	2		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7404	021	0	1	04	01	H7404_021_0	2		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H7404	021	0	1	04	01	H7404_021_0	2		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7404	021	0	1	04	01	H7404_021_0	2		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H7404	021	0	1	04	01	H7404_021_0	2		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7404	021	0	1	04	01	H7404_021_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7404	021	0	1	04	01	H7404_021_0	2		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				611.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7404	022	0	1	04	01	H7404_022_0	4		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7404	022	0	1	04	01	H7404_022_0	4		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H7404	022	0	1	04	01	H7404_022_0	4		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7404	022	0	1	04	01	H7404_022_0	4		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H7404	022	0	1	04	01	H7404_022_0	4		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7404	022	0	1	04	01	H7404_022_0	4		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7404	022	0	1	04	01	H7404_022_0	4		Y	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												
H7404	023	0	1	04	01	H7404_023_0	4		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7404	023	0	1	04	01	H7404_023_0	4		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H7404	023	0	1	04	01	H7404_023_0	4		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7404	023	0	1	04	01	H7404_023_0	4		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H7404	023	0	1	04	01	H7404_023_0	4		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7404	023	0	1	04	01	H7404_023_0	4		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7404	023	0	1	04	01	H7404_023_0	4		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				338.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7404	024	0	1	04	01	H7404_024_0	2		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7404	024	0	1	04	01	H7404_024_0	2		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H7404	024	0	1	04	01	H7404_024_0	2		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	14.00		42.00																											42.00						0.00				14.00				14.00		0.46						0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7404	024	0	1	04	01	H7404_024_0	2		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	14.00		42.00																											42.00						0.00				14.00				14.00		0.46						0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H7404	024	0	1	04	01	H7404_024_0	2		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7404	024	0	1	04	01	H7404_024_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7404	024	0	1	04	01	H7404_024_0	2		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				265.00	28																										28						28					28			28								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	02	01	H7445_005_0	2		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7445	005	0	1	02	01	H7445_005_0	2		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H7445	005	0	1	02	01	H7445_005_0	2		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	8.00		24.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7445	005	0	1	02	01	H7445_005_0	2		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	8.00		24.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H7445	005	0	1	02	01	H7445_005_0	2		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7445	005	0	1	02	01	H7445_005_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7445	005	0	1	02	01	H7445_005_0	2		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				461.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7511	002	0	1	01	01	H7511_002_0	5			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	5			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	5			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	5			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	5			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	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												
H7512	001	0	1	04	01	H7512_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												
H7512	001	0	1	04	01	H7512_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												
H7512	001	0	1	04	01	H7512_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												
H7512	001	0	1	04	01	H7512_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												
H7512	001	0	1	04	01	H7512_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												
H7512	002	0	1	04	01	H7512_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								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00				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	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												
H7512	002	0	1	04	01	H7512_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												
H7512	002	0	1	04	01	H7512_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												
H7512	002	0	1	04	01	H7512_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												
H7512	002	0	1	04	01	H7512_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												
H7512	003	0	1	04	01	H7512_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								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00				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	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												
H7512	003	0	1	04	01	H7512_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												
H7512	003	0	1	04	01	H7512_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												
H7512	003	0	1	04	01	H7512_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												
H7512	003	0	1	04	01	H7512_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												
H7512	004	0	1	04	01	H7512_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												
H7512	004	0	1	04	01	H7512_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												
H7512	004	0	1	04	01	H7512_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												
H7512	004	0	1	04	01	H7512_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												
H7512	004	0	1	04	01	H7512_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												
H7512	004	0	1	04	01	H7512_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												
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											88.49	50	50	50				84.95	48	48	48										50	50	50				48	48	48			50			50								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	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											81.18	45	45	45				77.57	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	3	11	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								19.00	38.00	57.00					0.00	0.00	0.00											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	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					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00				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	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	74.00				47.00				47.00			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	3	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											92.58	45	45	45				92.58	45	45	45										45	45	45				45	45	45			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	3	11	1	1	5	1		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	3	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7524	001	0	1	01	01	H7524_001_0	9		N	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7524	001	0	1	01	01	H7524_001_0	9		N	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	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												
H7524	001	0	1	01	01	H7524_001_0	9		N	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	141.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7524	001	0	1	01	01	H7524_001_0	9		N	Non-Preferred Drug	4	11	1	1	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31				99.00	34	34	34																		34	34	34															34			34								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7524	001	0	1	01	01	H7524_001_0	9		N	Specialty Tier	4	11	1	1	5	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31				1.00	25	25	25																		25	25	25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7524	002	0	1	01	01	H7524_002_0	9		N	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7524	002	0	1	01	01	H7524_002_0	9		N	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	20.00	40.00	60.00																			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												
H7524	002	0	1	01	01	H7524_002_0	9		N	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	141.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7524	002	0	1	01	01	H7524_002_0	9		N	Non-Preferred Drug	4	11	1	1	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31				99.00	32	32	32																		32	32	32															32			32								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7524	002	0	1	01	01	H7524_002_0	9		N	Specialty Tier	4	11	1	1	5	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31				1.00	25	25	25																		25	25	25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7524	003	0	1	01	01	H7524_003_0	9		N	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7524	003	0	1	01	01	H7524_003_0	9		N	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	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												
H7524	003	0	1	01	01	H7524_003_0	9		N	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	141.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7524	003	0	1	01	01	H7524_003_0	9		N	Non-Preferred Drug	4	11	1	1	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31				99.00	34	34	34																		34	34	34															34			34								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7524	003	0	1	01	01	H7524_003_0	9		N	Specialty Tier	4	11	1	1	5	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31				1.00	25	25	25																		25	25	25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7524	004	0	1	01	01	H7524_004_0	9		N	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7524	004	0	1	01	01	H7524_004_0	9		N	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	20.00	40.00	60.00																			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												
H7524	004	0	1	01	01	H7524_004_0	9		N	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	141.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7524	004	0	1	01	01	H7524_004_0	9		N	Non-Preferred Drug	4	11	1	1	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31				99.00	32	32	32																		32	32	32															32			32								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7524	004	0	1	01	01	H7524_004_0	9		N	Specialty Tier	4	11	1	1	5	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31				1.00	25	25	25																		25	25	25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7556	001	0	1	04	01	H7556_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												
H7556	001	0	1	04	01	H7556_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												
H7556	001	0	1	04	01	H7556_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												
H7556	001	0	1	04	01	H7556_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												
H7556	001	0	1	04	01	H7556_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												
H7556	001	0	1	04	01	H7556_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												
H7556	002	0	1	04	01	H7556_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								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00				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	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												
H7556	002	0	1	04	01	H7556_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												
H7556	002	0	1	04	01	H7556_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												
H7556	002	0	1	04	01	H7556_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												
H7556	002	0	1	04	01	H7556_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												
H7556	003	0	1	04	01	H7556_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								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00				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	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												
H7556	003	0	1	04	01	H7556_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												
H7556	003	0	1	04	01	H7556_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												
H7556	003	0	1	04	01	H7556_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												
H7556	003	0	1	04	01	H7556_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												
H7556	004	0	1	04	01	H7556_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								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00				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	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												
H7556	004	0	1	04	01	H7556_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												
H7556	004	0	1	04	01	H7556_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												
H7556	004	0	1	04	01	H7556_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, Select Care Drugs												
H7556	004	0	1	04	01	H7556_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												
H7559	002	0	1	01	01	H7559_002_0	7		N	Preferred Generic	4	11	1	2	1	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7559	002	0	1	01	01	H7559_002_0	7		N	Generic	4	11	1	2	2	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7559	002	0	1	01	01	H7559_002_0	7		N	Preferred Brand	4	11	1	2	3	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31	29.00	58.00	87.00																			29.00	58.00	87.00																29.00				29.00		0.94			0.94			0.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7559	002	0	1	01	01	H7559_002_0	7		N	Non-Preferred Drug	4	11	1	1	4	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31				97.11	33	33	33																		33	33	33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7559	002	0	1	01	01	H7559_002_0	7		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	31								31						31		31				748.38	25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7559	003	0	1	01	01	H7559_003_0	7		Y	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												
H7559	003	0	1	01	01	H7559_003_0	7		Y	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												
H7559	003	0	1	01	01	H7559_003_0	7		Y	Preferred Brand	4	11	1	2	3	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31	47.00	94.00	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												
H7559	003	0	1	01	01	H7559_003_0	7		Y	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												
H7559	003	0	1	01	01	H7559_003_0	7		Y	Specialty Tier	4	11	1	1	5	1	010		01	010		1	31								31						31		31				818.17	31																				31																	31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7559	003	0	1	01	01	H7559_003_0	7		Y	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												
H7605	001	0	1	01	01	H7605_001_0	11		Y	Preferred Generic	4	11	1	2	1	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7605	001	0	1	01	01	H7605_001_0	11		Y	Preferred Generic	4	11	1	2	1	3	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H7605	001	0	1	01	01	H7605_001_0	11		Y	Generic	4	11	3	2	2	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7605	001	0	1	01	01	H7605_001_0	11		Y	Generic	4	11	3	2	2	3	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	3
H7605	001	0	1	01	01	H7605_001_0	11		Y	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	47.00	94.00	141.00																			47.00	94.00	117.50																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7605	001	0	1	01	01	H7605_001_0	11		Y	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	95.00	190.00	285.00																			95.00	190.00	285.00																95.00				95.00		3.17			3.17			3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7605	001	0	1	01	01	H7605_001_0	11		Y	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												
H7605	002	0	1	01	01	H7605_002_0	12		N	Preferred Generic	4	11	1	2	1	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7605	002	0	1	01	01	H7605_002_0	12		N	Preferred Generic	4	11	1	2	1	3	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H7605	002	0	1	01	01	H7605_002_0	12		N	Generic	4	11	3	2	2	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	7.00	14.00	21.00																			7.00	14.00	17.50																7.00				7.00		0.23			0.23			0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7605	002	0	1	01	01	H7605_002_0	12		N	Generic	4	11	3	2	2	3	111		01	111		1	30	60	100				1	2	30	60	100				30		31	7.00	14.00	21.00																			7.00	14.00	17.50																7.00				7.00		0.23			0.23			0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	2	2
H7605	002	0	1	01	01	H7605_002_0	12		N	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	45.00	90.00	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												
H7605	002	0	1	01	01	H7605_002_0	12		N	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	100.00	200.00	300.00																			100.00	200.00	300.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7605	002	0	1	01	01	H7605_002_0	12		N	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												
H7605	003	0	1	01	01	H7605_003_0	11		Y	Preferred Generic	4	11	1	2	1	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7605	003	0	1	01	01	H7605_003_0	11		Y	Preferred Generic	4	11	1	2	1	3	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H7605	003	0	1	01	01	H7605_003_0	11		Y	Generic	4	11	3	2	2	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7605	003	0	1	01	01	H7605_003_0	11		Y	Generic	4	11	3	2	2	3	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	3
H7605	003	0	1	01	01	H7605_003_0	11		Y	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	45.00	90.00	135.00																			45.00	90.00	112.50																45.00				45.00		1.50			1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7605	003	0	1	01	01	H7605_003_0	11		Y	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	95.00	190.00	285.00																			95.00	190.00	285.00																95.00				95.00		3.17			3.17			3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7605	003	0	1	01	01	H7605_003_0	11		Y	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												
H7605	004	0	1	01	01	H7605_004_0	10		Y	Preferred Generic	4	11	1	2	1	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7605	004	0	1	01	01	H7605_004_0	10		Y	Preferred Generic	4	11	1	2	1	3	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H7605	004	0	1	01	01	H7605_004_0	10		Y	Generic	4	11	3	2	2	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7605	004	0	1	01	01	H7605_004_0	10		Y	Generic	4	11	3	2	2	3	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	3
H7605	004	0	1	01	01	H7605_004_0	10		Y	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	45.00	90.00	135.00																			45.00	90.00	112.50																45.00				45.00		1.50			1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7605	004	0	1	01	01	H7605_004_0	10		Y	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	97.00	194.00	291.00																			97.00	194.00	291.00																97.00				97.00		3.23			3.23			3.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7605	004	0	1	01	01	H7605_004_0	10		Y	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												
H7605	005	0	1	01	01	H7605_005_0	11		N	Preferred Generic	4	11	1	2	1	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7605	005	0	1	01	01	H7605_005_0	11		N	Preferred Generic	4	11	1	2	1	3	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H7605	005	0	1	01	01	H7605_005_0	11		N	Generic	4	11	3	2	2	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	7.00	14.00	21.00																			7.00	14.00	17.50																7.00				7.00		0.23			0.23			0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7605	005	0	1	01	01	H7605_005_0	11		N	Generic	4	11	3	2	2	3	111		01	111		1	30	60	100				1	2	30	60	100				30		31	7.00	14.00	21.00																			7.00	14.00	17.50																7.00				7.00		0.23			0.23			0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	2	2
H7605	005	0	1	01	01	H7605_005_0	11		N	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	45.00	90.00	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												
H7605	005	0	1	01	01	H7605_005_0	11		N	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	100.00	200.00	300.00																			100.00	200.00	300.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7605	005	0	1	01	01	H7605_005_0	11		N	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												
H7605	006	0	1	01	01	H7605_006_0	10		N	Preferred Generic	4	11	1	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												
H7605	006	0	1	01	01	H7605_006_0	10		N	Generic	4	11	3	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												
H7605	006	0	1	01	01	H7605_006_0	10		N	Generic	4	11	3	2	2	3	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	2	2
H7605	006	0	1	01	01	H7605_006_0	10		N	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												
H7605	006	0	1	01	01	H7605_006_0	10		N	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												
H7605	006	0	1	01	01	H7605_006_0	10		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31					25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7605	007	0	1	01	01	H7605_007_0	11		Y	Preferred Generic	4	11	1	2	1	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7605	007	0	1	01	01	H7605_007_0	11		Y	Preferred Generic	4	11	1	2	1	3	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H7605	007	0	1	01	01	H7605_007_0	11		Y	Generic	4	11	3	2	2	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7605	007	0	1	01	01	H7605_007_0	11		Y	Generic	4	11	3	2	2	3	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	3
H7605	007	0	1	01	01	H7605_007_0	11		Y	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	45.00	90.00	135.00																			45.00	90.00	112.50																45.00				45.00		1.50			1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7605	007	0	1	01	01	H7605_007_0	11		Y	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	100.00	200.00	300.00																			100.00	200.00	300.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7605	007	0	1	01	01	H7605_007_0	11		Y	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												
H7605	008	0	1	01	01	H7605_008_0	12		N	Preferred Generic	4	11	1	2	1	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7605	008	0	1	01	01	H7605_008_0	12		N	Preferred Generic	4	11	1	2	1	3	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H7605	008	0	1	01	01	H7605_008_0	12		N	Generic	4	11	3	2	2	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	7.00	14.00	21.00																			7.00	14.00	17.50																7.00				7.00		0.23			0.23			0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7605	008	0	1	01	01	H7605_008_0	12		N	Generic	4	11	3	2	2	3	111		01	111		1	30	60	100				1	2	30	60	100				30		31	7.00	14.00	21.00																			7.00	14.00	17.50																7.00				7.00		0.23			0.23			0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	2	2
H7605	008	0	1	01	01	H7605_008_0	12		N	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	47.00	94.00	141.00																			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												
H7605	008	0	1	01	01	H7605_008_0	12		N	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	100.00	200.00	300.00																			100.00	200.00	300.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7605	008	0	1	01	01	H7605_008_0	12		N	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												
H7607	002	1	1	01	01	H7607_002_1	9		Y	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 Brand, Specialty Tier, Supplemental Drugs												
H7607	002	1	1	01	01	H7607_002_1	9		Y	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 Brand, Specialty Tier, Supplemental Drugs										1		
H7607	002	1	1	01	01	H7607_002_1	9		Y	Generic	4	01	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 Brand, Specialty Tier, Supplemental Drugs												
H7607	002	1	1	01	01	H7607_002_1	9		Y	Generic	4	01	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 Brand, Specialty Tier, Supplemental Drugs										1		
H7607	002	1	1	01	01	H7607_002_1	9		Y	Preferred Brand	4	10	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 Brand, Specialty Tier, Supplemental Drugs												
H7607	002	1	1	01	01	H7607_002_1	9		Y	Preferred Brand	4	10	1	2	3	3	110		01	100		1	30		100				1	2			100				30		31	35.00		105.00																					70.00																35.00				35.00		1.16						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs										2		
H7607	002	1	1	01	01	H7607_002_1	9		Y	Non-Preferred Brand	4	11	1	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 Brand, Specialty Tier, Supplemental Drugs												
H7607	002	1	1	01	01	H7607_002_1	9		Y	Specialty Tier	4	11	1	1	5	1	110		01	100		1	30		100				2	2			100				30		31				812.64	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	9		Y	Supplemental Drugs	4	01	2	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 Brand, Specialty Tier, Supplemental Drugs												
H7607	002	2	1	01	01	H7607_002_2	9		Y	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 Brand, Specialty Tier, Supplemental Drugs												
H7607	002	2	1	01	01	H7607_002_2	9		Y	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 Brand, Specialty Tier, Supplemental Drugs										1		
H7607	002	2	1	01	01	H7607_002_2	9		Y	Generic	4	01	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 Brand, Specialty Tier, Supplemental Drugs												
H7607	002	2	1	01	01	H7607_002_2	9		Y	Generic	4	01	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 Brand, Specialty Tier, Supplemental Drugs										1		
H7607	002	2	1	01	01	H7607_002_2	9		Y	Preferred Brand	4	10	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 Brand, Specialty Tier, Supplemental Drugs												
H7607	002	2	1	01	01	H7607_002_2	9		Y	Preferred Brand	4	10	1	2	3	3	110		01	100		1	30		100				1	2			100				30		31	35.00		105.00																					70.00																35.00				35.00		1.16						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs										2		
H7607	002	2	1	01	01	H7607_002_2	9		Y	Non-Preferred Brand	4	11	1	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 Brand, Specialty Tier, Supplemental Drugs												
H7607	002	2	1	01	01	H7607_002_2	9		Y	Specialty Tier	4	11	1	1	5	1	110		01	100		1	30		100				2	2			100				30		31				812.64	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	9		Y	Supplemental Drugs	4	01	2	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 Brand, Specialty Tier, Supplemental Drugs												
H7607	002	3	1	01	01	H7607_002_3	9		Y	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 Brand, Specialty Tier, Supplemental Drugs												
H7607	002	3	1	01	01	H7607_002_3	9		Y	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 Brand, Specialty Tier, Supplemental Drugs										1		
H7607	002	3	1	01	01	H7607_002_3	9		Y	Generic	4	01	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 Brand, Specialty Tier, Supplemental Drugs												
H7607	002	3	1	01	01	H7607_002_3	9		Y	Generic	4	01	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 Brand, Specialty Tier, Supplemental Drugs										1		
H7607	002	3	1	01	01	H7607_002_3	9		Y	Preferred Brand	4	10	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 Brand, Specialty Tier, Supplemental Drugs												
H7607	002	3	1	01	01	H7607_002_3	9		Y	Preferred Brand	4	10	1	2	3	3	110		01	100		1	30		100				1	2			100				30		31	35.00		105.00																					70.00																35.00				35.00		1.16						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs										2		
H7607	002	3	1	01	01	H7607_002_3	9		Y	Non-Preferred Brand	4	11	1	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 Brand, Specialty Tier, Supplemental Drugs												
H7607	002	3	1	01	01	H7607_002_3	9		Y	Specialty Tier	4	11	1	1	5	1	110		01	100		1	30		100				2	2			100				30		31				812.64	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	9		Y	Supplemental Drugs	4	01	2	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 Brand, Specialty Tier, Supplemental Drugs												
H7607	002	4	1	01	01	H7607_002_4	9		Y	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 Brand, Specialty Tier, Supplemental Drugs												
H7607	002	4	1	01	01	H7607_002_4	9		Y	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 Brand, Specialty Tier, Supplemental Drugs										1		
H7607	002	4	1	01	01	H7607_002_4	9		Y	Generic	4	01	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 Brand, Specialty Tier, Supplemental Drugs												
H7607	002	4	1	01	01	H7607_002_4	9		Y	Generic	4	01	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 Brand, Specialty Tier, Supplemental Drugs										1		
H7607	002	4	1	01	01	H7607_002_4	9		Y	Preferred Brand	4	10	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 Brand, Specialty Tier, Supplemental Drugs												
H7607	002	4	1	01	01	H7607_002_4	9		Y	Preferred Brand	4	10	1	2	3	3	110		01	100		1	30		100				1	2			100				30		31	35.00		105.00																					70.00																35.00				35.00		1.16						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs										2		
H7607	002	4	1	01	01	H7607_002_4	9		Y	Non-Preferred Brand	4	11	1	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 Brand, Specialty Tier, Supplemental Drugs												
H7607	002	4	1	01	01	H7607_002_4	9		Y	Specialty Tier	4	11	1	1	5	1	110		01	100		1	30		100				2	2			100				30		31				812.64	33		33																				33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs												
H7607	002	4	1	01	01	H7607_002_4	9		Y	Supplemental Drugs	4	01	2	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 Brand, Specialty Tier, Supplemental Drugs												
H7607	002	5	1	01	01	H7607_002_5	9		Y	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 Brand, Specialty Tier, Supplemental Drugs												
H7607	002	5	1	01	01	H7607_002_5	9		Y	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 Brand, Specialty Tier, Supplemental Drugs										1		
H7607	002	5	1	01	01	H7607_002_5	9		Y	Generic	4	01	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 Brand, Specialty Tier, Supplemental Drugs												
H7607	002	5	1	01	01	H7607_002_5	9		Y	Generic	4	01	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 Brand, Specialty Tier, Supplemental Drugs										1		
H7607	002	5	1	01	01	H7607_002_5	9		Y	Preferred Brand	4	10	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 Brand, Specialty Tier, Supplemental Drugs												
H7607	002	5	1	01	01	H7607_002_5	9		Y	Preferred Brand	4	10	1	2	3	3	110		01	100		1	30		100				1	2			100				30		31	35.00		105.00																					70.00																35.00				35.00		1.16						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs										2		
H7607	002	5	1	01	01	H7607_002_5	9		Y	Non-Preferred Brand	4	11	1	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 Brand, Specialty Tier, Supplemental Drugs												
H7607	002	5	1	01	01	H7607_002_5	9		Y	Specialty Tier	4	11	1	1	5	1	110		01	100		1	30		100				2	2			100				30		31				812.64	33		33																				33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs												
H7607	002	5	1	01	01	H7607_002_5	9		Y	Supplemental Drugs	4	01	2	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 Brand, Specialty Tier, Supplemental Drugs												
H7607	007	1	1	01	01	H7607_007_1	10		Y	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 Brand, Specialty Tier, Supplemental Drugs												
H7607	007	1	1	01	01	H7607_007_1	10		Y	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 Brand, Specialty Tier, Supplemental Drugs										1		
H7607	007	1	1	01	01	H7607_007_1	10		Y	Generic	4	01	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 Brand, Specialty Tier, Supplemental Drugs												
H7607	007	1	1	01	01	H7607_007_1	10		Y	Generic	4	01	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 Brand, Specialty Tier, Supplemental Drugs										1		
H7607	007	1	1	01	01	H7607_007_1	10		Y	Preferred Brand	4	10	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 Brand, Specialty Tier, Supplemental Drugs												
H7607	007	1	1	01	01	H7607_007_1	10		Y	Preferred Brand	4	10	1	2	3	3	110		01	100		1	30		100				1	2			100				30		31	35.00		105.00																					70.00																35.00				35.00		1.16						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs										2		
H7607	007	1	1	01	01	H7607_007_1	10		Y	Non-Preferred Brand	4	11	1	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 Brand, Specialty Tier, Supplemental Drugs												
H7607	007	1	1	01	01	H7607_007_1	10		Y	Specialty Tier	4	11	1	1	5	1	110		01	100		1	30		100				2	2			100				30		31				1302.61	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	10		Y	Supplemental Drugs	4	01	2	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 Brand, Specialty Tier, Supplemental Drugs												
H7607	007	2	1	01	01	H7607_007_2	10		Y	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 Brand, Specialty Tier, Supplemental Drugs												
H7607	007	2	1	01	01	H7607_007_2	10		Y	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 Brand, Specialty Tier, Supplemental Drugs										1		
H7607	007	2	1	01	01	H7607_007_2	10		Y	Generic	4	01	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 Brand, Specialty Tier, Supplemental Drugs												
H7607	007	2	1	01	01	H7607_007_2	10		Y	Generic	4	01	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 Brand, Specialty Tier, Supplemental Drugs										1		
H7607	007	2	1	01	01	H7607_007_2	10		Y	Preferred Brand	4	10	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 Brand, Specialty Tier, Supplemental Drugs												
H7607	007	2	1	01	01	H7607_007_2	10		Y	Preferred Brand	4	10	1	2	3	3	110		01	100		1	30		100				1	2			100				30		31	35.00		105.00																					70.00																35.00				35.00		1.16						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs										2		
H7607	007	2	1	01	01	H7607_007_2	10		Y	Non-Preferred Brand	4	11	1	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 Brand, Specialty Tier, Supplemental Drugs												
H7607	007	2	1	01	01	H7607_007_2	10		Y	Specialty Tier	4	11	1	1	5	1	110		01	100		1	30		100				2	2			100				30		31				1302.61	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	10		Y	Supplemental Drugs	4	01	2	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 Brand, Specialty Tier, Supplemental Drugs												
H7607	007	3	1	01	01	H7607_007_3	10		Y	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 Brand, Specialty Tier, Supplemental Drugs												
H7607	007	3	1	01	01	H7607_007_3	10		Y	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 Brand, Specialty Tier, Supplemental Drugs										1		
H7607	007	3	1	01	01	H7607_007_3	10		Y	Generic	4	01	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 Brand, Specialty Tier, Supplemental Drugs												
H7607	007	3	1	01	01	H7607_007_3	10		Y	Generic	4	01	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 Brand, Specialty Tier, Supplemental Drugs										1		
H7607	007	3	1	01	01	H7607_007_3	10		Y	Preferred Brand	4	10	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 Brand, Specialty Tier, Supplemental Drugs												
H7607	007	3	1	01	01	H7607_007_3	10		Y	Preferred Brand	4	10	1	2	3	3	110		01	100		1	30		100				1	2			100				30		31	35.00		105.00																					70.00																35.00				35.00		1.16						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs										2		
H7607	007	3	1	01	01	H7607_007_3	10		Y	Non-Preferred Brand	4	11	1	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 Brand, Specialty Tier, Supplemental Drugs												
H7607	007	3	1	01	01	H7607_007_3	10		Y	Specialty Tier	4	11	1	1	5	1	110		01	100		1	30		100				2	2			100				30		31				1302.61	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	10		Y	Supplemental Drugs	4	01	2	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 Brand, Specialty Tier, Supplemental Drugs												
H7607	007	4	1	01	01	H7607_007_4	10		Y	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 Brand, Specialty Tier, Supplemental Drugs												
H7607	007	4	1	01	01	H7607_007_4	10		Y	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 Brand, Specialty Tier, Supplemental Drugs										1		
H7607	007	4	1	01	01	H7607_007_4	10		Y	Generic	4	01	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 Brand, Specialty Tier, Supplemental Drugs												
H7607	007	4	1	01	01	H7607_007_4	10		Y	Generic	4	01	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 Brand, Specialty Tier, Supplemental Drugs										1		
H7607	007	4	1	01	01	H7607_007_4	10		Y	Preferred Brand	4	10	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 Brand, Specialty Tier, Supplemental Drugs												
H7607	007	4	1	01	01	H7607_007_4	10		Y	Preferred Brand	4	10	1	2	3	3	110		01	100		1	30		100				1	2			100				30		31	35.00		105.00																					70.00																35.00				35.00		1.16						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs										2		
H7607	007	4	1	01	01	H7607_007_4	10		Y	Non-Preferred Brand	4	11	1	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 Brand, Specialty Tier, Supplemental Drugs												
H7607	007	4	1	01	01	H7607_007_4	10		Y	Specialty Tier	4	11	1	1	5	1	110		01	100		1	30		100				2	2			100				30		31				1302.61	33		33																				33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs												
H7607	007	4	1	01	01	H7607_007_4	10		Y	Supplemental Drugs	4	01	2	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 Brand, Specialty Tier, Supplemental Drugs												
H7607	007	5	1	01	01	H7607_007_5	10		Y	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 Brand, Specialty Tier, Supplemental Drugs												
H7607	007	5	1	01	01	H7607_007_5	10		Y	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 Brand, Specialty Tier, Supplemental Drugs										1		
H7607	007	5	1	01	01	H7607_007_5	10		Y	Generic	4	01	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 Brand, Specialty Tier, Supplemental Drugs												
H7607	007	5	1	01	01	H7607_007_5	10		Y	Generic	4	01	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 Brand, Specialty Tier, Supplemental Drugs										1		
H7607	007	5	1	01	01	H7607_007_5	10		Y	Preferred Brand	4	10	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 Brand, Specialty Tier, Supplemental Drugs												
H7607	007	5	1	01	01	H7607_007_5	10		Y	Preferred Brand	4	10	1	2	3	3	110		01	100		1	30		100				1	2			100				30		31	35.00		105.00																					70.00																35.00				35.00		1.16						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs										2		
H7607	007	5	1	01	01	H7607_007_5	10		Y	Non-Preferred Brand	4	11	1	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 Brand, Specialty Tier, Supplemental Drugs												
H7607	007	5	1	01	01	H7607_007_5	10		Y	Specialty Tier	4	11	1	1	5	1	110		01	100		1	30		100				2	2			100				30		31				1302.61	33		33																				33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs												
H7607	007	5	1	01	01	H7607_007_5	10		Y	Supplemental Drugs	4	01	2	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 Brand, Specialty Tier, Supplemental Drugs												
H7607	008	1	1	01	01	H7607_008_1	10		Y	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 Brand, Specialty Tier, Supplemental Drugs												
H7607	008	1	1	01	01	H7607_008_1	10		Y	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 Brand, Specialty Tier, Supplemental Drugs										1		
H7607	008	1	1	01	01	H7607_008_1	10		Y	Generic	4	01	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 Brand, Specialty Tier, Supplemental Drugs												
H7607	008	1	1	01	01	H7607_008_1	10		Y	Generic	4	01	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 Brand, Specialty Tier, Supplemental Drugs										1		
H7607	008	1	1	01	01	H7607_008_1	10		Y	Preferred Brand	4	10	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 Brand, Specialty Tier, Supplemental Drugs												
H7607	008	1	1	01	01	H7607_008_1	10		Y	Preferred Brand	4	10	1	2	3	3	110		01	100		1	30		100				1	2			100				30		31	35.00		105.00																					70.00																35.00				35.00		1.16						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs										2		
H7607	008	1	1	01	01	H7607_008_1	10		Y	Non-Preferred Brand	4	11	1	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 Brand, Specialty Tier, Supplemental Drugs												
H7607	008	1	1	01	01	H7607_008_1	10		Y	Specialty Tier	4	11	1	1	5	1	110		01	100		1	30		100				2	2			100				30		31				914.16	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	10		Y	Supplemental Drugs	4	01	2	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 Brand, Specialty Tier, Supplemental Drugs												
H7607	008	2	1	01	01	H7607_008_2	10		Y	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 Brand, Specialty Tier, Supplemental Drugs												
H7607	008	2	1	01	01	H7607_008_2	10		Y	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 Brand, Specialty Tier, Supplemental Drugs										1		
H7607	008	2	1	01	01	H7607_008_2	10		Y	Generic	4	01	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 Brand, Specialty Tier, Supplemental Drugs												
H7607	008	2	1	01	01	H7607_008_2	10		Y	Generic	4	01	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 Brand, Specialty Tier, Supplemental Drugs										1		
H7607	008	2	1	01	01	H7607_008_2	10		Y	Preferred Brand	4	10	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 Brand, Specialty Tier, Supplemental Drugs												
H7607	008	2	1	01	01	H7607_008_2	10		Y	Preferred Brand	4	10	1	2	3	3	110		01	100		1	30		100				1	2			100				30		31	35.00		105.00																					70.00																35.00				35.00		1.16						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs										2		
H7607	008	2	1	01	01	H7607_008_2	10		Y	Non-Preferred Brand	4	11	1	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 Brand, Specialty Tier, Supplemental Drugs												
H7607	008	2	1	01	01	H7607_008_2	10		Y	Specialty Tier	4	11	1	1	5	1	110		01	100		1	30		100				2	2			100				30		31				914.16	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	10		Y	Supplemental Drugs	4	01	2	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 Brand, Specialty Tier, Supplemental Drugs												
H7607	008	3	1	01	01	H7607_008_3	10		Y	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 Brand, Specialty Tier, Supplemental Drugs												
H7607	008	3	1	01	01	H7607_008_3	10		Y	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 Brand, Specialty Tier, Supplemental Drugs										1		
H7607	008	3	1	01	01	H7607_008_3	10		Y	Generic	4	01	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 Brand, Specialty Tier, Supplemental Drugs												
H7607	008	3	1	01	01	H7607_008_3	10		Y	Generic	4	01	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 Brand, Specialty Tier, Supplemental Drugs										1		
H7607	008	3	1	01	01	H7607_008_3	10		Y	Preferred Brand	4	10	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 Brand, Specialty Tier, Supplemental Drugs												
H7607	008	3	1	01	01	H7607_008_3	10		Y	Preferred Brand	4	10	1	2	3	3	110		01	100		1	30		100				1	2			100				30		31	35.00		105.00																					70.00																35.00				35.00		1.16						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs										2		
H7607	008	3	1	01	01	H7607_008_3	10		Y	Non-Preferred Brand	4	11	1	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 Brand, Specialty Tier, Supplemental Drugs												
H7607	008	3	1	01	01	H7607_008_3	10		Y	Specialty Tier	4	11	1	1	5	1	110		01	100		1	30		100				2	2			100				30		31				914.16	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	10		Y	Supplemental Drugs	4	01	2	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 Brand, Specialty Tier, Supplemental Drugs												
H7607	008	4	1	01	01	H7607_008_4	10		Y	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 Brand, Specialty Tier, Supplemental Drugs												
H7607	008	4	1	01	01	H7607_008_4	10		Y	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 Brand, Specialty Tier, Supplemental Drugs										1		
H7607	008	4	1	01	01	H7607_008_4	10		Y	Generic	4	01	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 Brand, Specialty Tier, Supplemental Drugs												
H7607	008	4	1	01	01	H7607_008_4	10		Y	Generic	4	01	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 Brand, Specialty Tier, Supplemental Drugs										1		
H7607	008	4	1	01	01	H7607_008_4	10		Y	Preferred Brand	4	10	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 Brand, Specialty Tier, Supplemental Drugs												
H7607	008	4	1	01	01	H7607_008_4	10		Y	Preferred Brand	4	10	1	2	3	3	110		01	100		1	30		100				1	2			100				30		31	35.00		105.00																					70.00																35.00				35.00		1.16						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs										2		
H7607	008	4	1	01	01	H7607_008_4	10		Y	Non-Preferred Brand	4	11	1	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 Brand, Specialty Tier, Supplemental Drugs												
H7607	008	4	1	01	01	H7607_008_4	10		Y	Specialty Tier	4	11	1	1	5	1	110		01	100		1	30		100				2	2			100				30		31				914.16	33		33																				33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs												
H7607	008	4	1	01	01	H7607_008_4	10		Y	Supplemental Drugs	4	01	2	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 Brand, Specialty Tier, Supplemental Drugs												
H7607	008	5	1	01	01	H7607_008_5	10		Y	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 Brand, Specialty Tier, Supplemental Drugs												
H7607	008	5	1	01	01	H7607_008_5	10		Y	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 Brand, Specialty Tier, Supplemental Drugs										1		
H7607	008	5	1	01	01	H7607_008_5	10		Y	Generic	4	01	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 Brand, Specialty Tier, Supplemental Drugs												
H7607	008	5	1	01	01	H7607_008_5	10		Y	Generic	4	01	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 Brand, Specialty Tier, Supplemental Drugs										1		
H7607	008	5	1	01	01	H7607_008_5	10		Y	Preferred Brand	4	10	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 Brand, Specialty Tier, Supplemental Drugs												
H7607	008	5	1	01	01	H7607_008_5	10		Y	Preferred Brand	4	10	1	2	3	3	110		01	100		1	30		100				1	2			100				30		31	35.00		105.00																					70.00																35.00				35.00		1.16						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs										2		
H7607	008	5	1	01	01	H7607_008_5	10		Y	Non-Preferred Brand	4	11	1	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 Brand, Specialty Tier, Supplemental Drugs												
H7607	008	5	1	01	01	H7607_008_5	10		Y	Specialty Tier	4	11	1	1	5	1	110		01	100		1	30		100				2	2			100				30		31				914.16	33		33																				33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs												
H7607	008	5	1	01	01	H7607_008_5	10		Y	Supplemental Drugs	4	01	2	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 Brand, Specialty Tier, Supplemental Drugs												
H7607	011	1	1	01	01	H7607_011_1	9		Y	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 Brand, Specialty Tier, Supplemental Drugs												
H7607	011	1	1	01	01	H7607_011_1	9		Y	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 Brand, Specialty Tier, Supplemental Drugs										1		
H7607	011	1	1	01	01	H7607_011_1	9		Y	Generic	4	01	1	1	2	1	110		01	100		1	30		100				1	2			100				30		31				15.86	25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs												
H7607	011	1	1	01	01	H7607_011_1	9		Y	Generic	4	01	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 Brand, Specialty Tier, Supplemental Drugs										1		
H7607	011	1	1	01	01	H7607_011_1	9		Y	Preferred Brand	4	10	1	1	3	1	110		01	100		1	30		100				1	2			100				30		31				136.09	25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs												
H7607	011	1	1	01	01	H7607_011_1	9		Y	Preferred Brand	4	10	1	2	3	3	110		01	100		1	30		100				1	2			100				30		31	35.00		105.00																					70.00																35.00				35.00		1.16						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs										2		
H7607	011	1	1	01	01	H7607_011_1	9		Y	Non-Preferred Brand	4	11	1	1	4	1	110		01	100		1	30		100				1	2			100				30		31				80.26	25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs												
H7607	011	1	1	01	01	H7607_011_1	9		Y	Specialty Tier	4	11	1	1	5	1	110		01	100		1	30		100				2	2			100				30		31				630.04	25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs												
H7607	011	1	1	01	01	H7607_011_1	9		Y	Supplemental Drugs	4	01	2	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 Brand, Specialty Tier, Supplemental Drugs												
H7607	011	2	1	01	01	H7607_011_2	9		Y	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 Brand, Specialty Tier, Supplemental Drugs												
H7607	011	2	1	01	01	H7607_011_2	9		Y	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 Brand, Specialty Tier, Supplemental Drugs										1		
H7607	011	2	1	01	01	H7607_011_2	9		Y	Generic	4	01	1	1	2	1	110		01	100		1	30		100				1	2			100				30		31				15.86	25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs												
H7607	011	2	1	01	01	H7607_011_2	9		Y	Generic	4	01	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 Brand, Specialty Tier, Supplemental Drugs										1		
H7607	011	2	1	01	01	H7607_011_2	9		Y	Preferred Brand	4	10	1	1	3	1	110		01	100		1	30		100				1	2			100				30		31				136.09	25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs												
H7607	011	2	1	01	01	H7607_011_2	9		Y	Preferred Brand	4	10	1	2	3	3	110		01	100		1	30		100				1	2			100				30		31	35.00		105.00																					70.00																35.00				35.00		1.16						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs										2		
H7607	011	2	1	01	01	H7607_011_2	9		Y	Non-Preferred Brand	4	11	1	1	4	1	110		01	100		1	30		100				1	2			100				30		31				80.26	25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs												
H7607	011	2	1	01	01	H7607_011_2	9		Y	Specialty Tier	4	11	1	1	5	1	110		01	100		1	30		100				2	2			100				30		31				630.04	25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs												
H7607	011	2	1	01	01	H7607_011_2	9		Y	Supplemental Drugs	4	01	2	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 Brand, Specialty Tier, Supplemental Drugs												
H7607	011	4	1	01	01	H7607_011_4	9		Y	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 Brand, Specialty Tier, Supplemental Drugs												
H7607	011	4	1	01	01	H7607_011_4	9		Y	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 Brand, Specialty Tier, Supplemental Drugs										1		
H7607	011	4	1	01	01	H7607_011_4	9		Y	Generic	4	01	1	1	2	1	110		01	100		1	30		100				1	2			100				30		31				15.86	25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs												
H7607	011	4	1	01	01	H7607_011_4	9		Y	Generic	4	01	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 Brand, Specialty Tier, Supplemental Drugs										1		
H7607	011	4	1	01	01	H7607_011_4	9		Y	Preferred Brand	4	10	1	1	3	1	110		01	100		1	30		100				1	2			100				30		31				136.09	25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs												
H7607	011	4	1	01	01	H7607_011_4	9		Y	Preferred Brand	4	10	1	2	3	3	110		01	100		1	30		100				1	2			100				30		31	35.00		105.00																					70.00																35.00				35.00		1.16						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs										2		
H7607	011	4	1	01	01	H7607_011_4	9		Y	Non-Preferred Brand	4	11	1	1	4	1	110		01	100		1	30		100				1	2			100				30		31				80.26	25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs												
H7607	011	4	1	01	01	H7607_011_4	9		Y	Specialty Tier	4	11	1	1	5	1	110		01	100		1	30		100				2	2			100				30		31				630.04	25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs												
H7607	011	4	1	01	01	H7607_011_4	9		Y	Supplemental Drugs	4	01	2	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 Brand, Specialty Tier, Supplemental Drugs												
H7607	011	5	1	01	01	H7607_011_5	8		Y	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 Brand, Specialty Tier, Supplemental Drugs												
H7607	011	5	1	01	01	H7607_011_5	8		Y	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 Brand, Specialty Tier, Supplemental Drugs										1		
H7607	011	5	1	01	01	H7607_011_5	8		Y	Generic	4	01	1	1	2	1	110		01	100		1	30		100				1	2			100				30		31				15.86	25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs												
H7607	011	5	1	01	01	H7607_011_5	8		Y	Generic	4	01	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 Brand, Specialty Tier, Supplemental Drugs										1		
H7607	011	5	1	01	01	H7607_011_5	8		Y	Preferred Brand	4	10	1	1	3	1	110		01	100		1	30		100				1	2			100				30		31				136.09	25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs												
H7607	011	5	1	01	01	H7607_011_5	8		Y	Preferred Brand	4	10	1	2	3	3	110		01	100		1	30		100				1	2			100				30		31	35.00		105.00																					70.00																35.00				35.00		1.16						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs										2		
H7607	011	5	1	01	01	H7607_011_5	8		Y	Non-Preferred Brand	4	11	1	1	4	1	110		01	100		1	30		100				1	2			100				30		31				80.26	25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs												
H7607	011	5	1	01	01	H7607_011_5	8		Y	Specialty Tier	4	11	1	1	5	1	110		01	100		1	30		100				2	2			100				30		31				630.04	25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs												
H7607	011	5	1	01	01	H7607_011_5	8		Y	Supplemental Drugs	4	01	2	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 Brand, Specialty Tier, Supplemental Drugs												
H7621	001	0	1	01	01	H7621_001_0	3		Y	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	6.00		18.00																									10.00		30.00				6.00		0.00				6.00				6.00		0.20				0.33	0.20	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7621	001	0	1	01	01	H7621_001_0	3		Y	Generic	4	11	3	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	11.00		33.00																									20.00		60.00				11.00		0.00				11.00				11.00		0.37				0.67	0.37	0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7621	001	0	1	01	01	H7621_001_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7621	001	0	1	01	01	H7621_001_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	99.00		297.00																									100.00		300.00				99.00		287.00				99.00				99.00		3.30				3.33	3.30	3.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7621	001	0	1	01	01	H7621_001_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7621	002	0	1	01	01	H7621_002_0	3		Y	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		100				1	2				30		100	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7621	002	0	1	01	01	H7621_002_0	3		Y	Preferred Generic	4	11	3	2	1	3	110		01		110	1	30		100				1	2				30		100	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H7621	002	0	1	01	01	H7621_002_0	3		Y	Generic	4	11	3	2	2	1	110		01		110	1	30		100				2	2				30		100	30		31	5.00		15.00																									20.00		60.00				5.00		0.00				5.00				5.00		0.17				0.67	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7621	002	0	1	01	01	H7621_002_0	3		Y	Generic	4	11	3	2	2	3	110		01		110	1	30		100				2	2				30		100	30		31	5.00		15.00																									20.00		60.00				5.00		0.00				5.00				5.00		0.17				0.67	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H7621	002	0	1	01	01	H7621_002_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		100				2	2				30		100	30		31	47.00		141.00																									47.00		141.00				47.00		94.00				47.00				47.00		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	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		100				2	2				30		100	30		31	100.00		300.00																									100.00		300.00				100.00		200.00				100.00				100.00		3.33				3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7621	002	0	1	01	01	H7621_002_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7621	003	0	1	01	01	H7621_003_0	3		Y	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		100				1	2				30		100	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7621	003	0	1	01	01	H7621_003_0	3		Y	Generic	4	11	3	2	2	1	110		01		110	1	30		100				2	2				30		100	30		31	5.00		15.00																									20.00		60.00				5.00		0.00				5.00				5.00		0.17				0.67	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7621	003	0	1	01	01	H7621_003_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		100				2	2				30		100	30		31	47.00		141.00																									47.00		141.00				47.00		94.00				47.00				47.00		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	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		100				2	2				30		100	30		31	100.00		300.00																									100.00		300.00				100.00		200.00				100.00				100.00		3.33				3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7621	003	0	1	01	01	H7621_003_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7646	001	0	1	02	01	H7646_001_0	6		Y	Preferred Generic	4	11	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								5.00	10.00	15.00					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		Y	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		Y	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								45.00	90.00	135.00					40.00	80.00	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		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								95.00	190.00	285.00					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		Y	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7646	002	0	1	02	01	H7646_002_0	6		Y	Preferred Generic	4	11	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								5.00	10.00	15.00					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		Y	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		Y	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								45.00	90.00	135.00					40.00	80.00	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		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								95.00	190.00	285.00					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		Y	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7646	003	0	1	02	01	H7646_003_0	7		Y	Preferred Generic	4	11	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								5.00	10.00	15.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7646	003	0	1	02	01	H7646_003_0	7		Y	Generic	4	11	3	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								10.00	20.00	30.00					0.00	0.00	0.00					0.00	0.00	0.00																10.00				10.00			0.33	0.00	0.00			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7646	003	0	1	02	01	H7646_003_0	7		Y	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								45.00	90.00	135.00					40.00	80.00	120.00					45.00	90.00	112.50																45.00				45.00			1.50	1.33	1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7646	003	0	1	02	01	H7646_003_0	7		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								95.00	190.00	285.00					90.00	180.00	270.00					95.00	190.00	237.50																95.00				95.00			3.17	3.00	3.17			3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7646	003	0	1	02	01	H7646_003_0	7		Y	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7646	004	0	1	02	01	H7646_004_0	5		Y	Preferred Generic	4	11	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								5.00	10.00	15.00					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	5		Y	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	5		Y	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								45.00	90.00	135.00					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	5		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								95.00	190.00	285.00					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	5		Y	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7646	005	0	1	02	01	H7646_005_0	6		Y	Preferred Generic	4	11	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								5.00	10.00	15.00					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	6		Y	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	6		Y	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								45.00	90.00	135.00					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	6		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								95.00	190.00	285.00					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	6		Y	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7646	006	0	1	02	01	H7646_006_0	6		Y	Preferred Generic	4	11	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								5.00	10.00	15.00					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	6		Y	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	6		Y	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								45.00	90.00	135.00					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	6		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								95.00	190.00	285.00					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	6		Y	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7646	007	0	1	02	01	H7646_007_0	6		Y	Preferred Generic	4	11	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								5.00	10.00	15.00					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	6		Y	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	6		Y	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								45.00	90.00	135.00					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	6		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								95.00	190.00	285.00					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	6		Y	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7646	008	0	1	02	01	H7646_008_0	7		Y	Preferred Generic	4	11	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								5.00	10.00	15.00					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	7		Y	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	7		Y	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								45.00	90.00	135.00					40.00	80.00	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	7		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								95.00	190.00	285.00					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	7		Y	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7670	001	0	1	01	01	H7670_001_0	7		Y	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	7		Y	Preferred Generic	4	11	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										1		
H7670	001	0	1	01	01	H7670_001_0	7		Y	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	8.00																			4.00	8.00	8.00																4.00				4.00		0.13			0.13			0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7670	001	0	1	01	01	H7670_001_0	7		Y	Generic	4	11	1	2	2	3	111		01	111		1	30	60	90				1	1	30	60	90				30		31	4.00	8.00	8.00																			4.00	8.00	8.00																4.00				4.00		0.13			0.13			0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H7670	001	0	1	01	01	H7670_001_0	7		Y	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	94.00	94.00																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	7		Y	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	200.00	200.00																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	7		Y	Specialty Tier	4	11	1	1	5	1	111		01	111		1	30	60	90				1	1	30	60	90				30		31				1093.25	30	30	30																		30	30	30															30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7670	002	0	1	01	01	H7670_002_0	7		Y	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	7		Y	Preferred Generic	4	11	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										1		
H7670	002	0	1	01	01	H7670_002_0	7		Y	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	8.00																			4.00	8.00	8.00																4.00				4.00		0.13			0.13			0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7670	002	0	1	01	01	H7670_002_0	7		Y	Generic	4	11	1	2	2	3	111		01	111		1	30	60	90				1	1	30	60	90				30		31	4.00	8.00	8.00																			4.00	8.00	8.00																4.00				4.00		0.13			0.13			0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H7670	002	0	1	01	01	H7670_002_0	7		Y	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	94.00	94.00																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	7		Y	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	200.00	200.00																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	7		Y	Specialty Tier	4	11	1	1	5	1	111		01	111		1	30	60	90				1	1	30	60	90				30		31				1075.91	33	33	33																		33	33	33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7678	001	0	1	01	01	H7678_001_0	7		N	Preferred Generic	4	11	1	2	1	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7678	001	0	1	01	01	H7678_001_0	7		N	Preferred Generic	4	11	1	2	1	3	111		01	111		1	31	60	90				1	2	31	60	90				31		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H7678	001	0	1	01	01	H7678_001_0	7		N	Generic	4	11	1	2	2	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31	5.00	10.00	15.00																			5.00	10.00	15.00																5.00				5.00		0.16			0.16			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7678	001	0	1	01	01	H7678_001_0	7		N	Preferred Brand	4	11	1	2	3	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31	42.00	84.00	126.00																			42.00	84.00	126.00																42.00				42.00		1.35			1.35			1.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7678	001	0	1	01	01	H7678_001_0	7		N	Non-Preferred Drug	4	11	1	1	4	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31				93.00	33	33	33																		33	33	33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7678	001	0	1	01	01	H7678_001_0	7		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	31								31						31		31				788.77	25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7678	003	0	1	01	01	H7678_003_0	8			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	8			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	8			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	8			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	8			Non-Preferred Drug	4	11	1	1	4	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31				81.75	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	8			Specialty Tier	4	11	1	1	5	1	010		01	010		1	31								31						31		31				469.67	25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7678	004	0	1	01	01	H7678_004_0	7		Y	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	7		Y	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	7		Y	Preferred Brand	4	11	1	2	3	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31	47.00	94.00	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	7		Y	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	7		Y	Specialty Tier	4	11	1	1	5	1	010		01	010		1	31								31						31		31				827.38	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	7		Y	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	9		Y	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	9		Y	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	9		Y	Preferred Brand	4	11	1	2	3	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31	47.00	94.00	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	9		Y	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	9		Y	Specialty Tier	4	11	1	1	5	1	010		01	010		1	31								31						31		31				754.32	29																				29																	29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7678	005	0	1	01	01	H7678_005_0	9		Y	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	5		Y	Preferred Generic	4	01	3	2	1	1	111		01	100		1	30	60	100				1	2			100				30		31	0.00	0.00	0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7680	001	0	1	01	01	H7680_001_0	5		Y	Preferred Generic	4	01	3	2	1	3	111		01	100		1	30	60	100				1	2			100				30		31	0.00	0.00	0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		3
H7680	001	0	1	01	01	H7680_001_0	5		Y	Generic	4	01	1	2	2	1	111		01	100		1	30	60	100				1	2			100				30		31	12.00	24.00	24.00																					24.00																12.00				12.00		0.40						0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7680	001	0	1	01	01	H7680_001_0	5		Y	Generic	4	01	1	2	2	3	111		01	100		1	30	60	100				1	2			100				30		31	12.00	24.00	24.00																					24.00																12.00				12.00		0.40						0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H7680	001	0	1	01	01	H7680_001_0	5		Y	Preferred Brand	4	11	1	2	3	1	111		01	100		1	30	60	100				1	2			100				30		31	35.00	70.00	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												
H7680	001	0	1	01	01	H7680_001_0	5		Y	Non-Preferred Drug	4	11	1	2	4	1	111		01	100		1	30	60	100				1	2			100				30		31	100.00	200.00	300.00																					300.00																100.00				100.00		3.33						3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7680	001	0	1	01	01	H7680_001_0	5		Y	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				139.00	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	5		Y	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												
H7680	001	0	1	01	01	H7680_001_0	5		Y	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 Drug, Specialty Tier, Select Care Drugs										1		
H7680	002	0	1	01	01	H7680_002_0	5		Y	Preferred Generic	4	01	3	2	1	1	111		01	100		1	30	60	100				1	2			100				30		31	0.00	0.00	0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7680	002	0	1	01	01	H7680_002_0	5		Y	Preferred Generic	4	01	3	2	1	3	111		01	100		1	30	60	100				1	2			100				30		31	0.00	0.00	0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		3
H7680	002	0	1	01	01	H7680_002_0	5		Y	Generic	4	01	1	2	2	1	111		01	100		1	30	60	100				1	2			100				30		31	12.00	24.00	24.00																					24.00																12.00				12.00		0.40						0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7680	002	0	1	01	01	H7680_002_0	5		Y	Generic	4	01	1	2	2	3	111		01	100		1	30	60	100				1	2			100				30		31	12.00	24.00	24.00																					24.00																12.00				12.00		0.40						0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H7680	002	0	1	01	01	H7680_002_0	5		Y	Preferred Brand	4	11	1	2	3	1	111		01	100		1	30	60	100				1	2			100				30		31	35.00	70.00	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												
H7680	002	0	1	01	01	H7680_002_0	5		Y	Non-Preferred Drug	4	11	1	2	4	1	111		01	100		1	30	60	100				1	2			100				30		31	100.00	200.00	300.00																					300.00																100.00				100.00		3.33						3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7680	002	0	1	01	01	H7680_002_0	5		Y	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				100.37	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	5		Y	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												
H7680	002	0	1	01	01	H7680_002_0	5		Y	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 Drug, Specialty Tier, Select Care Drugs										1		
H7680	007	0	1	01	01	H7680_007_0	4		N	Preferred Generic	4	01	3	1	1	1	111		01	100		1	30	60	100				1	2			100				30		31				1.10	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	4		N	Generic	4	01	1	1	2	1	111		01	100		1	30	60	100				1	2			100				30		31				11.27	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	4		N	Preferred Brand	4	11	1	1	3	1	111		01	100		1	30	60	100				1	2			100				30		31				142.31	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	4		N	Non-Preferred Drug	4	11	1	1	4	1	111		01	100		1	30	60	100				1	2			100				30		31				70.74	50	50	50																				50															50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7680	007	0	1	01	01	H7680_007_0	4		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				178.08	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	4		N	Select Care Drugs	4	01	1	1	6	1	111		01	100		1	30	60	100				1	2			100				30		31				0.08	15	15	15																				15															15			15								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7728	002	0	1	04	01	H7728_002_0	7		N	Preferred Generic	4	01	3	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								8.00	16.00	24.00					3.00	6.00	9.00					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		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								15.00	30.00	45.00					10.00	20.00	30.00					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		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								46.00	92.00	138.00					41.00	82.00	123.00					41.00	82.00	82.00																46.00				46.00			1.53	1.37	1.37			1.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7728	002	0	1	04	01	H7728_002_0	7		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	190.00	190.00																100.00				100.00			3.33	3.17	3.17			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7728	002	0	1	04	01	H7728_002_0	7		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												29							29						29																	29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7728	002	0	1	04	01	H7728_002_0	7		N	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7728	002	0	1	04	01	H7728_002_0	7		N	Select Care Drugs	4	01	1	2	6	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H7728	005	0	1	04	01	H7728_005_0	6		Y	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		Y	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		Y	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												
H7728	005	0	1	04	01	H7728_005_0	6		Y	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	
H7728	005	0	1	04	01	H7728_005_0	6		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				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		Y	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7728	005	0	1	04	01	H7728_005_0	6		Y	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				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		Y	Select Care Drugs	4	01	1	2	6	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H7728	006	0	1	04	01	H7728_006_0	6		Y	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	6		Y	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	6		Y	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												
H7728	006	0	1	04	01	H7728_006_0	6		Y	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	
H7728	006	0	1	04	01	H7728_006_0	6		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	190.00	190.00																100.00				100.00			3.33	3.17	3.17			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7728	006	0	1	04	01	H7728_006_0	6		Y	Specialty Tier	4	11	1	1	5	1		010	01	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	006	0	1	04	01	H7728_006_0	6		Y	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7728	006	0	1	04	01	H7728_006_0	6		Y	Select Care Drugs	4	01	1	2	6	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				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	5		Y	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	5		Y	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	5		Y	Preferred Brand	4	11	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	5		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				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	5		Y	Specialty Tier	4	11	1	1	5	1		010	01	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	009	0	1	04	01	H7728_009_0	5		Y	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				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	5		Y	Select Care Drugs	4	01	1	2	6	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				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	5		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								9.00	18.00	27.00					4.00	8.00	12.00					0.00	0.00	0.00																9.00				9.00			0.30	0.13	0.00			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7728	010	0	1	04	01	H7728_010_0	5		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								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	5		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00	84.00	84.00																47.00				47.00			1.57	1.40	1.40			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7728	010	0	1	04	01	H7728_010_0	5		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								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	5		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												31							31						31																	31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7728	010	0	1	04	01	H7728_010_0	5		N	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7728	010	0	1	04	01	H7728_010_0	5		N	Select Care Drugs	4	01	1	2	6	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H7728	011	0	1	04	01	H7728_011_0	6		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								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	6		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								20.00	40.00	60.00					20.00	40.00	60.00					20.00	60.00	60.00																20.00				20.00			0.67	0.67	0.67			0.59	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7728	011	0	1	04	01	H7728_011_0	6		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								47.00	94.00	141.00					47.00	94.00	141.00					47.00	141.00	141.00																47.00				47.00			1.57	1.57	1.57			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7728	011	0	1	04	01	H7728_011_0	6		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	285.00	285.00																100.00				100.00			3.33	3.17	3.17			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7728	011	0	1	04	01	H7728_011_0	6		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												26							26						26																	26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7728	011	0	1	04	01	H7728_011_0	6		N	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								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		Y	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		Y	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		Y	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												
H7728	012	0	1	04	01	H7728_012_0	6		Y	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	
H7728	012	0	1	04	01	H7728_012_0	6		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				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		Y	Specialty Tier	4	11	1	1	5	1		010	01	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	012	0	1	04	01	H7728_012_0	6		Y	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				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		Y	Select Care Drugs	4	01	1	2	6	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				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	013	0	1	04	01	H7728_013_0	5		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								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	013	0	1	04	01	H7728_013_0	5		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								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	013	0	1	04	01	H7728_013_0	5		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								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	013	0	1	04	01	H7728_013_0	5		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								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	013	0	1	04	01	H7728_013_0	5		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7728	013	0	1	04	01	H7728_013_0	5		N	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7728	013	0	1	04	01	H7728_013_0	5		N	Select Care Drugs	4	01	1	2	6	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H7746	001	0	1	01	01	H7746_001_0	7		Y	Preferred Generic	4	01	1	2	1	1	111		01	100		1	30	60	90				2	2			90				30		31	0.00	0.00	0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H7746	001	0	1	01	01	H7746_001_0	7		Y	Preferred Generic	4	01	1	2	1	3	111		01	100		1	30	60	90				2	2			90				30		31	0.00	0.00	0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H7746	001	0	1	01	01	H7746_001_0	7		Y	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																					27.00																12.00				12.00		0.40						0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H7746	001	0	1	01	01	H7746_001_0	7		Y	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	7		Y	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	7		Y	Specialty Tier	4	11	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	001	0	1	01	01	H7746_001_0	7		Y	Select Care Drugs	4	11	1	2	6	1	111		01	100		1	30	60	90				2	2			90				30		31	0.00	0.00	0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H7746	001	0	1	01	01	H7746_001_0	7		Y	Select Care Drugs	4	11	1	2	6	3	111		01	100		1	30	60	90				2	2			90				30		31	0.00	0.00	0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H7746	002	0	1	01	01	H7746_002_0	7		Y	Preferred Generic	4	01	1	2	1	1	111		01	100		1	30	60	90				2	2			90				30		31	0.00	0.00	0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H7746	002	0	1	01	01	H7746_002_0	7		Y	Preferred Generic	4	01	1	2	1	3	111		01	100		1	30	60	90				2	2			90				30		31	0.00	0.00	0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H7746	002	0	1	01	01	H7746_002_0	7		Y	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																					27.00																12.00				12.00		0.40						0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H7746	002	0	1	01	01	H7746_002_0	7		Y	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	7		Y	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	7		Y	Specialty Tier	4	11	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	7		Y	Select Care Drugs	4	11	1	2	6	1	111		01	100		1	30	60	90				2	2			90				30		31	0.00	0.00	0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H7746	002	0	1	01	01	H7746_002_0	7		Y	Select Care Drugs	4	11	1	2	6	3	111		01	100		1	30	60	90				2	2			90				30		31	0.00	0.00	0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H7746	003	0	1	02	01	H7746_003_0	7		Y	Preferred Generic	4	01	1	2	1	1	111		01	100		1	30	60	90				2	2			90				30		31	0.00	0.00	0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H7746	003	0	1	02	01	H7746_003_0	7		Y	Preferred Generic	4	01	1	2	1	3	111		01	100		1	30	60	90				2	2			90				30		31	0.00	0.00	0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H7746	003	0	1	02	01	H7746_003_0	7		Y	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																					27.00																12.00				12.00		0.40						0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H7746	003	0	1	02	01	H7746_003_0	7		Y	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	7		Y	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	7		Y	Specialty Tier	4	11	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	7		Y	Select Care Drugs	4	11	1	2	6	1	111		01	100		1	30	60	90				2	2			90				30		31	0.00	0.00	0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H7746	003	0	1	02	01	H7746_003_0	7		Y	Select Care Drugs	4	11	1	2	6	3	111		01	100		1	30	60	90				2	2			90				30		31	0.00	0.00	0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H7787	001	0	1	04	01	H7787_001_0	4		Y	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												
H7787	001	0	1	04	01	H7787_001_0	4		Y	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										1		3
H7787	001	0	1	04	01	H7787_001_0	4		Y	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								15.00	30.00	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												
H7787	001	0	1	04	01	H7787_001_0	4		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7787	001	0	1	04	01	H7787_001_0	4		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7787	001	0	1	04	01	H7787_001_0	4		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											922.91	33						671.06	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7833	001	0	1	48	05	H7833_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	4.15	0.00	4.15	0.00	4.15	0.00	4.15			
H7833	001	0	1	48	05	H7833_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	10.35	0.00	10.35	0.00	10.35	0.00	10.35			
H7833	001	0	1	48	05	H7833_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			
H7844	001	0	1	48	05	H7844_001_0	4			Generic Drugs	4	01			1	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31																																																					Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	1	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H7844	001	0	1	48	05	H7844_001_0	4			Brand Drugs	4	11			2	1	111		01	111		1	31	60	90				2	2	31	60	90				31		31																																																					Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	1	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H7844	001	0	1	48	05	H7844_001_0	4			Non-Medicare Rx/OTC Drugs	4	11			3	1	010		01	010		1	31								31						31		31																																																					Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	2	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H7849	001	0	1	04	01	H7849_001_0	5		Y	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												
H7849	001	0	1	04	01	H7849_001_0	5		Y	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
H7849	001	0	1	04	01	H7849_001_0	5		Y	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								15.00	30.00	45.00					4.00	8.00	10.00											15.00	30.00	45.00				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		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	001	0	1	04	01	H7849_001_0	5		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								100.00	200.00	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												
H7849	001	0	1	04	01	H7849_001_0	5		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											849.54	33						676.83	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	002	0	1	04	01	H7849_002_0	5		Y	Preferred Generic	4	01	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	002	0	1	04	01	H7849_002_0	5		Y	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00				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	002	0	1	04	01	H7849_002_0	5		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	002	0	1	04	01	H7849_002_0	5		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00				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	002	0	1	04	01	H7849_002_0	5		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											732.69	33						671.84	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		Y	Preferred Generic	4	01	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		Y	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					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		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	003	0	1	04	01	H7849_003_0	4		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								100.00	200.00	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		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											756.72	33						682.35	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		Y	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		Y	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		Y	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								15.00	30.00	30.00					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		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	006	0	1	04	01	H7849_006_0	4		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								100.00	200.00	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		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											808.68	33						701.48	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		Y	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		Y	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		Y	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	40.00					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		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	008	0	1	04	01	H7849_008_0	4		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								100.00	200.00	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		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											810.76	33						742.72	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		Y	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								5.00	10.00	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		Y	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					2.00	4.00	5.00											9.00	18.00	22.50				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												
H7849	010	0	1	04	01	H7849_010_0	4		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								45.00	90.00	135.00					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		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								100.00	200.00	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	010	0	1	04	01	H7849_010_0	4		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											877.38	33						724.49	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		Y	Preferred Generic	4	01	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	011	0	1	04	01	H7849_011_0	4		Y	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					10.00	20.00	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	011	0	1	04	01	H7849_011_0	4		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00				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		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00				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	011	0	1	04	01	H7849_011_0	4		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											625.02	33						730.65	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		Y	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								7.00	14.00	21.00					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												
H7849	012	0	1	04	01	H7849_012_0	4		Y	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		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								45.00	90.00	135.00					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		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								100.00	200.00	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		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											643.39	33						532.85	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		Y	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								7.00	14.00	21.00					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												
H7849	013	0	1	04	01	H7849_013_0	4		Y	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		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								45.00	90.00	135.00					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		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								100.00	200.00	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		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											868.58	33						649.05	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		Y	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		Y	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		Y	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00				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	014	0	1	04	01	H7849_014_0	4		Y	Generic	4	01	1	2	2	3		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00				20.00				20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H7849	014	0	1	04	01	H7849_014_0	4		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					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		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00				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		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											817.86	30						586.38	30												30						30					30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	015	0	1	04	01	H7849_015_0	5		Y	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	015	0	1	04	01	H7849_015_0	5		Y	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	015	0	1	04	01	H7849_015_0	5		Y	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00				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	015	0	1	04	01	H7849_015_0	5		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	015	0	1	04	01	H7849_015_0	5		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00				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	015	0	1	04	01	H7849_015_0	5		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											890.59	33						733.63	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	016	0	1	04	01	H7849_016_0	4		Y	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								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												
H7849	016	0	1	04	01	H7849_016_0	4		Y	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								15.00	30.00	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												
H7849	016	0	1	04	01	H7849_016_0	4		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	016	0	1	04	01	H7849_016_0	4		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								100.00	200.00	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	4		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											817.13	30						521.75	30												30						30					30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	017	0	1	04	01	H7849_017_0	5		Y	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												
H7849	017	0	1	04	01	H7849_017_0	5		Y	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
H7849	017	0	1	04	01	H7849_017_0	5		Y	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					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												
H7849	017	0	1	04	01	H7849_017_0	5		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								45.00	90.00	135.00					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	5		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								100.00	200.00	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	5		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											792.64	33						583.04	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	018	0	1	04	01	H7849_018_0	4		Y	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00				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	018	0	1	04	01	H7849_018_0	4		Y	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					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												
H7849	018	0	1	04	01	H7849_018_0	4		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00				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	4		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00				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	018	0	1	04	01	H7849_018_0	4		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											653.37	33						663.96	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		Y	Preferred Generic	4	01	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	019	0	1	04	01	H7849_019_0	4		Y	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					10.00	20.00	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		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00				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		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00				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	019	0	1	04	01	H7849_019_0	4		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											730.51	33						537.65	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	020	0	1	04	01	H7849_020_0	4		Y	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								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	020	0	1	04	01	H7849_020_0	4		Y	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	4		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	020	0	1	04	01	H7849_020_0	4		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								100.00	200.00	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	4		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											870.41	33						621.59	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	021	0	1	04	01	H7849_021_0	5		Y	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	021	0	1	04	01	H7849_021_0	5		Y	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		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	021	0	1	04	01	H7849_021_0	5		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								100.00	200.00	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		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											835.61	33						692.34	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	022	0	1	04	01	H7849_022_0	4		Y	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								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	022	0	1	04	01	H7849_022_0	4		Y	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	4		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	022	0	1	04	01	H7849_022_0	4		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								100.00	200.00	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	4		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											606.27	30						661.87	30												30						30					30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	023	0	1	04	01	H7849_023_0	4		Y	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								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	4		Y	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	4		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	023	0	1	04	01	H7849_023_0	4		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								100.00	200.00	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	4		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											669.53	33						722.49	33												33						33					33			33								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					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	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											93.60	50	50	50				76.98	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											881.08	33						638.36	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		Y	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												
H7849	026	0	1	04	01	H7849_026_0	5		Y	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
H7849	026	0	1	04	01	H7849_026_0	5		Y	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								15.00	30.00	45.00					4.00	8.00	10.00											15.00	30.00	45.00				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		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	026	0	1	04	01	H7849_026_0	5		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								100.00	200.00	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												
H7849	026	0	1	04	01	H7849_026_0	5		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											1045.11	33						642.45	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		Y	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												
H7849	027	0	1	04	01	H7849_027_0	5		Y	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
H7849	027	0	1	04	01	H7849_027_0	5		Y	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								15.00	30.00	45.00					4.00	8.00	10.00											15.00	30.00	45.00				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		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	027	0	1	04	01	H7849_027_0	5		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								100.00	200.00	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												
H7849	027	0	1	04	01	H7849_027_0	5		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											645.10	33						695.32	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		Y	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	028	0	1	04	01	H7849_028_0	5		Y	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
H7849	028	0	1	04	01	H7849_028_0	5		Y	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					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		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	028	0	1	04	01	H7849_028_0	5		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	028	0	1	04	01	H7849_028_0	5		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											840.40	33						729.04	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	029	0	1	04	01	H7849_029_0	5		Y	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	029	0	1	04	01	H7849_029_0	5		Y	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
H7849	029	0	1	04	01	H7849_029_0	5		Y	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					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	5		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	029	0	1	04	01	H7849_029_0	5		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	029	0	1	04	01	H7849_029_0	5		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											663.32	33						686.89	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	030	0	1	04	01	H7849_030_0	4		Y	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								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	4		Y	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	4		Y	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								15.00	30.00	30.00					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	4		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	030	0	1	04	01	H7849_030_0	4		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								100.00	200.00	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	4		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											816.51	33						803.47	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		Y	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		Y	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		Y	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								15.00	30.00	30.00					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		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	031	0	1	04	01	H7849_031_0	4		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								100.00	200.00	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		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											733.81	33						580.14	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		Y	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		Y	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		Y	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								15.00	30.00	30.00					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		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	032	0	1	04	01	H7849_032_0	4		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								100.00	200.00	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		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											759.95	33						658.46	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		Y	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		Y	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		Y	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								15.00	30.00	30.00					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		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	033	0	1	04	01	H7849_033_0	4		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								100.00	200.00	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		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											774.28	33						642.62	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		Y	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								5.00	10.00	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		Y	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		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								45.00	90.00	135.00					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		Y	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		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											850.13	33						653.77	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	035	0	1	04	01	H7849_035_0	5		Y	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								5.00	10.00	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	5		Y	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	5		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								45.00	90.00	135.00					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	5		Y	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	5		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											905.85	33						715.80	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		Y	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								5.00	10.00	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		Y	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		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								45.00	90.00	135.00					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		Y	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		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											1048.63	33						753.69	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		Y	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								5.00	10.00	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		Y	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		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								45.00	90.00	135.00					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		Y	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		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											819.93	33						763.77	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		Y	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												
H7849	038	0	1	04	01	H7849_038_0	4		Y	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										1		3
H7849	038	0	1	04	01	H7849_038_0	4		Y	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								15.00	30.00	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												
H7849	038	0	1	04	01	H7849_038_0	4		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	038	0	1	04	01	H7849_038_0	4		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00				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	038	0	1	04	01	H7849_038_0	4		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											708.80	33						533.17	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	039	0	1	04	01	H7849_039_0	4		Y	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												
H7849	039	0	1	04	01	H7849_039_0	4		Y	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										1		3
H7849	039	0	1	04	01	H7849_039_0	4		Y	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								15.00	30.00	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												
H7849	039	0	1	04	01	H7849_039_0	4		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	039	0	1	04	01	H7849_039_0	4		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00				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	039	0	1	04	01	H7849_039_0	4		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											844.52	33						709.02	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	040	0	1	04	01	H7849_040_0	4		Y	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												
H7849	040	0	1	04	01	H7849_040_0	4		Y	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										1		3
H7849	040	0	1	04	01	H7849_040_0	4		Y	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								15.00	30.00	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												
H7849	040	0	1	04	01	H7849_040_0	4		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	040	0	1	04	01	H7849_040_0	4		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00				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	040	0	1	04	01	H7849_040_0	4		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											813.80	33						672.40	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	041	0	1	04	01	H7849_041_0	4		Y	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												
H7849	041	0	1	04	01	H7849_041_0	4		Y	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										1		3
H7849	041	0	1	04	01	H7849_041_0	4		Y	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								15.00	30.00	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												
H7849	041	0	1	04	01	H7849_041_0	4		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	041	0	1	04	01	H7849_041_0	4		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00				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	041	0	1	04	01	H7849_041_0	4		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											779.08	33						629.68	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	042	0	1	04	01	H7849_042_0	4		Y	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												
H7849	042	0	1	04	01	H7849_042_0	4		Y	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										1		3
H7849	042	0	1	04	01	H7849_042_0	4		Y	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								15.00	30.00	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												
H7849	042	0	1	04	01	H7849_042_0	4		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	042	0	1	04	01	H7849_042_0	4		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00				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	042	0	1	04	01	H7849_042_0	4		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											769.64	33						794.97	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	043	0	1	04	01	H7849_043_0	4		Y	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								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		Y	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		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								45.00	90.00	135.00					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		Y	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		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											929.81	33						752.05	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		Y	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								7.00	14.00	21.00					2.00	4.00	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		Y	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		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								45.00	90.00	135.00					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		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								100.00	200.00	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		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											803.62	31						665.38	31												31						31					31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	045	0	1	04	01	H7849_045_0	4		Y	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00				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	045	0	1	04	01	H7849_045_0	4		Y	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					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												
H7849	045	0	1	04	01	H7849_045_0	4		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00				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	4		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00				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	045	0	1	04	01	H7849_045_0	4		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											779.02	33						844.39	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		Y	Preferred Generic	4	01	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	046	0	1	04	01	H7849_046_0	4		Y	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					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												
H7849	046	0	1	04	01	H7849_046_0	4		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00				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		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00				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	046	0	1	04	01	H7849_046_0	4		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											723.62	33						754.00	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	047	0	1	04	01	H7849_047_0	5		Y	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					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	5		Y	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					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										2		2
H7849	047	0	1	04	01	H7849_047_0	5		Y	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	5		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								45.00	90.00	135.00					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	5		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								100.00	200.00	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	5		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											935.40	33						674.94	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	048	0	1	04	01	H7849_048_0	5		Y	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												
H7849	048	0	1	04	01	H7849_048_0	5		Y	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
H7849	048	0	1	04	01	H7849_048_0	5		Y	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					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												
H7849	048	0	1	04	01	H7849_048_0	5		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								45.00	90.00	135.00					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	5		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								100.00	200.00	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	5		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											935.41	33						674.88	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		Y	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												
H7849	050	0	1	04	01	H7849_050_0	5		Y	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
H7849	050	0	1	04	01	H7849_050_0	5		Y	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								15.00	30.00	45.00					4.00	8.00	10.00											15.00	30.00	45.00				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		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	050	0	1	04	01	H7849_050_0	5		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								100.00	200.00	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												
H7849	050	0	1	04	01	H7849_050_0	5		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											800.22	33						692.28	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		Y	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												
H7849	051	0	1	04	01	H7849_051_0	5		Y	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
H7849	051	0	1	04	01	H7849_051_0	5		Y	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								15.00	30.00	45.00					4.00	8.00	10.00											15.00	30.00	45.00				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		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	051	0	1	04	01	H7849_051_0	5		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								100.00	200.00	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												
H7849	051	0	1	04	01	H7849_051_0	5		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											800.22	33						692.28	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	052	0	1	04	01	H7849_052_0	5		Y	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	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	5		Y	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	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
H7849	052	0	1	04	01	H7849_052_0	5		Y	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	40.00					0.00	0.00	0.00											20.00	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	5		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	052	0	1	04	01	H7849_052_0	5		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								100.00	200.00	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	5		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											754.07	33						763.72	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		Y	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	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		Y	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	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
H7849	054	0	1	04	01	H7849_054_0	4		Y	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	40.00					0.00	0.00	0.00											20.00	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		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	054	0	1	04	01	H7849_054_0	4		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								100.00	200.00	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		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											754.07	33						763.72	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	055	0	1	04	01	H7849_055_0	5		Y	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	055	0	1	04	01	H7849_055_0	5		Y	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	055	0	1	04	01	H7849_055_0	5		Y	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00				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	055	0	1	04	01	H7849_055_0	5		Y	Generic	4	01	1	2	2	3		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00				20.00				20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H7849	055	0	1	04	01	H7849_055_0	5		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	055	0	1	04	01	H7849_055_0	5		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00				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	055	0	1	04	01	H7849_055_0	5		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											800.33	33						692.13	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	056	0	1	04	01	H7849_056_0	5		Y	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	056	0	1	04	01	H7849_056_0	5		Y	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	056	0	1	04	01	H7849_056_0	5		Y	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					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												
H7849	056	0	1	04	01	H7849_056_0	5		Y	Generic	4	01	1	2	2	3		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					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		
H7849	056	0	1	04	01	H7849_056_0	5		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					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	5		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00				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	5		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											824.45	30						634.74	30												30						30					30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	057	0	1	04	01	H7849_057_0	6		Y	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00				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	057	0	1	04	01	H7849_057_0	6		Y	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00				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	057	0	1	04	01	H7849_057_0	6		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	057	0	1	04	01	H7849_057_0	6		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00				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	057	0	1	04	01	H7849_057_0	6		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											785.83	33						723.09	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	058	0	1	04	01	H7849_058_0	5		Y	Preferred Generic	4	01	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	058	0	1	04	01	H7849_058_0	5		Y	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00				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	058	0	1	04	01	H7849_058_0	5		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	058	0	1	04	01	H7849_058_0	5		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00				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	058	0	1	04	01	H7849_058_0	5		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											785.83	33						723.09	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	059	0	1	04	01	H7849_059_0	5		Y	Preferred Generic	4	01	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	059	0	1	04	01	H7849_059_0	5		Y	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00				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	059	0	1	04	01	H7849_059_0	5		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	059	0	1	04	01	H7849_059_0	5		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00				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	059	0	1	04	01	H7849_059_0	5		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											785.83	33						723.09	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		Y	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								5.00	10.00	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		Y	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		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								45.00	90.00	135.00					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		Y	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		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											897.07	33						789.26	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	062	0	1	04	01	H7849_062_0	5		Y	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												
H7849	062	0	1	04	01	H7849_062_0	5		Y	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										1		3
H7849	062	0	1	04	01	H7849_062_0	5		Y	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								15.00	30.00	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												
H7849	062	0	1	04	01	H7849_062_0	5		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	062	0	1	04	01	H7849_062_0	5		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00				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	062	0	1	04	01	H7849_062_0	5		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											820.43	33						603.29	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	064	1	1	04	01	H7849_064_1	5		Y	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								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												
H7849	064	1	1	04	01	H7849_064_1	5		Y	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	064	1	1	04	01	H7849_064_1	5		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								45.00	90.00	135.00					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	064	1	1	04	01	H7849_064_1	5		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								100.00	200.00	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	064	1	1	04	01	H7849_064_1	5		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											818.09	33						691.01	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	064	2	1	04	01	H7849_064_2	4		Y	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								7.00	14.00	21.00					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												
H7849	064	2	1	04	01	H7849_064_2	4		Y	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	064	2	1	04	01	H7849_064_2	4		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								45.00	90.00	135.00					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	064	2	1	04	01	H7849_064_2	4		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								100.00	200.00	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	064	2	1	04	01	H7849_064_2	4		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											818.09	33						691.01	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	065	0	1	04	01	H7849_065_0	5		Y	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	065	0	1	04	01	H7849_065_0	5		Y	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	065	0	1	04	01	H7849_065_0	5		Y	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					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												
H7849	065	0	1	04	01	H7849_065_0	5		Y	Generic	4	01	1	2	2	3		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					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		
H7849	065	0	1	04	01	H7849_065_0	5		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00				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	065	0	1	04	01	H7849_065_0	5		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00				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	065	0	1	04	01	H7849_065_0	5		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											733.36	33						757.53	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	066	0	1	04	01	H7849_066_0	6		Y	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	066	0	1	04	01	H7849_066_0	6		Y	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	066	0	1	04	01	H7849_066_0	6		Y	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					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												
H7849	066	0	1	04	01	H7849_066_0	6		Y	Generic	4	01	1	2	2	3		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					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		
H7849	066	0	1	04	01	H7849_066_0	6		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00				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	066	0	1	04	01	H7849_066_0	6		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00				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	066	0	1	04	01	H7849_066_0	6		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											733.36	33						757.53	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	067	0	1	04	01	H7849_067_0	4		Y	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00				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	067	0	1	04	01	H7849_067_0	4		Y	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					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	067	0	1	04	01	H7849_067_0	4		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	067	0	1	04	01	H7849_067_0	4		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								100.00	200.00	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	067	0	1	04	01	H7849_067_0	4		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											905.75	33						793.62	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	068	0	1	04	01	H7849_068_0	4		Y	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00				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	068	0	1	04	01	H7849_068_0	4		Y	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					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	068	0	1	04	01	H7849_068_0	4		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	068	0	1	04	01	H7849_068_0	4		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								100.00	200.00	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	068	0	1	04	01	H7849_068_0	4		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											905.75	33						793.62	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	069	0	1	04	01	H7849_069_0	4		Y	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00				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	069	0	1	04	01	H7849_069_0	4		Y	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					5.00	10.00	12.50											20.00	40.00	60.00				5.00	10.00	0.00				20.00				20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	069	0	1	04	01	H7849_069_0	4		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	069	0	1	04	01	H7849_069_0	4		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								100.00	200.00	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	069	0	1	04	01	H7849_069_0	4		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											665.38	26						600.00	26												26						26					26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	070	0	1	04	01	H7849_070_0	4		Y	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								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	070	0	1	04	01	H7849_070_0	4		Y	Preferred Generic	4	01	1	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								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	070	0	1	04	01	H7849_070_0	4		Y	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								15.00	30.00	30.00					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	070	0	1	04	01	H7849_070_0	4		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	070	0	1	04	01	H7849_070_0	4		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								100.00	200.00	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	070	0	1	04	01	H7849_070_0	4		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											754.06	33						763.73	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	071	0	1	04	01	H7849_071_0	4		Y	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								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	071	0	1	04	01	H7849_071_0	4		Y	Preferred Generic	4	01	1	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								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	071	0	1	04	01	H7849_071_0	4		Y	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								15.00	30.00	30.00					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	071	0	1	04	01	H7849_071_0	4		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	071	0	1	04	01	H7849_071_0	4		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								100.00	200.00	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	071	0	1	04	01	H7849_071_0	4		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											754.06	33						763.73	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	076	0	1	04	01	H7849_076_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	076	0	1	04	01	H7849_076_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												
H7849	076	0	1	04	01	H7849_076_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	076	0	1	04	01	H7849_076_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												
H7849	076	0	1	04	01	H7849_076_0	5			Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											786.50	33						728.82	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	077	0	1	04	01	H7849_077_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	077	0	1	04	01	H7849_077_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												
H7849	077	0	1	04	01	H7849_077_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	077	0	1	04	01	H7849_077_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												
H7849	077	0	1	04	01	H7849_077_0	5			Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											786.50	33						728.82	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	080	0	1	04	01	H7849_080_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	080	0	1	04	01	H7849_080_0	5			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				0.00	0.00	0.00				12.00				12.00			0.40	0.13		0.40	0.00	0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	080	0	1	04	01	H7849_080_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	080	0	1	04	01	H7849_080_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											98.75	43	43	43				91.46	43	43	43										43	43	43				43	43	43			43			43								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	080	0	1	04	01	H7849_080_0	5			Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											732.10	33						671.68	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	081	0	1	04	01	H7849_081_0	4		Y	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	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	081	0	1	04	01	H7849_081_0	4		Y	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	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
H7849	081	0	1	04	01	H7849_081_0	4		Y	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	40.00					0.00	0.00	0.00											20.00	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	081	0	1	04	01	H7849_081_0	4		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	081	0	1	04	01	H7849_081_0	4		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								100.00	200.00	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	081	0	1	04	01	H7849_081_0	4		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											754.07	33						763.72	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	082	0	1	04	01	H7849_082_0	4		Y	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	082	0	1	04	01	H7849_082_0	4		Y	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	082	0	1	04	01	H7849_082_0	4		Y	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					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												
H7849	082	0	1	04	01	H7849_082_0	4		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00				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	082	0	1	04	01	H7849_082_0	4		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00				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	082	0	1	04	01	H7849_082_0	4		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											800.78	33						706.11	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	083	0	1	04	01	H7849_083_0	4		Y	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	083	0	1	04	01	H7849_083_0	4		Y	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	083	0	1	04	01	H7849_083_0	4		Y	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					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												
H7849	083	0	1	04	01	H7849_083_0	4		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00				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	083	0	1	04	01	H7849_083_0	4		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00				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	083	0	1	04	01	H7849_083_0	4		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											800.78	33						706.11	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	084	0	1	04	01	H7849_084_0	4		Y	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	084	0	1	04	01	H7849_084_0	4		Y	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	084	0	1	04	01	H7849_084_0	4		Y	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					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												
H7849	084	0	1	04	01	H7849_084_0	4		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00				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	084	0	1	04	01	H7849_084_0	4		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00				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	084	0	1	04	01	H7849_084_0	4		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											800.78	33						706.11	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	085	0	1	04	01	H7849_085_0	4		Y	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	085	0	1	04	01	H7849_085_0	4		Y	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	085	0	1	04	01	H7849_085_0	4		Y	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					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												
H7849	085	0	1	04	01	H7849_085_0	4		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00				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	085	0	1	04	01	H7849_085_0	4		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00				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	085	0	1	04	01	H7849_085_0	4		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											800.78	33						706.11	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	087	0	1	04	01	H7849_087_0	4		Y	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	087	0	1	04	01	H7849_087_0	4		Y	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	087	0	1	04	01	H7849_087_0	4		Y	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					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												
H7849	087	0	1	04	01	H7849_087_0	4		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00				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	087	0	1	04	01	H7849_087_0	4		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00				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	087	0	1	04	01	H7849_087_0	4		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											800.78	33						706.11	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	088	0	1	04	01	H7849_088_0	4		Y	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	088	0	1	04	01	H7849_088_0	4		Y	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	088	0	1	04	01	H7849_088_0	4		Y	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00				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	088	0	1	04	01	H7849_088_0	4		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	088	0	1	04	01	H7849_088_0	4		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00				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	088	0	1	04	01	H7849_088_0	4		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											897.34	33						788.82	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	101	0	1	04	01	H7849_101_0	4		Y	Preferred Generic	4	01	3	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												
H7849	101	0	1	04	01	H7849_101_0	4		Y	Preferred Generic	4	01	3	2	1	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
H7849	101	0	1	04	01	H7849_101_0	4		Y	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00				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	101	0	1	04	01	H7849_101_0	4		Y	Generic	4	01	1	2	2	3		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00				20.00				20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H7849	101	0	1	04	01	H7849_101_0	4		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	101	0	1	04	01	H7849_101_0	4		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00				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	101	0	1	04	01	H7849_101_0	4		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											937.95	33						721.02	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	102	1	1	04	01	H7849_102_1	4		Y	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								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	102	1	1	04	01	H7849_102_1	4		Y	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	102	1	1	04	01	H7849_102_1	4		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								45.00	90.00	135.00					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	102	1	1	04	01	H7849_102_1	4		Y	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	102	1	1	04	01	H7849_102_1	4		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											897.07	33						789.26	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	102	2	1	04	01	H7849_102_2	4		Y	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								5.00	10.00	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	102	2	1	04	01	H7849_102_2	4		Y	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	102	2	1	04	01	H7849_102_2	4		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								45.00	90.00	135.00					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	102	2	1	04	01	H7849_102_2	4		Y	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	102	2	1	04	01	H7849_102_2	4		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											897.07	33						789.26	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	102	3	1	04	01	H7849_102_3	4		Y	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								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	102	3	1	04	01	H7849_102_3	4		Y	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	102	3	1	04	01	H7849_102_3	4		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								45.00	90.00	135.00					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	102	3	1	04	01	H7849_102_3	4		Y	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	102	3	1	04	01	H7849_102_3	4		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											897.07	33						789.26	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	102	4	1	04	01	H7849_102_4	4		Y	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								5.00	10.00	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	102	4	1	04	01	H7849_102_4	4		Y	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	102	4	1	04	01	H7849_102_4	4		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								45.00	90.00	135.00					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	102	4	1	04	01	H7849_102_4	4		Y	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	102	4	1	04	01	H7849_102_4	4		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											897.07	33						789.26	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	103	0	1	04	01	H7849_103_0	4		Y	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												
H7849	103	0	1	04	01	H7849_103_0	4		Y	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										1		3
H7849	103	0	1	04	01	H7849_103_0	4		Y	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								15.00	30.00	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												
H7849	103	0	1	04	01	H7849_103_0	4		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	103	0	1	04	01	H7849_103_0	4		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00				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	103	0	1	04	01	H7849_103_0	4		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											820.43	33						603.29	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	104	0	1	04	01	H7849_104_0	4		Y	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								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	104	0	1	04	01	H7849_104_0	4		Y	Preferred Generic	4	01	1	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								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	104	0	1	04	01	H7849_104_0	4		Y	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								15.00	30.00	30.00					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	104	0	1	04	01	H7849_104_0	4		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	104	0	1	04	01	H7849_104_0	4		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								100.00	200.00	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	104	0	1	04	01	H7849_104_0	4		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											800.74	33						706.18	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	105	0	1	04	01	H7849_105_0	4		Y	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								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	105	0	1	04	01	H7849_105_0	4		Y	Preferred Generic	4	01	1	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								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	105	0	1	04	01	H7849_105_0	4		Y	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								15.00	30.00	30.00					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	105	0	1	04	01	H7849_105_0	4		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	105	0	1	04	01	H7849_105_0	4		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								100.00	200.00	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	105	0	1	04	01	H7849_105_0	4		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											800.74	33						706.18	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	106	0	1	04	01	H7849_106_0	4		Y	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00				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	106	0	1	04	01	H7849_106_0	4		Y	Preferred Generic	4	01	1	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00				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	106	0	1	04	01	H7849_106_0	4		Y	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00				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	106	0	1	04	01	H7849_106_0	4		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					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												
H7849	106	0	1	04	01	H7849_106_0	4		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								100.00	200.00	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	106	0	1	04	01	H7849_106_0	4		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											800.79	33						706.07	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	107	0	1	04	01	H7849_107_0	4		Y	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00				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	107	0	1	04	01	H7849_107_0	4		Y	Preferred Generic	4	01	1	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00				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	107	0	1	04	01	H7849_107_0	4		Y	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00				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	107	0	1	04	01	H7849_107_0	4		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					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												
H7849	107	0	1	04	01	H7849_107_0	4		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								100.00	200.00	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	107	0	1	04	01	H7849_107_0	4		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											800.79	33						706.07	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	108	0	1	04	01	H7849_108_0	4		Y	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00				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	108	0	1	04	01	H7849_108_0	4		Y	Preferred Generic	4	01	1	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00				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	108	0	1	04	01	H7849_108_0	4		Y	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00				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	108	0	1	04	01	H7849_108_0	4		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					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												
H7849	108	0	1	04	01	H7849_108_0	4		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								100.00	200.00	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	108	0	1	04	01	H7849_108_0	4		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											800.79	33						706.07	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	109	0	1	04	01	H7849_109_0	4		Y	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00				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	109	0	1	04	01	H7849_109_0	4		Y	Preferred Generic	4	01	1	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00				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	109	0	1	04	01	H7849_109_0	4		Y	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00				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	109	0	1	04	01	H7849_109_0	4		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					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												
H7849	109	0	1	04	01	H7849_109_0	4		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								100.00	200.00	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	109	0	1	04	01	H7849_109_0	4		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											800.79	33						706.07	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	110	0	1	04	01	H7849_110_0	4		Y	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								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	110	0	1	04	01	H7849_110_0	4		Y	Preferred Generic	4	01	1	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								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	110	0	1	04	01	H7849_110_0	4		Y	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								15.00	30.00	30.00					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	110	0	1	04	01	H7849_110_0	4		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	110	0	1	04	01	H7849_110_0	4		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								100.00	200.00	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	110	0	1	04	01	H7849_110_0	4		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											800.74	33						706.18	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	111	0	1	04	01	H7849_111_0	4		Y	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00				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	111	0	1	04	01	H7849_111_0	4		Y	Preferred Generic	4	01	1	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00				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	111	0	1	04	01	H7849_111_0	4		Y	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00				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	111	0	1	04	01	H7849_111_0	4		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					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												
H7849	111	0	1	04	01	H7849_111_0	4		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								100.00	200.00	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	111	0	1	04	01	H7849_111_0	4		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											800.79	33						706.07	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7917	009	0	1	04	01	H7917_009_0	3		Y	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	15.00					0.00	0.00	0.00											6.00	12.00	15.00				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												
H7917	009	0	1	04	01	H7917_009_0	3		Y	Preferred Generic	4	11	1	2	1	3		111	01		111	1				30	60	100	1	2				30	60	100	30		31								6.00	12.00	15.00					0.00	0.00	0.00											6.00	12.00	15.00				0.00	0.00	0.00				6.00				6.00			0.20	0.00		0.20	0.00	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H7917	009	0	1	04	01	H7917_009_0	3		Y	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	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	3		Y	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	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	3		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		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	3		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7917	010	0	1	04	01	H7917_010_0	3		Y	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	15.00					0.00	0.00	0.00											6.00	12.00	15.00				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												
H7917	010	0	1	04	01	H7917_010_0	3		Y	Preferred Generic	4	11	1	2	1	3		111	01		111	1				30	60	100	1	2				30	60	100	30		31								6.00	12.00	15.00					0.00	0.00	0.00											6.00	12.00	15.00				0.00	0.00	0.00				6.00				6.00			0.20	0.00		0.20	0.00	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H7917	010	0	1	04	01	H7917_010_0	3		Y	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	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	3		Y	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	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	3		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		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	3		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7917	011	0	1	04	01	H7917_011_0	4		Y	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	15.00					0.00	0.00	0.00											6.00	12.00	15.00				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												
H7917	011	0	1	04	01	H7917_011_0	4		Y	Preferred Generic	4	11	1	2	1	3		111	01		111	1				30	60	100	1	2				30	60	100	30		31								6.00	12.00	15.00					0.00	0.00	0.00											6.00	12.00	15.00				0.00	0.00	0.00				6.00				6.00			0.20	0.00		0.20	0.00	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H7917	011	0	1	04	01	H7917_011_0	4		Y	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	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	4		Y	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	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	4		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		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	4		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7917	012	0	1	04	01	H7917_012_0	4		Y	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	15.00					0.00	0.00	0.00											6.00	12.00	15.00				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												
H7917	012	0	1	04	01	H7917_012_0	4		Y	Preferred Generic	4	11	1	2	1	3		111	01		111	1				30	60	100	1	2				30	60	100	30		31								6.00	12.00	15.00					0.00	0.00	0.00											6.00	12.00	15.00				0.00	0.00	0.00				6.00				6.00			0.20	0.00		0.20	0.00	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H7917	012	0	1	04	01	H7917_012_0	4		Y	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	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	4		Y	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	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	4		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		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	4		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7917	013	0	1	04	01	H7917_013_0	4		Y	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	15.00					0.00	0.00	0.00											6.00	12.00	15.00				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												
H7917	013	0	1	04	01	H7917_013_0	4		Y	Preferred Generic	4	11	1	2	1	3		111	01		111	1				30	60	100	1	2				30	60	100	30		31								6.00	12.00	15.00					0.00	0.00	0.00											6.00	12.00	15.00				0.00	0.00	0.00				6.00				6.00			0.20	0.00		0.20	0.00	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H7917	013	0	1	04	01	H7917_013_0	4		Y	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	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	4		Y	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	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	4		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		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	4		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7917	014	0	1	04	01	H7917_014_0	4		Y	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	15.00					0.00	0.00	0.00											6.00	12.00	15.00				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												
H7917	014	0	1	04	01	H7917_014_0	4		Y	Preferred Generic	4	11	1	2	1	3		111	01		111	1				30	60	100	1	2				30	60	100	30		31								6.00	12.00	15.00					0.00	0.00	0.00											6.00	12.00	15.00				0.00	0.00	0.00				6.00				6.00			0.20	0.00		0.20	0.00	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H7917	014	0	1	04	01	H7917_014_0	4		Y	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	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	4		Y	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	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	4		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		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	4		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7917	015	0	1	04	01	H7917_015_0	3		Y	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	15.00					0.00	0.00	0.00											6.00	12.00	15.00				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												
H7917	015	0	1	04	01	H7917_015_0	3		Y	Preferred Generic	4	11	1	2	1	3		111	01		111	1				30	60	100	1	2				30	60	100	30		31								6.00	12.00	15.00					0.00	0.00	0.00											6.00	12.00	15.00				0.00	0.00	0.00				6.00				6.00			0.20	0.00		0.20	0.00	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H7917	015	0	1	04	01	H7917_015_0	3		Y	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	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	3		Y	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	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	3		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		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	3		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7917	030	0	1	04	01	H7917_030_0	4		Y	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	15.00					0.00	0.00	0.00											6.00	12.00	15.00				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												
H7917	030	0	1	04	01	H7917_030_0	4		Y	Preferred Generic	4	11	1	2	1	3		111	01		111	1				30	60	100	1	2				30	60	100	30		31								6.00	12.00	15.00					0.00	0.00	0.00											6.00	12.00	15.00				0.00	0.00	0.00				6.00				6.00			0.20	0.00		0.20	0.00	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H7917	030	0	1	04	01	H7917_030_0	4		Y	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	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	4		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	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	4		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								99.00	198.00	290.00					94.00	188.00	230.00											99.00	198.00	290.00				94.00	188.00	230.00				99.00				99.00			3.30	3.13		3.30	3.13	3.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7917	030	0	1	04	01	H7917_030_0	4		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7917	031	0	1	04	01	H7917_031_0	4		Y	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	15.00					0.00	0.00	0.00											6.00	12.00	15.00				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												
H7917	031	0	1	04	01	H7917_031_0	4		Y	Preferred Generic	4	11	1	2	1	3		111	01		111	1				30	60	100	1	2				30	60	100	30		31								6.00	12.00	15.00					0.00	0.00	0.00											6.00	12.00	15.00				0.00	0.00	0.00				6.00				6.00			0.20	0.00		0.20	0.00	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H7917	031	0	1	04	01	H7917_031_0	4		Y	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	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	4		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	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	4		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								99.00	198.00	290.00					94.00	188.00	230.00											99.00	198.00	290.00				94.00	188.00	230.00				99.00				99.00			3.30	3.13		3.30	3.13	3.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7917	031	0	1	04	01	H7917_031_0	4		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7917	032	0	1	04	01	H7917_032_0	4		Y	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	15.00					0.00	0.00	0.00											6.00	12.00	15.00				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												
H7917	032	0	1	04	01	H7917_032_0	4		Y	Preferred Generic	4	11	1	2	1	3		111	01		111	1				30	60	100	1	2				30	60	100	30		31								6.00	12.00	15.00					0.00	0.00	0.00											6.00	12.00	15.00				0.00	0.00	0.00				6.00				6.00			0.20	0.00		0.20	0.00	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H7917	032	0	1	04	01	H7917_032_0	4		Y	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	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	4		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	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	4		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								99.00	198.00	290.00					94.00	188.00	230.00											99.00	198.00	290.00				94.00	188.00	230.00				99.00				99.00			3.30	3.13		3.30	3.13	3.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7917	032	0	1	04	01	H7917_032_0	4		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7917	033	0	1	04	01	H7917_033_0	4		Y	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	15.00					0.00	0.00	0.00											6.00	12.00	15.00				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												
H7917	033	0	1	04	01	H7917_033_0	4		Y	Preferred Generic	4	11	1	2	1	3		111	01		111	1				30	60	100	1	2				30	60	100	30		31								6.00	12.00	15.00					0.00	0.00	0.00											6.00	12.00	15.00				0.00	0.00	0.00				6.00				6.00			0.20	0.00		0.20	0.00	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H7917	033	0	1	04	01	H7917_033_0	4		Y	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	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	4		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	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	4		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								99.00	198.00	290.00					94.00	188.00	230.00											99.00	198.00	290.00				94.00	188.00	230.00				99.00				99.00			3.30	3.13		3.30	3.13	3.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7917	033	0	1	04	01	H7917_033_0	4		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7917	034	0	1	04	01	H7917_034_0	3		Y	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	15.00					0.00	0.00	0.00											6.00	12.00	15.00				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												
H7917	034	0	1	04	01	H7917_034_0	3		Y	Preferred Generic	4	11	1	2	1	3		111	01		111	1				30	60	100	1	2				30	60	100	30		31								6.00	12.00	15.00					0.00	0.00	0.00											6.00	12.00	15.00				0.00	0.00	0.00				6.00				6.00			0.20	0.00		0.20	0.00	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H7917	034	0	1	04	01	H7917_034_0	3		Y	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	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	3		Y	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	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	3		Y	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	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	3		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7917	035	0	1	04	01	H7917_035_0	3		Y	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	15.00					0.00	0.00	0.00											6.00	12.00	15.00				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												
H7917	035	0	1	04	01	H7917_035_0	3		Y	Preferred Generic	4	11	1	2	1	3		111	01		111	1				30	60	100	1	2				30	60	100	30		31								6.00	12.00	15.00					0.00	0.00	0.00											6.00	12.00	15.00				0.00	0.00	0.00				6.00				6.00			0.20	0.00		0.20	0.00	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H7917	035	0	1	04	01	H7917_035_0	3		Y	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	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	3		Y	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	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	3		Y	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	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	3		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7917	036	0	1	04	01	H7917_036_0	3		Y	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	15.00					0.00	0.00	0.00											6.00	12.00	15.00				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												
H7917	036	0	1	04	01	H7917_036_0	3		Y	Preferred Generic	4	11	1	2	1	3		111	01		111	1				30	60	100	1	2				30	60	100	30		31								6.00	12.00	15.00					0.00	0.00	0.00											6.00	12.00	15.00				0.00	0.00	0.00				6.00				6.00			0.20	0.00		0.20	0.00	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H7917	036	0	1	04	01	H7917_036_0	3		Y	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	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	3		Y	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	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	3		Y	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	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	3		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7917	037	0	1	04	01	H7917_037_0	3		Y	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	15.00					0.00	0.00	0.00											6.00	12.00	15.00				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												
H7917	037	0	1	04	01	H7917_037_0	3		Y	Preferred Generic	4	11	1	2	1	3		111	01		111	1				30	60	100	1	2				30	60	100	30		31								6.00	12.00	15.00					0.00	0.00	0.00											6.00	12.00	15.00				0.00	0.00	0.00				6.00				6.00			0.20	0.00		0.20	0.00	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H7917	037	0	1	04	01	H7917_037_0	3		Y	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	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	3		Y	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	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	3		Y	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	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	3		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7917	038	0	1	04	01	H7917_038_0	3		Y	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	15.00					0.00	0.00	0.00											6.00	12.00	15.00				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												
H7917	038	0	1	04	01	H7917_038_0	3		Y	Preferred Generic	4	11	1	2	1	3		111	01		111	1				30	60	100	1	2				30	60	100	30		31								6.00	12.00	15.00					0.00	0.00	0.00											6.00	12.00	15.00				0.00	0.00	0.00				6.00				6.00			0.20	0.00		0.20	0.00	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H7917	038	0	1	04	01	H7917_038_0	3		Y	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	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	3		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	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	3		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								99.00	198.00	290.00					94.00	188.00	230.00											99.00	198.00	290.00				94.00	188.00	230.00				99.00				99.00			3.30	3.13		3.30	3.13	3.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7917	038	0	1	04	01	H7917_038_0	3		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7917	040	0	1	04	01	H7917_040_0	4		Y	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	15.00					0.00	0.00	0.00											6.00	12.00	15.00				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												
H7917	040	0	1	04	01	H7917_040_0	4		Y	Preferred Generic	4	11	1	2	1	3		111	01		111	1				30	60	100	1	2				30	60	100	30		31								6.00	12.00	15.00					0.00	0.00	0.00											6.00	12.00	15.00				0.00	0.00	0.00				6.00				6.00			0.20	0.00		0.20	0.00	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H7917	040	0	1	04	01	H7917_040_0	4		Y	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	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	040	0	1	04	01	H7917_040_0	4		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	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	040	0	1	04	01	H7917_040_0	4		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								99.00	198.00	290.00					94.00	188.00	230.00											99.00	198.00	290.00				94.00	188.00	230.00				99.00				99.00			3.30	3.13		3.30	3.13	3.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7917	040	0	1	04	01	H7917_040_0	4		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7925	001	0	1	01	01	H7925_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												
H7925	001	0	1	01	01	H7925_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					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	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												
H7925	001	0	1	01	01	H7925_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												
H7925	001	0	1	01	01	H7925_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												
H7925	001	0	1	01	01	H7925_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												
H7925	002	0	1	01	01	H7925_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								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00				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	5			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	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												
H7925	002	0	1	01	01	H7925_002_0	5			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	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												
H7925	002	0	1	01	01	H7925_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												
H7925	002	0	1	01	01	H7925_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												
H7925	002	0	1	01	01	H7925_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												
H7925	002	0	1	01	01	H7925_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	
H7925	003	0	1	01	01	H7925_003_0	6		N	Preferred Generic	3	11	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								19.00	38.00	57.00					3.00	6.00	9.00											19.00	38.00	57.00				3.00	6.00	0.00				19.00				19.00			0.63	0.1		0.63	0.1	0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7925	003	0	1	01	01	H7925_003_0	6		N	Generic	3	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					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												
H7925	003	0	1	01	01	H7925_003_0	6		N	Preferred Brand	3	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					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, Select Care Drugs												
H7925	003	0	1	01	01	H7925_003_0	6		N	Non-Preferred Drug	3	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											99.57	41	41	41				99.57	41	41	41										41	41	41				41	41	41			41			41								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7925	003	0	1	01	01	H7925_003_0	6		N	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7925	003	0	1	01	01	H7925_003_0	6		N	Select Care Drugs	3	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7993	001	0	1	01	01	H7993_001_0	10		Y	Preferred Generic	4	11	1	2	1	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7993	001	0	1	01	01	H7993_001_0	10		Y	Preferred Generic	4	11	1	2	1	3	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H7993	001	0	1	01	01	H7993_001_0	10		Y	Generic	4	11	3	2	2	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7993	001	0	1	01	01	H7993_001_0	10		Y	Generic	4	11	3	2	2	3	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H7993	001	0	1	01	01	H7993_001_0	10		Y	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	40.00	80.00	120.00																			40.00	80.00	100.00																40.00				40.00		1.33			1.33			1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7993	001	0	1	01	01	H7993_001_0	10		Y	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	80.00	160.00	240.00																			80.00	160.00	240.00																80.00				80.00		2.67			2.67			2.58	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7993	001	0	1	01	01	H7993_001_0	10		Y	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												
H7993	002	0	1	01	01	H7993_002_0	12		Y	Preferred Generic	4	11	1	2	1	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7993	002	0	1	01	01	H7993_002_0	12		Y	Preferred Generic	4	11	1	2	1	3	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H7993	002	0	1	01	01	H7993_002_0	12		Y	Generic	4	11	3	2	2	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7993	002	0	1	01	01	H7993_002_0	12		Y	Generic	4	11	3	2	2	3	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H7993	002	0	1	01	01	H7993_002_0	12		Y	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	40.00	80.00	120.00																			40.00	80.00	100.00																40.00				40.00		1.33			1.33			1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7993	002	0	1	01	01	H7993_002_0	12		Y	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	80.00	160.00	240.00																			80.00	160.00	240.00																80.00				80.00		2.67			2.67			2.58	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7993	002	0	1	01	01	H7993_002_0	12		Y	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												
H7993	003	0	1	01	01	H7993_003_0	10		N	Preferred Generic	4	11	1	2	1	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7993	003	0	1	01	01	H7993_003_0	10		N	Preferred Generic	4	11	1	2	1	3	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H7993	003	0	1	01	01	H7993_003_0	10		N	Generic	4	11	3	2	2	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7993	003	0	1	01	01	H7993_003_0	10		N	Generic	4	11	3	2	2	3	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	3
H7993	003	0	1	01	01	H7993_003_0	10		N	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	10		N	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	10		N	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												
H7993	004	0	1	01	01	H7993_004_0	10		N	Preferred Generic	4	11	1	2	1	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7993	004	0	1	01	01	H7993_004_0	10		N	Preferred Generic	4	11	1	2	1	3	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H7993	004	0	1	01	01	H7993_004_0	10		N	Generic	4	11	3	2	2	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7993	004	0	1	01	01	H7993_004_0	10		N	Generic	4	11	3	2	2	3	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	3
H7993	004	0	1	01	01	H7993_004_0	10		N	Preferred Brand	4	11	1	1	3	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31				1.00	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		N	Non-Preferred Drug	4	11	1	1	4	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31				1.00	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		N	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												
H7993	005	0	1	01	01	H7993_005_0	9		Y	Preferred Generic	4	11	1	2	1	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7993	005	0	1	01	01	H7993_005_0	9		Y	Preferred Generic	4	11	1	2	1	3	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H7993	005	0	1	01	01	H7993_005_0	9		Y	Generic	4	11	3	2	2	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7993	005	0	1	01	01	H7993_005_0	9		Y	Generic	4	11	3	2	2	3	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	3
H7993	005	0	1	01	01	H7993_005_0	9		Y	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	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	9		Y	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	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	9		Y	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												
H7993	006	0	1	01	01	H7993_006_0	11		N	Preferred Generic	4	11	1	2	1	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7993	006	0	1	01	01	H7993_006_0	11		N	Preferred Generic	4	11	1	2	1	3	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H7993	006	0	1	01	01	H7993_006_0	11		N	Generic	4	11	3	2	2	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	7.00	14.00	21.00																			7.00	14.00	17.50																7.00				7.00		0.23			0.23			0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7993	006	0	1	01	01	H7993_006_0	11		N	Generic	4	11	3	2	2	3	111		01	111		1	30	60	100				1	2	30	60	100				30		31	7.00	14.00	21.00																			7.00	14.00	17.50																7.00				7.00		0.23			0.23			0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	2	2
H7993	006	0	1	01	01	H7993_006_0	11		N	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	47.00	94.00	141.00																			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												
H7993	006	0	1	01	01	H7993_006_0	11		N	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	100.00	200.00	300.00																			100.00	200.00	300.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7993	006	0	1	01	01	H7993_006_0	11		N	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												
H7993	007	0	1	01	01	H7993_007_0	10		Y	Preferred Generic	4	11	1	2	1	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7993	007	0	1	01	01	H7993_007_0	10		Y	Preferred Generic	4	11	1	2	1	3	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H7993	007	0	1	01	01	H7993_007_0	10		Y	Generic	4	11	3	2	2	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7993	007	0	1	01	01	H7993_007_0	10		Y	Generic	4	11	3	2	2	3	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	3
H7993	007	0	1	01	01	H7993_007_0	10		Y	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	47.00	94.00	141.00																			47.00	94.00	117.50																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7993	007	0	1	01	01	H7993_007_0	10		Y	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	95.00	190.00	285.00																			95.00	190.00	285.00																95.00				95.00		3.17			3.17			3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7993	007	0	1	01	01	H7993_007_0	10		Y	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												
H7993	008	0	1	01	01	H7993_008_0	11		N	Preferred Generic	4	11	1	2	1	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7993	008	0	1	01	01	H7993_008_0	11		N	Preferred Generic	4	11	1	2	1	3	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H7993	008	0	1	01	01	H7993_008_0	11		N	Generic	4	11	3	2	2	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7993	008	0	1	01	01	H7993_008_0	11		N	Generic	4	11	3	2	2	3	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	2	2
H7993	008	0	1	01	01	H7993_008_0	11		N	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	47.00	94.00	141.00																			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												
H7993	008	0	1	01	01	H7993_008_0	11		N	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	100.00	200.00	300.00																			100.00	200.00	300.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7993	008	0	1	01	01	H7993_008_0	11		N	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												
H7993	009	0	1	01	01	H7993_009_0	9		N	Preferred Generic	4	11	1	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												
H7993	009	0	1	01	01	H7993_009_0	9		N	Generic	4	11	3	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												
H7993	009	0	1	01	01	H7993_009_0	9		N	Generic	4	11	3	2	2	3	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	2	2
H7993	009	0	1	01	01	H7993_009_0	9		N	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												
H7993	009	0	1	01	01	H7993_009_0	9		N	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												
H7993	009	0	1	01	01	H7993_009_0	9		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31					25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8003	001	0	1	04	01	H8003_001_0	7		Y	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	2	2	30	60	90				30		31								5.00	10.00	15.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				0.00			0.17	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8003	001	0	1	04	01	H8003_001_0	7		Y	Preferred Generic	4	01	1	2	1	3		111	01	111		1				30	60	90	2	2	30	60	90				30		31								5.00	10.00	15.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				0.00			0.17	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H8003	001	0	1	04	01	H8003_001_0	7		Y	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		31								15.00	30.00	45.00					10.00	20.00	30.00					10.00	20.00	0.00																15.00				10.00			0.50	0.33	0.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8003	001	0	1	04	01	H8003_001_0	7		Y	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		31								47.00	94.00	141.00					42.00	84.00	126.00					42.00	84.00	105.00																47.00				42.00			1.57	1.40	1.40			1.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8003	001	0	1	04	01	H8003_001_0	7		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		31								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, Select Care Drugs												
H8003	001	0	1	04	01	H8003_001_0	7		Y	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								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8003	001	0	1	04	01	H8003_001_0	7		Y	Select Care Drugs	4	01	1	2	6	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					0.00	0.00	0.00																5.00				0.00			0.17	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8003	001	0	1	04	01	H8003_001_0	7		Y	Select Care Drugs	4	01	1	2	6	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					0.00	0.00	0.00																5.00				0.00			0.17	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H8003	002	0	1	04	01	H8003_002_0	7		Y	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	2	2	30	60	90				30		31								5.00	10.00	15.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				0.00			0.17	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8003	002	0	1	04	01	H8003_002_0	7		Y	Preferred Generic	4	01	1	2	1	3		111	01	111		1				30	60	90	2	2	30	60	90				30		31								5.00	10.00	15.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				0.00			0.17	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H8003	002	0	1	04	01	H8003_002_0	7		Y	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		31								15.00	30.00	45.00					10.00	20.00	30.00					10.00	20.00	0.00																15.00				10.00			0.50	0.33	0.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8003	002	0	1	04	01	H8003_002_0	7		Y	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		31								47.00	94.00	141.00					42.00	84.00	126.00					42.00	84.00	105.00																47.00				42.00			1.57	1.40	1.40			1.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8003	002	0	1	04	01	H8003_002_0	7		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		31								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, Select Care Drugs												
H8003	002	0	1	04	01	H8003_002_0	7		Y	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								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8003	002	0	1	04	01	H8003_002_0	7		Y	Select Care Drugs	4	01	1	2	6	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					0.00	0.00	0.00																5.00				0.00			0.17	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8003	002	0	1	04	01	H8003_002_0	7		Y	Select Care Drugs	4	01	1	2	6	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					0.00	0.00	0.00																5.00				0.00			0.17	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H8003	003	0	1	04	01	H8003_003_0	7		Y	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	2	2	30	60	90				30		31								5.00	10.00	15.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				0.00			0.17	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8003	003	0	1	04	01	H8003_003_0	7		Y	Preferred Generic	4	01	1	2	1	3		111	01	111		1				30	60	90	2	2	30	60	90				30		31								5.00	10.00	15.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				0.00			0.17	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H8003	003	0	1	04	01	H8003_003_0	7		Y	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		31								15.00	30.00	45.00					10.00	20.00	30.00					10.00	20.00	0.00																15.00				10.00			0.50	0.33	0.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8003	003	0	1	04	01	H8003_003_0	7		Y	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		31								47.00	94.00	141.00					42.00	84.00	126.00					42.00	84.00	105.00																47.00				42.00			1.57	1.40	1.40			1.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8003	003	0	1	04	01	H8003_003_0	7		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		31								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, Select Care Drugs												
H8003	003	0	1	04	01	H8003_003_0	7		Y	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								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8003	003	0	1	04	01	H8003_003_0	7		Y	Select Care Drugs	4	01	1	2	6	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					0.00	0.00	0.00																5.00				0.00			0.17	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8003	003	0	1	04	01	H8003_003_0	7		Y	Select Care Drugs	4	01	1	2	6	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					0.00	0.00	0.00																5.00				0.00			0.17	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H8003	004	0	1	04	01	H8003_004_0	7		Y	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	2	2	30	60	90				30		31								5.00	10.00	15.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				0.00			0.17	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8003	004	0	1	04	01	H8003_004_0	7		Y	Preferred Generic	4	01	1	2	1	3		111	01	111		1				30	60	90	2	2	30	60	90				30		31								5.00	10.00	15.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				0.00			0.17	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H8003	004	0	1	04	01	H8003_004_0	7		Y	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		31								15.00	30.00	45.00					10.00	20.00	30.00					10.00	20.00	0.00																15.00				10.00			0.50	0.33	0.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8003	004	0	1	04	01	H8003_004_0	7		Y	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		31								47.00	94.00	141.00					42.00	84.00	126.00					42.00	84.00	105.00																47.00				42.00			1.57	1.40	1.40			1.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8003	004	0	1	04	01	H8003_004_0	7		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		31								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, Select Care Drugs												
H8003	004	0	1	04	01	H8003_004_0	7		Y	Specialty Tier	4	11	1	1	5	1		111	01	111		1				30	60	90	2	2	30	60	90				30		31												32	32	32					32	32	32				32	32	32															32			32								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8003	004	0	1	04	01	H8003_004_0	7		Y	Select Care Drugs	4	01	1	2	6	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					0.00	0.00	0.00																5.00				0.00			0.17	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8003	004	0	1	04	01	H8003_004_0	7		Y	Select Care Drugs	4	01	1	2	6	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					0.00	0.00	0.00																5.00				0.00			0.17	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H8003	005	0	1	04	01	H8003_005_0	8		Y	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	2	2	30	60	90				30		31								5.00	10.00	15.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				0.00			0.17	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8003	005	0	1	04	01	H8003_005_0	8		Y	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					0.00	0.00	0.00																5.00				0.00			0.17	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H8003	005	0	1	04	01	H8003_005_0	8		Y	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		31								15.00	30.00	45.00					10.00	20.00	30.00					10.00	20.00	0.00																15.00				10.00			0.50	0.33	0.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8003	005	0	1	04	01	H8003_005_0	8		Y	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		31								47.00	94.00	141.00					42.00	84.00	126.00					42.00	84.00	105.00																47.00				42.00			1.57	1.40	1.40			1.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8003	005	0	1	04	01	H8003_005_0	8		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		31								100.00	200.00	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, Select Care Drugs												
H8003	005	0	1	04	01	H8003_005_0	8		Y	Specialty Tier	4	11	1	1	5	1		111	01	111		1				30	60	90	2	2	30	60	90				30		31												32	32	32					32	32	32				32	32	32															32			32								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8003	005	0	1	04	01	H8003_005_0	8		Y	Select Care Drugs	4	01	1	2	6	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					0.00	0.00	0.00																5.00				0.00			0.17	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8003	005	0	1	04	01	H8003_005_0	8		Y	Select Care Drugs	4	01	1	2	6	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					0.00	0.00	0.00																5.00				0.00			0.17	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H8003	006	0	1	04	01	H8003_006_0	7		Y	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	2	2	30	60	90				30		31								5.00	10.00	15.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				0.00			0.17	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8003	006	0	1	04	01	H8003_006_0	7		Y	Preferred Generic	4	01	1	2	1	3		111	01	111		1				30	60	90	2	2	30	60	90				30		31								5.00	10.00	15.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				0.00			0.17	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H8003	006	0	1	04	01	H8003_006_0	7		Y	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		31								15.00	30.00	45.00					10.00	20.00	30.00					10.00	20.00	0.00																15.00				10.00			0.50	0.33	0.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8003	006	0	1	04	01	H8003_006_0	7		Y	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		31								47.00	94.00	141.00					42.00	84.00	126.00					42.00	84.00	105.00																47.00				42.00			1.57	1.40	1.40			1.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8003	006	0	1	04	01	H8003_006_0	7		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		31								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, Select Care Drugs												
H8003	006	0	1	04	01	H8003_006_0	7		Y	Specialty Tier	4	11	1	1	5	1		111	01	111		1				30	60	90	2	2	30	60	90				30		31												32	32	32					32	32	32				32	32	32															32			32								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8003	006	0	1	04	01	H8003_006_0	7		Y	Select Care Drugs	4	01	1	2	6	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					0.00	0.00	0.00																5.00				0.00			0.17	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8003	006	0	1	04	01	H8003_006_0	7		Y	Select Care Drugs	4	01	1	2	6	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					0.00	0.00	0.00																5.00				0.00			0.17	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H8010	002	0	1	01	01	H8010_002_0	8		Y	Preferred Generic	4	11	1	2	1	1		111	01	100		1				30	60	100	1	2			100				30		31								10.00	20.00	30.00					0.00	0.00	0.00							0.00																10.00				10.00			0.33	0.00				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8010	002	0	1	01	01	H8010_002_0	8		Y	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	8		Y	Preferred Brand	4	11	1	2	3	1		111	01	100		1				30	60	100	1	2			100				30		31								47.00	94.00	141.00					40.00	80.00	120.00							110.00																47.00				47.00			1.57	1.33				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8010	002	0	1	01	01	H8010_002_0	8		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01	100		1				30	60	100	1	2			100				30		31								100.00	200.00	300.00					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	8		Y	Specialty Tier	4	11	1	1	5	1		111	01	100		1				30	60	100	1	2			100				30		31											2252.04	30	30	30				2252.04	30	30	30						30															30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8010	003	0	1	01	01	H8010_003_0	5			Preferred Generic	4	11	1	2	1	1		111	01	100		1				30	60	100	1	2			100				30		31								12.00	24.00	36.00					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	5			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	5			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	5			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	5			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												
H8014	001	0	1	04	01	H8014_001_0	7		Y	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								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												
H8014	001	0	1	04	01	H8014_001_0	7		Y	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												
H8014	001	0	1	04	01	H8014_001_0	7		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8014	001	0	1	04	01	H8014_001_0	7		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								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												
H8014	001	0	1	04	01	H8014_001_0	7		Y	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												
H8014	002	0	1	04	01	H8014_002_0	6		Y	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												
H8014	002	0	1	04	01	H8014_002_0	6		Y	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												
H8014	002	0	1	04	01	H8014_002_0	6		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8014	002	0	1	04	01	H8014_002_0	6		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								100.00	200.00	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												
H8014	002	0	1	04	01	H8014_002_0	6		Y	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												
H8019	002	0	1	02	01	H8019_002_0	6		Y	Preferred Generic	4	01	1	2	1	1		111	10	111		1				30	60	100	1	2	30	60	100					29	31								7.00	14.00	7.00					2.00	4.00	2.00					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, Vaccines												
H8019	002	0	1	02	01	H8019_002_0	6		Y	Preferred Generic	4	01	1	2	1	3		111	10	111		1				30	60	100	1	2	30	60	100					29	31								7.00	14.00	7.00					2.00	4.00	2.00					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, Vaccines										1		
H8019	002	0	1	02	01	H8019_002_0	6		Y	Generic	4	11	1	2	2	1		111	10	111		1				30	60	100	1	2	30	60	100					29	31								13.00	26.00	26.00					8.00	16.00	16.00					8.00	16.00	0.00																	13.00			13.00			0.43	0.27	0.27			0.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H8019	002	0	1	02	01	H8019_002_0	6		Y	Preferred Brand	4	11	1	2	3	1		111	10	111		1				30	60	100	1	2	30	60	100					29	31								47.00	94.00	130.00					42.00	84.00	117.50					42.00	84.00	117.50																	47.00			47.00			1.57	1.40	1.40			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H8019	002	0	1	02	01	H8019_002_0	6		Y	Non-Preferred Drug	4	11	1	2	4	1		111	10	111		1				30	60	100	1	2	30	60	100					29	31								100.00	200.00	300.00					95.00	190.00	285.00					95.00	190.00	285.00																	100.00			100.00			3.33	3.17	3.17			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H8019	002	0	1	02	01	H8019_002_0	6		Y	Specialty Tier	4	11	1	1	5	1		010	10	010		1				30					30							29	31												33							33						33																		33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H8019	002	0	1	02	01	H8019_002_0	6		Y	Vaccines	4	11	1	2	6	1		010	10			1				30												29	31								0.00							0.00																										0.00			0.00			0.00	0.00				0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H8019	002	0	1	02	01	H8019_002_0	6		Y	Vaccines	4	11	1	2	6	3		010	10			1				30												29	31								0.00							0.00																										0.00			0.00			0.00	0.00				0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines										1		
H8019	005	0	1	02	01	H8019_005_0	6		Y	Preferred Generic	4	01	1	2	1	1		111	10	111		1				30	60	100	1	2	30	60	100					29	31								7.00	14.00	7.00					2.00	4.00	2.00					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, Vaccines												
H8019	005	0	1	02	01	H8019_005_0	6		Y	Preferred Generic	4	01	1	2	1	3		111	10	111		1				30	60	100	1	2	30	60	100					29	31								7.00	14.00	7.00					2.00	4.00	2.00					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, Vaccines										1		
H8019	005	0	1	02	01	H8019_005_0	6		Y	Generic	4	11	1	2	2	1		111	10	111		1				30	60	100	1	2	30	60	100					29	31								13.00	26.00	26.00					8.00	16.00	16.00					8.00	16.00	0.00																	13.00			13.00			0.43	0.27	0.27			0.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H8019	005	0	1	02	01	H8019_005_0	6		Y	Preferred Brand	4	11	1	2	3	1		111	10	111		1				30	60	100	1	2	30	60	100					29	31								47.00	94.00	130.00					42.00	84.00	117.50					42.00	84.00	117.50																	47.00			47.00			1.57	1.40	1.40			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H8019	005	0	1	02	01	H8019_005_0	6		Y	Non-Preferred Drug	4	11	1	2	4	1		111	10	111		1				30	60	100	1	2	30	60	100					29	31								100.00	200.00	300.00					95.00	190.00	285.00					95.00	190.00	285.00																	100.00			100.00			3.33	3.17	3.17			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H8019	005	0	1	02	01	H8019_005_0	6		Y	Specialty Tier	4	11	1	1	5	1		010	10	010		1				30					30							29	31												33							33						33																		33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H8019	005	0	1	02	01	H8019_005_0	6		Y	Vaccines	4	11	1	2	6	1		010	10			1				30												29	31								0.00							0.00																										0.00			0.00			0.00	0.00				0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H8019	005	0	1	02	01	H8019_005_0	6		Y	Vaccines	4	11	1	2	6	3		010	10			1				30												29	31								0.00							0.00																										0.00			0.00			0.00	0.00				0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines										1		
H8026	001	0	1	48	05	H8026_001_0	8			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	8			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	8			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	1			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	1			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	1			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		Y	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	2.00	4.00	6.00																			2.00	4.00	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		Y	Preferred Generic	4	01	1	2	1	3	111		01	111		1	30	60	90				1	2	30	60	90				30		31	2.00	4.00	6.00																			2.00	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		Y	Generic	4	11	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	15.00	30.00	45.00																			15.00	30.00	37.50																15.00				15.00		0.50			0.50			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8064	002	0	1	04	01	H8064_002_0	9		Y	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	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		Y	Non-Preferred Drug	4	11	1	1	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31				81.45	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		Y	Specialty Tier	4	11	1	1	5	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31					33	33	33																		33	33	33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8070	001	0	1	04	01	H8070_001_0	6			Preferred Generic	4	11	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		29	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8070	001	0	1	04	01	H8070_001_0	6			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					12.00	24.00	36.00											20.00	40.00	60.00				12.00	24.00	24.00					20.00			20.00			0.67	0.40		0.67	0.40	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8070	001	0	1	04	01	H8070_001_0	6			Preferred Brand	4	11	1	1	3	1		111	10		111	1				30	60	90	1	2				30	60	90		29	31											60.00	25	25	25				60.00	25	25	25										25	25	25				25	25	25				25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8070	001	0	1	04	01	H8070_001_0	6			Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		29	31											90.00	50	50	50				90.00	50	50	50										50	50	50				50	50	50				50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8070	001	0	1	04	01	H8070_001_0	6			Specialty Tier	4	11	1	1	5	1		111	10		111	1				30	60	90	1	2				30	60	90		29	31											2723.00	29	29	29				2723.00	29	29	29										29	29	29				29	29	29				29		29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8070	002	0	1	04	01	H8070_002_0	3			Preferred Generic	4	11	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		29	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8070	002	0	1	04	01	H8070_002_0	3			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												
H8070	002	0	1	04	01	H8070_002_0	3			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												
H8070	002	0	1	04	01	H8070_002_0	3			Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		29	31											84.00	50	50	50				84.00	50	50	50										50	50	50				50	50	50				50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8070	002	0	1	04	01	H8070_002_0	3			Specialty Tier	4	11	1	1	5	1		111	10		111	1				30	60	90	1	2				30	60	90		29	31											1745.00	29	29	29				1745.00	29	29	29										29	29	29				29	29	29				29		29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8087	001	0	1	04	01	H8087_001_0	4		Y	Preferred Generic	4	11	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8087	001	0	1	04	01	H8087_001_0	4		Y	Generic	4	11	1	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	8.00		24.00																									20.00		60.00				8.00		0.00				8.00				8.00		0.27				0.67	0.27	0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8087	001	0	1	04	01	H8087_001_0	4		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8087	001	0	1	04	01	H8087_001_0	4		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	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												
H8087	001	0	1	04	01	H8087_001_0	4		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8087	002	0	1	04	01	H8087_002_0	4		Y	Preferred Generic	4	11	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0				0	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8087	002	0	1	04	01	H8087_002_0	4		Y	Generic	4	11	1	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	15.00		45.00																									20.00		60.00				15.00		0.00				15.00				15.00		0.50				0.67	0.50	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8087	002	0	1	04	01	H8087_002_0	4		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		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	4		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	97.00		291.00																									100.00		300.00				97.00		281.00				97.00				97.00		3.23				3.33	3.23	3.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8087	002	0	1	04	01	H8087_002_0	4		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					29																										29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8087	004	0	1	04	01	H8087_004_0	4		Y	Preferred Generic	4	11	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8087	004	0	1	04	01	H8087_004_0	4		Y	Preferred Generic	4	11	1	2	1	3	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H8087	004	0	1	04	01	H8087_004_0	4		Y	Generic	4	11	1	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	0.00		0.00																									20.00		60.00				0.00		0.00				0.00				0.00		0				0.67	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8087	004	0	1	04	01	H8087_004_0	4		Y	Generic	4	11	1	2	2	3	110		01		110	1	30		90				2	2				30		90	30		31	0.00		0.00																									20.00		60.00				0.00		0.00				0.00				0.00		0				0.67	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H8087	004	0	1	04	01	H8087_004_0	4		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		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	4		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		290.00				100.00				100.00		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	4		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8095	001	0	1	01	01	H8095_001_0	7		Y	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								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	7		Y	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	7		Y	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	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	7		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	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	7		Y	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											1439.66	33						1439.66	33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8121	001	0	1	04	01	H8121_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												
H8121	001	0	1	04	01	H8121_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												
H8121	001	0	1	04	01	H8121_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												
H8121	001	0	1	04	01	H8121_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												
H8121	001	0	1	04	01	H8121_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												
H8121	001	0	1	04	01	H8121_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												
H8121	002	0	1	04	01	H8121_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								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00				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	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												
H8121	002	0	1	04	01	H8121_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												
H8121	002	0	1	04	01	H8121_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												
H8121	002	0	1	04	01	H8121_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												
H8121	002	0	1	04	01	H8121_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												
H8130	001	0	1	01	01	H8130_001_0	7		N	Preferred Generic	4	11	1	2	1	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8130	001	0	1	01	01	H8130_001_0	7		N	Preferred Generic	4	11	1	2	1	3	111		01	111		1	31	60	90				1	2	31	60	90				31		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H8130	001	0	1	01	01	H8130_001_0	7		N	Generic	4	11	1	2	2	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8130	001	0	1	01	01	H8130_001_0	7		N	Generic	4	11	1	2	2	3	111		01	111		1	31	60	90				1	2	31	60	90				31		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H8130	001	0	1	01	01	H8130_001_0	7		N	Preferred Brand	4	11	1	2	3	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31	47.00	94.00	141.00																			47.00	94.00	141.00																47.00				47.00		1.52			1.52			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8130	001	0	1	01	01	H8130_001_0	7		N	Non-Preferred Drug	4	11	1	1	4	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31				91.46	35	35	35																		35	35	35															35			35								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8130	001	0	1	01	01	H8130_001_0	7		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	31								31						31		31				668.58	25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8130	008	0	1	01	01	H8130_008_0	7		N	Preferred Generic	4	11	1	2	1	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31	2.00	4.00	6.00																			2.00	4.00	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	7		N	Generic	4	11	1	2	2	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31	8.00	16.00	24.00																			8.00	16.00	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	7		N	Preferred Brand	4	11	1	2	3	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31	45.00	90.00	135.00																			45.00	90.00	135.00																45.00				45.00		1.45			1.45			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8130	008	0	1	01	01	H8130_008_0	7		N	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31	100.00	200.00	300.00																			100.00	200.00	300.00																100.00				100.00		3.23			3.23			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8130	008	0	1	01	01	H8130_008_0	7		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	31								31						31		31				876.44	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8130	009	0	1	01	01	H8130_009_0	9		N	Preferred Generic	4	11	1	2	1	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8130	009	0	1	01	01	H8130_009_0	9		N	Preferred Generic	4	11	1	2	1	3	111		01	111		1	31	60	90				1	2	31	60	90				31		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H8130	009	0	1	01	01	H8130_009_0	9		N	Generic	4	11	1	2	2	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8130	009	0	1	01	01	H8130_009_0	9		N	Generic	4	11	1	2	2	3	111		01	111		1	31	60	90				1	2	31	60	90				31		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H8130	009	0	1	01	01	H8130_009_0	9		N	Preferred Brand	4	11	1	2	3	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31	47.00	94.00	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	9		N	Non-Preferred Drug	4	11	1	1	4	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31				91.19	36	36	36																		36	36	36															36			36								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8130	009	0	1	01	01	H8130_009_0	9		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	31								31						31		31				663.44	25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8130	010	0	1	01	01	H8130_010_0	8		Y	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	8		Y	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	8		Y	Preferred Brand	4	11	1	2	3	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31	47.00	94.00	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	8		Y	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	8		Y	Specialty Tier	4	11	1	1	5	1	010		01	010		1	31								31						31		31				815.44	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	8		Y	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	7		Y	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	7		Y	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	7		Y	Preferred Brand	4	11	1	2	3	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31	47.00	94.00	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	7		Y	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	7		Y	Specialty Tier	4	11	1	1	5	1	010		01	010		1	31								31						31		31				705.34	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	7		Y	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	9			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											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												
H8133	001	0	1	01	01	H8133_001_0	9			Preferred Generic	4	01	1	2	1	3		111	01		111	1				30	60	100	1	2				30	60	100	30		31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	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		
H8133	001	0	1	01	01	H8133_001_0	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					10.00	20.00	30.00											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												
H8133	001	0	1	01	01	H8133_001_0	9			Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	94.00				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												
H8133	001	0	1	01	01	H8133_001_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												
H8133	001	0	1	01	01	H8133_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												
H8133	003	0	1	01	01	H8133_003_0	7			Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	100	1	2				30	60	100	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												
H8133	003	0	1	01	01	H8133_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					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												
H8133	003	0	1	01	01	H8133_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					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												
H8133	003	0	1	01	01	H8133_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					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												
H8133	003	0	1	01	01	H8133_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												
H8133	005	0	1	01	01	H8133_005_0	7			Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	100	1	2				30	60	100	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												
H8133	005	0	1	01	01	H8133_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					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												
H8133	005	0	1	01	01	H8133_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					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												
H8133	005	0	1	01	01	H8133_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					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												
H8133	005	0	1	01	01	H8133_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												
H8142	001	0	1	01	01	H8142_001_0	8		Y	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31	5.00	10.00	10.00																			0.00	0.00	0.00																5.00				5.00		0.17			0.00			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8142	001	0	1	01	01	H8142_001_0	8		Y	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31	20.00	40.00	40.00																			0.00	0.00	0.00																20.00				20.00		0.67			0.00			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8142	001	0	1	01	01	H8142_001_0	8		Y	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31	47.00	94.00	94.00																			47.00	94.00	94.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8142	001	0	1	01	01	H8142_001_0	8		Y	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31	100.00	200.00	200.00																			100.00	200.00	200.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8142	001	0	1	01	01	H8142_001_0	8		Y	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31					30																				30																	30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8142	002	0	1	01	01	H8142_002_0	8		Y	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31	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	8		Y	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31	15.00	30.00	30.00																			0.00	0.00	0.00																15.00				15.00		0.50			0.00			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8142	002	0	1	01	01	H8142_002_0	8		Y	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31	45.00	90.00	90.00																			45.00	90.00	90.00																45.00				45.00		1.50			1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8142	002	0	1	01	01	H8142_002_0	8		Y	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31	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	8		Y	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31					31																				31																	31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8142	003	0	1	01	01	H8142_003_0	8		Y	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31	2.00	4.00	4.00																			0.00	0.00	0.00																2.00				2.00		0.07			0.00			0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8142	003	0	1	01	01	H8142_003_0	8		Y	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31	12.00	24.00	24.00																			0.00	0.00	0.00																12.00				12.00		0.40			0.00			0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8142	003	0	1	01	01	H8142_003_0	8		Y	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31	45.00	90.00	90.00																			45.00	90.00	90.00																45.00				45.00		1.50			1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8142	003	0	1	01	01	H8142_003_0	8		Y	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31	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	8		Y	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31					33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8142	007	0	1	01	01	H8142_007_0	9		Y	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	10.00																			0.00	0.00	0.00																5.00				5.00		0.17			0.00			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8142	007	0	1	01	01	H8142_007_0	9		Y	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31	20.00	40.00	40.00																			0.00	0.00	0.00																20.00				20.00		0.67			0.00			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8142	007	0	1	01	01	H8142_007_0	9		Y	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31	47.00	94.00	94.00																			47.00	94.00	94.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8142	007	0	1	01	01	H8142_007_0	9		Y	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31	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	9		Y	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31					30																				30																	30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8145	004	0	1	09	04	H8145_004_0	3			Preferred Generic	4	11	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	5.00		15.00																									10.00		30.00				5.00		0.00				5.00				5.00		0.17				0.33	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8145	004	0	1	09	04	H8145_004_0	3			Generic	4	11	1	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	15.00		45.00																									20.00		60.00				15.00		0.00				15.00				15.00		0.50				0.67	0.50	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8145	004	0	1	09	04	H8145_004_0	3			Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8145	004	0	1	09	04	H8145_004_0	3			Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	99.00		297.00																									100.00		300.00				99.00		287.00				99.00				99.00		3.30				3.33	3.30	3.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8145	004	0	1	09	04	H8145_004_0	3			Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					30																										30						30					30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8145	006	0	1	09	04	H8145_006_0	3			Preferred Generic	4	11	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	6.00		18.00																									10.00		30.00				6.00		0.00				6.00				6.00		0.20				0.33	0.20	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8145	006	0	1	09	04	H8145_006_0	3			Generic	4	11	1	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	15.00		45.00																									20.00		60.00				15.00		0.00				15.00				15.00		0.50				0.67	0.50	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8145	006	0	1	09	04	H8145_006_0	3			Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		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	3			Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	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												
H8145	006	0	1	09	04	H8145_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												
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	6.00		18.00																									10.00		30.00				6.00		0.00				6.00				6.00		0.20				0.33	0.20	0.19	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	15.00		45.00																									20.00		60.00				15.00		0.00				15.00				15.00		0.50				0.67	0.50	0.48	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		131.00				47.00				47.00		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		290.00				100.00				100.00		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					27																										27						27					27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8145	032	0	1	09	04	H8145_032_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																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8145	032	0	1	09	04	H8145_032_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																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H8145	032	0	1	09	04	H8145_032_0	5			Generic	4	11	1	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	5.00		15.00																									20.00		60.00				5.00		0.00				5.00				5.00		0.17				0.67	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8145	032	0	1	09	04	H8145_032_0	5			Generic	4	11	1	2	2	3	110		01		110	1	30		90				2	2				30		90	30		31	5.00		15.00																									20.00		60.00				5.00		0.00				5.00				5.00		0.17				0.67	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H8145	032	0	1	09	04	H8145_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		131.00				47.00				47.00		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	5			Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	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												
H8145	032	0	1	09	04	H8145_032_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												
H8145	052	0	1	09	04	H8145_052_0	3			Preferred Generic	4	11	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	7.00		21.00																									10.00		30.00				7.00		0.00				7.00				7.00		0.23				0.33	0.23	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8145	052	0	1	09	04	H8145_052_0	3			Generic	4	11	1	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	17.00		51.00																									20.00		60.00				17.00		0.00				17.00				17.00		0.57				0.67	0.57	0.55	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8145	052	0	1	09	04	H8145_052_0	3			Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		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	3			Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	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												
H8145	052	0	1	09	04	H8145_052_0	3			Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					27																										27						27					27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8145	069	0	1	09	04	H8145_069_0	3			Preferred Generic	4	11	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	7.00		21.00																									10.00		30.00				7.00		0.00				7.00				7.00		0.23				0.33	0.23	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8145	069	0	1	09	04	H8145_069_0	3			Generic	4	11	1	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	17.00		51.00																									20.00		60.00				17.00		0.00				17.00				17.00		0.57				0.67	0.57	0.55	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8145	069	0	1	09	04	H8145_069_0	3			Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8145	069	0	1	09	04	H8145_069_0	3			Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		290.00				100.00				100.00		3.33				3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8145	069	0	1	09	04	H8145_069_0	3			Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					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	6.00		18.00																									10.00		30.00				6.00		0.00				6.00				6.00		0.20				0.33	0.20	0.19	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	3	110		01		110	1	30		90				1	2				30		90	30		31	6.00		18.00																									10.00		30.00				6.00		0.00				6.00				6.00		0.20				0.33	0.20	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
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	12.00		36.00																									20.00		60.00				12.00		0.00				12.00				12.00		0.40				0.67	0.40	0.39	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	3	110		01		110	1	30		90				2	2				30		90	30		31	12.00		36.00																									20.00		60.00				12.00		0.00				12.00				12.00		0.40				0.67	0.40	0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
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		131.00				47.00				47.00		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	99.00		297.00																									100.00		300.00				99.00		287.00				99.00				99.00		3.30				3.33	3.30	3.19	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					29																										29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8145	089	0	1	09	04	H8145_089_0	3			Preferred Generic	3	11	1	2	1	1	110		01		110	1	30		100				1	2				30		100	30		31	2.00		6.00																									10.00		30.00				2.00		0.00				2.00				2.00		0.07				0.33	0.07	0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8145	089	0	1	09	04	H8145_089_0	3			Generic	3	11	1	2	2	1	110		01		110	1	30		100				2	2				30		100	30		31	7.00		21.00																									20.00		60.00				7.00		0.00				7.00				7.00		0.23				0.67	0.23	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8145	089	0	1	09	04	H8145_089_0	3			Preferred Brand	3	11	1	1	3	1	110		01		110	1	30		100				2	2				30		100	30		31				64.00	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	3			Non-Preferred Drug	3	11	1	1	4	1	110		01		110	1	30		100				2	2				30		100	30		31				51.00	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	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												
H8145	091	0	1	09	04	H8145_091_0	5			Preferred Generic	4	11	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	7.00		21.00																									10.00		30.00				7.00		0.00				7.00				7.00		0.23				0.33	0.23	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8145	091	0	1	09	04	H8145_091_0	5			Generic	4	11	1	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	17.00		51.00																									20.00		60.00				17.00		0.00				17.00				17.00		0.57				0.67	0.57	0.55	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8145	091	0	1	09	04	H8145_091_0	5			Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		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	5			Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	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												
H8145	091	0	1	09	04	H8145_091_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												
H8145	122	0	1	09	04	H8145_122_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																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8145	122	0	1	09	04	H8145_122_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																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H8145	122	0	1	09	04	H8145_122_0	3			Generic	4	11	3	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	5.00		15.00																									20.00		60.00				5.00		0.00				5.00				5.00		0.17				0.67	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8145	122	0	1	09	04	H8145_122_0	3			Generic	4	11	3	2	2	3	110		01		110	1	30		90				2	2				30		90	30		31	5.00		15.00																									20.00		60.00				5.00		0.00				5.00				5.00		0.17				0.67	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H8145	122	0	1	09	04	H8145_122_0	3			Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8145	122	0	1	09	04	H8145_122_0	3			Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	99.00		297.00																									100.00		300.00				99.00		287.00				99.00				99.00		3.30				3.33	3.30	3.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8145	122	0	1	09	04	H8145_122_0	3			Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					30																										30						30					30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8145	123	0	1	09	04	H8145_123_0	3			Preferred Generic	4	11	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	7.00		21.00																									10.00		30.00				7.00		0.00				7.00				7.00		0.23				0.33	0.23	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8145	123	0	1	09	04	H8145_123_0	3			Generic	4	11	1	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	15.00		45.00																									20.00		60.00				15.00		0.00				15.00				15.00		0.50				0.67	0.50	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8145	123	0	1	09	04	H8145_123_0	3			Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	45.00		135.00																									47.00		141.00				45.00		90.00				45.00				45.00		1.50				1.57	1.50	1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8145	123	0	1	09	04	H8145_123_0	3			Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		200.00				100.00				100.00		3.33				3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8145	123	0	1	09	04	H8145_123_0	3			Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					28																										28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8145	125	0	1	09	04	H8145_125_0	4			Preferred Generic	4	11	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	8.00		24.00																									10.00		30.00				8.00		0.00				8.00				8.00		0.27				0.33	0.27	0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8145	125	0	1	09	04	H8145_125_0	4			Generic	4	11	1	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	15.00		45.00																									20.00		60.00				15.00		0.00				15.00				15.00		0.50				0.67	0.50	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8145	125	0	1	09	04	H8145_125_0	4			Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8145	125	0	1	09	04	H8145_125_0	4			Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	99.00		297.00																									100.00		300.00				99.00		287.00				99.00				99.00		3.30				3.33	3.30	3.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8145	125	0	1	09	04	H8145_125_0	4			Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					30																										30						30					30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8166	001	0	1	04	01	H8166_001_0	5			Preferred Generic	4	01	1	2	1	1		110	01		100	1				31		90	1	2						90	31		31								7.00		21.00					0.00		0.00													21.00						0.00				7.00				7.00			0.23	0.00				0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8166	001	0	1	04	01	H8166_001_0	5			Generic	4	01	1	2	2	1		110	01		100	1				31		90	1	2						90	31		31								15.00		45.00					5.00		15.00													45.00						0.00				15.00				15.00			0.48	0.16				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8166	001	0	1	04	01	H8166_001_0	5			Preferred Brand	4	11	1	2	3	1		110	01		100	1				31		90	1	2						90	31		31								47.00		141.00					47.00		141.00													141.00						120.00				47.00				47.00			1.52	1.52				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8166	001	0	1	04	01	H8166_001_0	5			Non-Preferred Drug	4	11	1	2	4	1		110	01		100	1				31		90	1	2						90	31		31								100.00		300.00					100.00		300.00													300.00						275.00				100.00				100.00			3.23	3.23				3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8166	001	0	1	04	01	H8166_001_0	5			Specialty Tier	4	11	1	1	5	1		010	01		010	1				31								31			31		31											825.06	33						825.06	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8166	002	0	1	04	01	H8166_002_0	5		Y	Preferred Generic	4	01	1	2	1	1		110	01		100	1				31		90	1	2						90	31		31								7.00		21.00					0.00		0.00													21.00						0.00				7.00				7.00			0.23	0.00				0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8166	002	0	1	04	01	H8166_002_0	5		Y	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													45.00						0.00				15.00				15.00			0.48	0.00				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8166	002	0	1	04	01	H8166_002_0	5		Y	Preferred Brand	4	11	1	2	3	1		110	01		100	1				31		90	1	2						90	31		31								47.00		141.00					47.00		141.00													141.00						120.00				47.00				47.00			1.52	1.52				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8166	002	0	1	04	01	H8166_002_0	5		Y	Non-Preferred Drug	4	11	1	2	4	1		110	01		100	1				31		90	1	2						90	31		31								100.00		300.00					100.00		300.00													300.00						275.00				100.00				100.00			3.23	3.23				3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8166	002	0	1	04	01	H8166_002_0	5		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				31								31			31		31											824.93	33						824.93	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8173	001	0	1	01	01	H8173_001_0	10		N	Preferred Generic	4	11	1	2	1	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8173	001	0	1	01	01	H8173_001_0	10		N	Preferred Generic	4	11	1	2	1	3	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H8173	001	0	1	01	01	H8173_001_0	10		N	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	10		N	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	3	3
H8173	001	0	1	01	01	H8173_001_0	10		N	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	45.00	90.00	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	10		N	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	95.00	190.00	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	10		N	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												
H8173	002	0	1	01	01	H8173_002_0	10		N	Preferred Generic	4	11	1	2	1	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8173	002	0	1	01	01	H8173_002_0	10		N	Preferred Generic	4	11	1	2	1	3	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H8173	002	0	1	01	01	H8173_002_0	10		N	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	002	0	1	01	01	H8173_002_0	10		N	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	3	3
H8173	002	0	1	01	01	H8173_002_0	10		N	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	45.00	90.00	135.00																			45.00	90.00	112.50																45.00				45.00		1.50			1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8173	002	0	1	01	01	H8173_002_0	10		N	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	95.00	190.00	285.00																			95.00	190.00	285.00																95.00				95.00		3.17			3.17			3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8173	002	0	1	01	01	H8173_002_0	10		N	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												
H8173	007	0	1	01	01	H8173_007_0	10		Y	Preferred Generic	4	11	1	2	1	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8173	007	0	1	01	01	H8173_007_0	10		Y	Preferred Generic	4	11	1	2	1	3	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H8173	007	0	1	01	01	H8173_007_0	10		Y	Generic	4	11	3	2	2	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	5.00	10.00	15.00																			0.00	0.00	0.00																5.00				5.00		0.17			0.00			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8173	007	0	1	01	01	H8173_007_0	10		Y	Generic	4	11	3	2	2	3	111		01	111		1	30	60	100				1	2	30	60	100				30		31	5.00	10.00	15.00																			0.00	0.00	0.00																5.00				5.00		0.17			0.00			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	3
H8173	007	0	1	01	01	H8173_007_0	10		Y	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	45.00	90.00	135.00																			45.00	90.00	112.50																45.00				45.00		1.50			1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8173	007	0	1	01	01	H8173_007_0	10		Y	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	100.00	200.00	300.00																			100.00	200.00	300.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8173	007	0	1	01	01	H8173_007_0	10		Y	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												
H8173	008	0	1	01	01	H8173_008_0	10		Y	Preferred Generic	4	11	1	2	1	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8173	008	0	1	01	01	H8173_008_0	10		Y	Preferred Generic	4	11	1	2	1	3	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H8173	008	0	1	01	01	H8173_008_0	10		Y	Generic	4	11	3	2	2	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	5.00	10.00	15.00																			0.00	0.00	0.00																5.00				5.00		0.17			0.00			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8173	008	0	1	01	01	H8173_008_0	10		Y	Generic	4	11	3	2	2	3	111		01	111		1	30	60	100				1	2	30	60	100				30		31	5.00	10.00	15.00																			0.00	0.00	0.00																5.00				5.00		0.17			0.00			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	3
H8173	008	0	1	01	01	H8173_008_0	10		Y	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	45.00	90.00	135.00																			45.00	90.00	112.50																45.00				45.00		1.50			1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8173	008	0	1	01	01	H8173_008_0	10		Y	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	100.00	200.00	300.00																			100.00	200.00	300.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8173	008	0	1	01	01	H8173_008_0	10		Y	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												
H8173	011	0	1	01	01	H8173_011_0	9		Y	Preferred Generic	4	11	1	2	1	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8173	011	0	1	01	01	H8173_011_0	9		Y	Preferred Generic	4	11	1	2	1	3	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H8173	011	0	1	01	01	H8173_011_0	9		Y	Generic	4	11	3	2	2	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8173	011	0	1	01	01	H8173_011_0	9		Y	Generic	4	11	3	2	2	3	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	3
H8173	011	0	1	01	01	H8173_011_0	9		Y	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	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	011	0	1	01	01	H8173_011_0	9		Y	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	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	011	0	1	01	01	H8173_011_0	9		Y	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												
H8173	013	0	1	01	01	H8173_013_0	11		N	Preferred Generic	4	11	1	2	1	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8173	013	0	1	01	01	H8173_013_0	11		N	Preferred Generic	4	11	1	2	1	3	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H8173	013	0	1	01	01	H8173_013_0	11		N	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												
H8173	013	0	1	01	01	H8173_013_0	11		N	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																			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										2	2	2
H8173	013	0	1	01	01	H8173_013_0	11		N	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												
H8173	013	0	1	01	01	H8173_013_0	11		N	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	100				1	2	30	60	100				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												
H8173	013	0	1	01	01	H8173_013_0	11		N	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												
H8173	014	0	1	01	01	H8173_014_0	9		N	Preferred Generic	4	11	1	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												
H8173	014	0	1	01	01	H8173_014_0	9		N	Generic	4	11	3	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												
H8173	014	0	1	01	01	H8173_014_0	9		N	Generic	4	11	3	2	2	3	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	2	2
H8173	014	0	1	01	01	H8173_014_0	9		N	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												
H8173	014	0	1	01	01	H8173_014_0	9		N	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												
H8173	014	0	1	01	01	H8173_014_0	9		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31					25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8173	015	0	1	01	01	H8173_015_0	5		N	Preferred Generic	4	11	1	2	1	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8173	015	0	1	01	01	H8173_015_0	5		N	Preferred Generic	4	11	1	2	1	3	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H8173	015	0	1	01	01	H8173_015_0	5		N	Generic	4	11	3	2	2	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8173	015	0	1	01	01	H8173_015_0	5		N	Generic	4	11	3	2	2	3	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	3
H8173	015	0	1	01	01	H8173_015_0	5		N	Preferred Brand	4	11	1	1	3	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31				1.00	25	25	25																		25	25	25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8173	015	0	1	01	01	H8173_015_0	5		N	Non-Preferred Drug	4	11	1	1	4	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31				1.00	25	25	25																		25	25	25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8173	015	0	1	01	01	H8173_015_0	5		N	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												
H8176	001	0	1	01	01	H8176_001_0	8		N	Preferred Generic	4	11	1	2	1	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8176	001	0	1	01	01	H8176_001_0	8		N	Generic	4	11	1	2	2	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31	4.00	8.00	12.00																			4.00	8.00	12.00																4.00				4.00		0.13			0.13			0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8176	001	0	1	01	01	H8176_001_0	8		N	Preferred Brand	4	11	1	2	3	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31	45.00	90.00	135.00																			45.00	90.00	135.00																45.00				45.00		1.45			1.45			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8176	001	0	1	01	01	H8176_001_0	8		N	Non-Preferred Drug	4	11	1	1	4	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31				91.64	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	8		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	31								31						31		31				817.03	25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8176	003	0	1	01	01	H8176_003_0	6		Y	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	6		Y	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	6		Y	Preferred Brand	4	11	1	2	3	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31	47.00	94.00	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	6		Y	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	6		Y	Specialty Tier	4	11	1	1	5	1	010		01	010		1	31								31						31		31				841.10	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	6		Y	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	7			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	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	0.00																14.00				14.00		0.47			0.47			0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8181	001	0	1	04	01	H8181_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																			47.00	94.00	141.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8181	001	0	1	04	01	H8181_001_0	7			Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	100.00	200.00	300.00																			100.00	200.00	300.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8181	001	0	1	04	01	H8181_001_0	7			Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				802.26	31																				31																	31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8181	002	0	1	04	01	H8181_002_0	7			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	002	0	1	04	01	H8181_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																			14.00	28.00	0.00																14.00				14.00		0.47			0.47			0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8181	002	0	1	04	01	H8181_002_0	7			Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	141.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8181	002	0	1	04	01	H8181_002_0	7			Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	100.00	200.00	300.00																			100.00	200.00	300.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8181	002	0	1	04	01	H8181_002_0	7			Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				773.45	30																				30																	30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8197	002	1	1	48	05	H8197_002_1	4			Generic Drugs	4	01			1	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31																																																					Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	1	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H8197	002	1	1	48	05	H8197_002_1	4			Brand Drugs	4	11			2	1	111		01	111		1	31	60	90				2	2	31	60	90				31		31																																																					Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	1	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H8197	002	1	1	48	05	H8197_002_1	4			Non-Medicare Rx/OTC Drugs	4	11			3	1	010		01	010		1	31								31						31		31																																																					Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	2	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H8197	002	2	1	48	05	H8197_002_2	4			Generic Drugs	4	01			1	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31																																																					Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	1	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H8197	002	2	1	48	05	H8197_002_2	4			Brand Drugs	4	11			2	1	111		01	111		1	31	60	90				2	2	31	60	90				31		31																																																					Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	1	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H8197	002	2	1	48	05	H8197_002_2	4			Non-Medicare Rx/OTC Drugs	4	11			3	1	010		01	010		1	31								31						31		31																																																					Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	2	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H8211	001	0	1	04	01	H8211_001_0	2		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8211	001	0	1	04	01	H8211_001_0	2		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H8211	001	0	1	04	01	H8211_001_0	2		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8211	001	0	1	04	01	H8211_001_0	2		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H8211	001	0	1	04	01	H8211_001_0	2		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8211	001	0	1	04	01	H8211_001_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8211	001	0	1	04	01	H8211_001_0	2		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				401.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8211	002	0	1	04	01	H8211_002_0	2		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8211	002	0	1	04	01	H8211_002_0	2		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H8211	002	0	1	04	01	H8211_002_0	2		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8211	002	0	1	04	01	H8211_002_0	2		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H8211	002	0	1	04	01	H8211_002_0	2		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8211	002	0	1	04	01	H8211_002_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8211	002	0	1	04	01	H8211_002_0	2		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				460.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8211	006	0	1	04	01	H8211_006_0	2		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8211	006	0	1	04	01	H8211_006_0	2		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H8211	006	0	1	04	01	H8211_006_0	2		Y	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												
H8211	006	0	1	04	01	H8211_006_0	2		Y	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
H8211	006	0	1	04	01	H8211_006_0	2		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8211	006	0	1	04	01	H8211_006_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8211	006	0	1	04	01	H8211_006_0	2		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				310.00	30																										30						30					30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8211	007	0	1	04	01	H8211_007_0	2		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8211	007	0	1	04	01	H8211_007_0	2		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H8211	007	0	1	04	01	H8211_007_0	2		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	8.00		24.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8211	007	0	1	04	01	H8211_007_0	2		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	8.00		24.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H8211	007	0	1	04	01	H8211_007_0	2		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8211	007	0	1	04	01	H8211_007_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8211	007	0	1	04	01	H8211_007_0	2		Y	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												
H8211	009	0	1	04	01	H8211_009_0	2		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8211	009	0	1	04	01	H8211_009_0	2		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H8211	009	0	1	04	01	H8211_009_0	2		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	15.00		45.00																											45.00						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	2		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	15.00		45.00																											45.00						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	2		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8211	009	0	1	04	01	H8211_009_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8211	009	0	1	04	01	H8211_009_0	2		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				406.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8213	001	0	1	48	05	H8213_001_0	6			Generic Drugs	4	01			1	1	111		01	100		1	30	60	100				1	2			100				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	6			Brand Drugs	4	11			2	1	111		01	100		1	30	60	100				1	2			100				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	6			Non-Medicare Rx/OTC Drugs	4	11			3	1	111		01	100		1	30	60	100				1	2			100				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	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												
H8225	001	0	1	01	01	H8225_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					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	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												
H8225	001	0	1	01	01	H8225_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												
H8225	001	0	1	01	01	H8225_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												
H8225	001	0	1	01	01	H8225_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												
H8225	003	0	1	01	01	H8225_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								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00				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	5			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	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					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	5			Generic	4	11	1	2	2	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								7.00	14.00	21.00					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	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												
H8225	003	0	1	01	01	H8225_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												
H8225	003	0	1	01	01	H8225_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												
H8225	003	0	1	01	01	H8225_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												
H8225	003	0	1	01	01	H8225_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	
H8225	004	0	1	01	01	H8225_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												
H8225	004	0	1	01	01	H8225_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								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00				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	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					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	5			Generic	4	11	1	2	2	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								7.00	14.00	21.00					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	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												
H8225	004	0	1	01	01	H8225_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												
H8225	004	0	1	01	01	H8225_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												
H8225	004	0	1	01	01	H8225_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												
H8225	004	0	1	01	01	H8225_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	
H8225	005	0	1	01	01	H8225_005_0	5		N	Preferred Generic	3	11	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								19.00	38.00	57.00					3.00	6.00	9.00											19.00	38.00	57.00				3.00	6.00	0.00				19.00				19.00			0.63	0.1		0.63	0.1	0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8225	005	0	1	01	01	H8225_005_0	5		N	Generic	3	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					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												
H8225	005	0	1	01	01	H8225_005_0	5		N	Preferred Brand	3	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					47.00	94.00	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, Select Care Drugs												
H8225	005	0	1	01	01	H8225_005_0	5		N	Non-Preferred Drug	3	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											97.75	40	40	40				97.75	40	40	40										40	40	40				40	40	40			40			40								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8225	005	0	1	01	01	H8225_005_0	5		N	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8225	005	0	1	01	01	H8225_005_0	5		N	Select Care Drugs	3	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8225	006	0	1	01	01	H8225_006_0	5		N	Preferred Generic	3	11	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								19.00	38.00	57.00					4.00	8.00	12.00											19.00	38.00	57.00				4.00	8.00	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, Select Care Drugs												
H8225	006	0	1	01	01	H8225_006_0	5		N	Generic	3	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					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												
H8225	006	0	1	01	01	H8225_006_0	5		N	Preferred Brand	3	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					47.00	94.00	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, Select Care Drugs												
H8225	006	0	1	01	01	H8225_006_0	5		N	Non-Preferred Drug	3	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											97.57	40	40	40				97.57	40	40	40										40	40	40				40	40	40			40			40								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8225	006	0	1	01	01	H8225_006_0	5		N	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8225	006	0	1	01	01	H8225_006_0	5		N	Select Care Drugs	3	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8225	007	0	1	02	01	H8225_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								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00				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	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												
H8225	007	0	1	02	01	H8225_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												
H8225	007	0	1	02	01	H8225_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												
H8225	007	0	1	02	01	H8225_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												
H8225	007	0	1	02	01	H8225_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												
H8225	008	0	1	02	01	H8225_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								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00				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	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												
H8225	008	0	1	02	01	H8225_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												
H8225	008	0	1	02	01	H8225_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												
H8225	008	0	1	02	01	H8225_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, Select Care Drugs												
H8225	008	0	1	02	01	H8225_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												
H8225	009	0	1	01	01	H8225_009_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												
H8225	009	0	1	01	01	H8225_009_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												
H8225	009	0	1	01	01	H8225_009_0	6			Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											47.00	94.00	141.00				37.00	74.00	74.00				47.00				47.00			1.57	1.23		1.57	1.23	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8225	009	0	1	01	01	H8225_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					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	009	0	1	01	01	H8225_009_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												
H8225	009	0	1	01	01	H8225_009_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												
H8229	001	0	1	04	01	H8229_001_0	6		Y	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												
H8229	001	0	1	04	01	H8229_001_0	6		Y	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												
H8229	001	0	1	04	01	H8229_001_0	6		Y	Preferred Brand	4	10	1	2	3	1		111	01	100		1				30	60	90	1	2			90				30		31								47.00	94.00	141.00					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												
H8229	001	0	1	04	01	H8229_001_0	6		Y	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												
H8229	001	0	1	04	01	H8229_001_0	6		Y	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8244	001	0	1	04	01	H8244_001_0	3		N	Preferred Generic	4	11	1	2	1	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8244	001	0	1	04	01	H8244_001_0	3		N	Generic	4	01	1	2	2	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	20.00	40.00	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												
H8244	001	0	1	04	01	H8244_001_0	3		N	Preferred Brand	4	11	3	1	3	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31				96.28	25	25	25																		25	25	25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8244	001	0	1	04	01	H8244_001_0	3		N	Non-Preferred Drug	4	11	3	1	4	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31				65.56	25	25	25																		25	25	25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8244	001	0	1	04	01	H8244_001_0	3		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				602.38	25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8244	001	0	1	04	01	H8244_001_0	3		N	Select Care Drugs	4	01	1	2	6	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	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												
H8293	001	0	1	01	01	H8293_001_0	5		Y	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		Y	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		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8293	001	0	1	01	01	H8293_001_0	5		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								100.00	200.00	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		Y	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	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	001	0	1	01	01	H8332_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		
H8332	001	0	1	01	01	H8332_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												
H8332	001	0	1	01	01	H8332_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		
H8332	001	0	1	01	01	H8332_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												
H8332	001	0	1	01	01	H8332_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												
H8332	001	0	1	01	01	H8332_001_0	3			Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1044.79	30						527.54	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								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												
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								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		
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								12.00	24.00	36.00					10.00	20.00	20.00											12.00	24.00	36.00				10.00	20.00	20.00					12.00			12.00			0.40	0.33		0.40	0.33	0.39	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								12.00	24.00	36.00					10.00	20.00	20.00											12.00	24.00	36.00				10.00	20.00	20.00					12.00			12.00			0.40	0.33		0.40	0.33	0.39	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											1236.38	33						546.31	33												33						33						33		33								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					10.00	20.00	20.00											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												
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					10.00	20.00	20.00											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										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											909.83	30						533.57	30												30						30						30		30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8332	004	0	1	01	01	H8332_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								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00					5.00			5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8332	004	0	1	01	01	H8332_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								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00					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		
H8332	004	0	1	01	01	H8332_004_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												
H8332	004	0	1	01	01	H8332_004_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		
H8332	004	0	1	01	01	H8332_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												
H8332	004	0	1	01	01	H8332_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												
H8332	004	0	1	01	01	H8332_004_0	2			Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											982.16	33						560.38	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8332	005	0	1	01	01	H8332_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												
H8332	005	0	1	01	01	H8332_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		
H8332	005	0	1	01	01	H8332_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	20.00											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												
H8332	005	0	1	01	01	H8332_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	20.00											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										1		
H8332	005	0	1	01	01	H8332_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												
H8332	005	0	1	01	01	H8332_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												
H8332	005	0	1	01	01	H8332_005_0	2			Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											909.83	30						533.57	30												30						30						30		30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8343	001	0	1	04	01	H8343_001_0	5		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								10.00	20.00	30.00					5.00	10.00	15.00					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	5		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								17.00	34.00	51.00					12.00	24.00	36.00					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	5		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								47.00	94.00	141.00					37.00	74.00	111.00					37.00	111.00	111.00																47.00				47.00			1.57	1.23	1.23			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8343	001	0	1	04	01	H8343_001_0	5		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								100.00	200.00	300.00					90.00	180.00	270.00					90.00	270.00	270.00																100.00				100.00			3.33	3.00	3.00			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8343	001	0	1	04	01	H8343_001_0	5		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8343	001	0	1	04	01	H8343_001_0	5		N	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8343	001	0	1	04	01	H8343_001_0	5		N	Select Care Drugs	4	01	1	2	6	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H8343	002	0	1	04	01	H8343_002_0	6		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								10.00	20.00	30.00					5.00	10.00	15.00					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	6		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								17.00	34.00	51.00					12.00	24.00	36.00					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	6		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								47.00	94.00	141.00					37.00	74.00	111.00					37.00	111.00	111.00																47.00				47.00			1.57	1.23	1.23			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8343	002	0	1	04	01	H8343_002_0	6		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								100.00	200.00	300.00					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	6		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8343	002	0	1	04	01	H8343_002_0	6		N	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8343	002	0	1	04	01	H8343_002_0	6		N	Select Care Drugs	4	01	1	2	6	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H8343	003	0	1	04	01	H8343_003_0	5		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								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	5		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								20.00	40.00	60.00					15.00	30.00	45.00					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	5		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								47.00	94.00	141.00					37.00	74.00	111.00					37.00	111.00	111.00																47.00				47.00			1.57	1.23	1.23			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8343	003	0	1	04	01	H8343_003_0	5		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	285.00	285.00																100.00				100.00			3.33	3.17	3.17			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8343	003	0	1	04	01	H8343_003_0	5		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8343	003	0	1	04	01	H8343_003_0	5		N	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8343	003	0	1	04	01	H8343_003_0	5		N	Select Care Drugs	4	01	1	2	6	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H8343	007	0	1	04	01	H8343_007_0	6		Y	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		Y	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		Y	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												
H8343	007	0	1	04	01	H8343_007_0	6		Y	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	
H8343	007	0	1	04	01	H8343_007_0	6		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				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		Y	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		Y	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				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		Y	Select Care Drugs	4	01	1	2	6	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				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	009	0	1	04	01	H8343_009_0	6		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								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			0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8343	009	0	1	04	01	H8343_009_0	6		N	Preferred Generic	4	01	1	2	1	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								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			0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H8343	009	0	1	04	01	H8343_009_0	6		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								17.00	34.00	51.00					12.00	24.00	36.00					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												
H8343	009	0	1	04	01	H8343_009_0	6		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								47.00	94.00	141.00					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												
H8343	009	0	1	04	01	H8343_009_0	6		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								100.00	200.00	300.00					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												
H8343	009	0	1	04	01	H8343_009_0	6		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8343	010	0	1	04	01	H8343_010_0	5		Y	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												
H8343	010	0	1	04	01	H8343_010_0	5		Y	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												
H8343	010	0	1	04	01	H8343_010_0	5		Y	Preferred Brand	4	11	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	010	0	1	04	01	H8343_010_0	5		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				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	010	0	1	04	01	H8343_010_0	5		Y	Specialty Tier	4	11	1	1	5	1		010	01	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	010	0	1	04	01	H8343_010_0	5		Y	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8343	010	0	1	04	01	H8343_010_0	5		Y	Select Care Drugs	4	01	1	2	6	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				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	16		N	Preferred Generic	3	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8379	001	0	1	01	01	H8379_001_0	16		N	Generic	3	11	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	20.00	40.00	60.00																			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												
H8379	001	0	1	01	01	H8379_001_0	16		N	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	16		N	Non-Preferred Drug	3	11	1	1	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31				58.02	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	16		N	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												
H8379	002	0	1	01	01	H8379_002_0	16		N	Preferred Generic	3	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8379	002	0	1	01	01	H8379_002_0	16		N	Generic	3	11	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	20.00	40.00	60.00																			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												
H8379	002	0	1	01	01	H8379_002_0	16		N	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	002	0	1	01	01	H8379_002_0	16		N	Non-Preferred Drug	3	11	1	1	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31				58.02	50	50	50																		50	50	50															50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8379	002	0	1	01	01	H8379_002_0	16		N	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	5		Y	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								2.00	4.00	6.00					0.00	0.00	0.00											2.00	4.00	6.00				0.00	0.00	0.00				0.00				0.00			0.07	0.00		0.07	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8385	001	0	1	04	01	H8385_001_0	5		Y	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								10.00	20.00	30.00					4.00	8.00	12.00											10.00	20.00	30.00				4.00	8.00	12.00				4.00				4.00			0.33	0.13		0.33	0.13	0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8385	001	0	1	04	01	H8385_001_0	5		Y	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				42.00				42.00			1.57	1.40		1.57	1.40	1.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8385	001	0	1	04	01	H8385_001_0	5		Y	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					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00				100.00				100.00			3.33	3.33		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	5		Y	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 Drug, Specialty Tier												
H8385	002	0	1	04	01	H8385_002_0	6		Y	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								4.00	8.00	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												
H8385	002	0	1	04	01	H8385_002_0	6		Y	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								10.00	20.00	30.00					4.00	8.00	12.00											10.00	20.00	30.00				4.00	8.00	12.00				10.00				10.00			0.33	0.13		0.33	0.13	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8385	002	0	1	04	01	H8385_002_0	6		Y	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												
H8385	002	0	1	04	01	H8385_002_0	6		Y	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					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00				100.00				100.00			3.33	3.33		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	6		Y	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 Drug, Specialty Tier												
H8385	003	0	1	04	01	H8385_003_0	5		Y	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								3.00	6.00	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												
H8385	003	0	1	04	01	H8385_003_0	5		Y	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					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												
H8385	003	0	1	04	01	H8385_003_0	5		Y	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												
H8385	003	0	1	04	01	H8385_003_0	5		Y	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					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00				100.00				100.00			3.33	3.33		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	5		Y	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 Drug, Specialty Tier												
H8385	004	0	1	04	01	H8385_004_0	5		Y	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								4.00	8.00	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												
H8385	004	0	1	04	01	H8385_004_0	5		Y	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								10.00	20.00	30.00					4.00	8.00	12.00											10.00	20.00	30.00				4.00	8.00	12.00				10.00				10.00			0.33	0.13		0.33	0.13	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8385	004	0	1	04	01	H8385_004_0	5		Y	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												
H8385	004	0	1	04	01	H8385_004_0	5		Y	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					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00				100.00				100.00			3.33	3.33		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	5		Y	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 Drug, Specialty Tier												
H8390	015	0	1	01	01	H8390_015_0	8		N	Preferred Generic	4	01	1	2	1	1	111		01	100		1	30	60	90				1	2			90				30		31	0.00	0.00	0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8390	015	0	1	01	01	H8390_015_0	8		N	Preferred Generic	4	01	1	2	1	3	111		01	100		1	30	60	90				1	2			90				30		31	0.00	0.00	0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H8390	015	0	1	01	01	H8390_015_0	8		N	Generic	4	01	1	1	2	1	111		01	100		1	30	60	90				1	2			90				30		31				5.96	25	25	25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8390	015	0	1	01	01	H8390_015_0	8		N	Preferred Brand	4	11	1	1	3	1	111		01	100		1	30	60	90				1	2			90				30		31				72.44	25	25	25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8390	015	0	1	01	01	H8390_015_0	8		N	Non-Preferred Drug	4	11	1	1	4	1	111		01	100		1	30	60	90				1	2			90				30		31				57.82	25	25	25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8390	015	0	1	01	01	H8390_015_0	8		N	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31				757.67	25																																					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8390	016	0	1	01	01	H8390_016_0	8		N	Preferred Generic	4	01	1	2	1	1	111		01	100		1	30	60	90				1	2			90				30		31	0.00	0.00	0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8390	016	0	1	01	01	H8390_016_0	8		N	Preferred Generic	4	01	1	2	1	3	111		01	100		1	30	60	90				1	2			90				30		31	0.00	0.00	0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H8390	016	0	1	01	01	H8390_016_0	8		N	Generic	4	01	1	1	2	1	111		01	100		1	30	60	90				1	2			90				30		31				5.96	25	25	25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8390	016	0	1	01	01	H8390_016_0	8		N	Preferred Brand	4	11	1	1	3	1	111		01	100		1	30	60	90				1	2			90				30		31				72.44	25	25	25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8390	016	0	1	01	01	H8390_016_0	8		N	Non-Preferred Drug	4	11	1	1	4	1	111		01	100		1	30	60	90				1	2			90				30		31				57.82	25	25	25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8390	016	0	1	01	01	H8390_016_0	8		N	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31				757.67	25																																					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8432	007	0	1	01	01	H8432_007_0	5		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								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	007	0	1	01	01	H8432_007_0	5		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								20.00	40.00	60.00					20.00	40.00	60.00					20.00	60.00	60.00																20.00				20.00			0.67	0.67	0.67			0.59	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8432	007	0	1	01	01	H8432_007_0	5		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								47.00	94.00	141.00					47.00	94.00	141.00					47.00	141.00	141.00																47.00				47.00			1.57	1.57	1.57			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8432	007	0	1	01	01	H8432_007_0	5		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	285.00	285.00																100.00				100.00			3.33	3.17	3.17			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8432	007	0	1	01	01	H8432_007_0	5		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												25							25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8432	007	0	1	01	01	H8432_007_0	5		N	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								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												
H8432	008	5	1	01	01	H8432_008_5	5			Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8432	008	5	1	01	01	H8432_008_5	5			Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								20.00	40.00	60.00					15.00	30.00	45.00					15.00	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	5			Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00	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	5			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	5			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	5			Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8432	008	6	1	01	01	H8432_008_6	5			Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								20.00	40.00	60.00					15.00	30.00	45.00					15.00	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	5			Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00	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	5			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	5			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	5			Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8432	008	7	1	01	01	H8432_008_7	5			Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								20.00	40.00	60.00					15.00	30.00	45.00					15.00	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	5			Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00	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	5			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	5			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	5			Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8432	009	0	1	01	01	H8432_009_0	5			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	5			Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00	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	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												
H8432	009	0	1	01	01	H8432_009_0	5			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	5			Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8432	010	0	1	01	01	H8432_010_0	5			Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								20.00	40.00	60.00					15.00	30.00	45.00					15.00	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	5			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	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												
H8432	010	0	1	01	01	H8432_010_0	5			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	5			Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8432	011	0	1	01	01	H8432_011_0	5			Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								20.00	40.00	60.00					15.00	30.00	45.00					15.00	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	5			Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00	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	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												
H8432	011	0	1	01	01	H8432_011_0	5			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	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	015	0	1	02	01	H8432_015_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					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	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	015	0	1	02	01	H8432_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								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	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	016	0	1	01	01	H8432_016_0	5			Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								9.00	18.00	27.00					4.00	8.00	12.00					4.00	12.00	12.00																9.00				9.00			0.30	0.13	0.13			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8432	016	0	1	01	01	H8432_016_0	5			Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	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	5			Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00	126.00	126.00																47.00				47.00			1.57	1.40	1.40			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8432	016	0	1	01	01	H8432_016_0	5			Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	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	5			Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												29							29						29																	29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8432	016	0	1	01	01	H8432_016_0	5			Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				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	5			Select Care Drugs	4	01	1	2	6	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H8432	027	0	1	01	01	H8432_027_0	5			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	5			Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								20.00	40.00	60.00					15.00	30.00	45.00					15.00	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	5			Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00	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	5			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	5			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	5			Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8432	027	0	1	01	01	H8432_027_0	5			Select Care Drugs	4	01	1	2	6	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H8432	028	0	1	01	01	H8432_028_0	5		N	Preferred Generic	4	01	3	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								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	028	0	1	01	01	H8432_028_0	5		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								20.00	40.00	60.00					20.00	40.00	60.00					20.00	60.00	60.00																20.00				20.00			0.67	0.67	0.67			0.59	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8432	028	0	1	01	01	H8432_028_0	5		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								47.00	94.00	141.00					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	5		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	285.00	285.00																100.00				100.00			3.33	3.17	3.17			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8432	028	0	1	01	01	H8432_028_0	5		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												25							25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8432	028	0	1	01	01	H8432_028_0	5		N	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								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												
H8432	034	0	1	01	01	H8432_034_0	6		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								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												
H8432	034	0	1	01	01	H8432_034_0	6		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								20.00	40.00	60.00					20.00	40.00	60.00					20.00	60.00	60.00																20.00				20.00			0.67	0.67	0.67			0.59	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8432	034	0	1	01	01	H8432_034_0	6		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								47.00	94.00	141.00					47.00	94.00	141.00					47.00	141.00	141.00																47.00				47.00			1.57	1.57	1.57			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8432	034	0	1	01	01	H8432_034_0	6		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	285.00	285.00																100.00				100.00			3.33	3.17	3.17			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8432	034	0	1	01	01	H8432_034_0	6		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												25							25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8432	034	0	1	01	01	H8432_034_0	6		N	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								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												
H8432	035	0	1	01	01	H8432_035_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												
H8432	035	0	1	01	01	H8432_035_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
H8432	035	0	1	01	01	H8432_035_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												
H8432	035	0	1	01	01	H8432_035_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												
H8432	035	0	1	01	01	H8432_035_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												
H8432	035	0	1	01	01	H8432_035_0	7			Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												25							25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8432	035	0	1	01	01	H8432_035_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												
H8432	035	0	1	01	01	H8432_035_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		
H8432	038	1	1	01	01	H8432_038_1	5			Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8432	038	1	1	01	01	H8432_038_1	5			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	5			Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								47.00	94.00	141.00					37.00	74.00	111.00					37.00	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	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												
H8432	038	1	1	01	01	H8432_038_1	5			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	5			Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8432	038	2	1	01	01	H8432_038_2	5			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	5			Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								47.00	94.00	141.00					37.00	74.00	111.00					37.00	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	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												
H8432	038	2	1	01	01	H8432_038_2	5			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	5		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								10.00	20.00	30.00					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												
H8432	039	1	1	01	01	H8432_039_1	5		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								20.00	40.00	60.00					20.00	40.00	60.00					20.00	60.00	60.00																20.00				20.00			0.67	0.67	0.67			0.59	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8432	039	1	1	01	01	H8432_039_1	5		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								47.00	94.00	141.00					47.00	94.00	141.00					47.00	141.00	141.00																47.00				47.00			1.57	1.57	1.57			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8432	039	1	1	01	01	H8432_039_1	5		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	285.00	285.00																100.00				100.00			3.33	3.17	3.17			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8432	039	1	1	01	01	H8432_039_1	5		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												25							25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8432	039	1	1	01	01	H8432_039_1	5		N	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								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												
H8432	039	2	1	01	01	H8432_039_2	6		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								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												
H8432	039	2	1	01	01	H8432_039_2	6		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								20.00	40.00	60.00					20.00	40.00	60.00					20.00	60.00	60.00																20.00				20.00			0.67	0.67	0.67			0.59	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8432	039	2	1	01	01	H8432_039_2	6		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								47.00	94.00	141.00					47.00	94.00	141.00					47.00	141.00	141.00																47.00				47.00			1.57	1.57	1.57			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8432	039	2	1	01	01	H8432_039_2	6		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	285.00	285.00																100.00				100.00			3.33	3.17	3.17			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8432	039	2	1	01	01	H8432_039_2	6		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												25							25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8432	039	2	1	01	01	H8432_039_2	6		N	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								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												
H8452	001	0	1	48	05	H8452_001_0	4			Generic Drugs	4	01			1	1	111		01	100		1	30	60	90				2	2			90				30		31																																																					Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	1	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	4			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	4			Non-Medicare Rx/OTC Drugs	4	11			3	1	111		01	100		1	30	60	90				1	2			90				30		31																																																					Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	2	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
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								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00				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												
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								15.00	30.00	45.00					7.00	14.00	21.00											15.00	30.00	45.00				7.00	14.00	0.00				15.00				15.00			0.5	0.23		0.5	0.23	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, 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											78.66	45	45	45				75.16	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								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00				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												
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								15.00	30.00	45.00					7.00	14.00	21.00											15.00	30.00	45.00				7.00	14.00	0.00				15.00				15.00			0.5	0.23		0.5	0.23	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, 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											79.93	45	45	45				76.38	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	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					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												
H8547	001	0	1	01	01	H8547_001_0	7			Preferred Generic	4	01	1	2	1	3		111	01		111	1				30	60	100	1	2				30	60	100	30		31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	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		
H8547	001	0	1	01	01	H8547_001_0	7			Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					10.00	20.00	30.00											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												
H8547	001	0	1	01	01	H8547_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					47.00	94.00	141.00											47.00	94.00	94.00				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												
H8547	001	0	1	01	01	H8547_001_0	7			Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00				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	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												
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												27							27						27																	27			27								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	6			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	6			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	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	028	0	1	04	01	H8552_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												
H8552	028	0	1	04	01	H8552_028_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												
H8552	028	0	1	04	01	H8552_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												
H8552	028	0	1	04	01	H8552_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		
H8552	029	0	1	04	01	H8552_029_0	5			Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								9.00	18.00	27.00					4.00	8.00	12.00					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	5			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	5			Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00	126.00	126.00																47.00				47.00			1.57	1.40	1.40			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8552	029	0	1	04	01	H8552_029_0	5			Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	285.00	285.00																100.00				100.00			3.33	3.17	3.17			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8552	029	0	1	04	01	H8552_029_0	5			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												
H8552	029	0	1	04	01	H8552_029_0	5			Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8552	030	0	1	04	01	H8552_030_0	8		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		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												
H8552	030	0	1	04	01	H8552_030_0	8		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								15.00	30.00	45.00					15.00	30.00	45.00					15.00	45.00	45.00																15.00				15.00			0.50	0.50	0.50			0.44	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8552	030	0	1	04	01	H8552_030_0	8		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								45.00	90.00	135.00					45.00	90.00	135.00					45.00	135.00	135.00																45.00				45.00			1.50	1.50	1.50			1.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8552	030	0	1	04	01	H8552_030_0	8		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	285.00	285.00																100.00				100.00			3.33	3.17	3.17			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8552	030	0	1	04	01	H8552_030_0	8		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												25							25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8552	030	0	1	04	01	H8552_030_0	8		N	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								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												
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								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00				15.00				15.00			0.5	0.00		0.5	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, 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	
H8554	001	0	1	01	01	H8554_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								10.00	20.00	30.00					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												
H8554	001	0	1	01	01	H8554_001_0	7			Preferred Generic	4	01	1	2	1	3		111	01		111	1				30	60	100	1	2				30	60	100	30		31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	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		
H8554	001	0	1	01	01	H8554_001_0	7			Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					10.00	20.00	30.00											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												
H8554	001	0	1	01	01	H8554_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					47.00	94.00	141.00											47.00	94.00	94.00				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												
H8554	001	0	1	01	01	H8554_001_0	7			Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00				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	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												
H8554	004	0	1	01	01	H8554_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								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00				15.00				15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8554	004	0	1	01	01	H8554_004_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					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												
H8554	004	0	1	01	01	H8554_004_0	7			Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					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												
H8554	004	0	1	01	01	H8554_004_0	7			Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	300.00					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												
H8554	004	0	1	01	01	H8554_004_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												
H8578	001	0	1	01	01	H8578_001_0	3		Y	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					0.00	0.00	0.00							8.00																4.00				4.00			0.13	0.00				0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8578	001	0	1	01	01	H8578_001_0	3		Y	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					0.00	0.00	0.00							8.00																4.00				4.00			0.13	0.00				0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H8578	001	0	1	01	01	H8578_001_0	3		Y	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					5.00	10.00	15.00							20.00																10.00				10.00			0.33	0.17				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8578	001	0	1	01	01	H8578_001_0	3		Y	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					40.00	80.00	120.00							90.00																45.00				45.00			1.50	1.33				1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8578	001	0	1	01	01	H8578_001_0	3		Y	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					90.00	180.00	270.00							285.00																95.00				95.00			3.17	3.00				3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8578	001	0	1	01	01	H8578_001_0	3		Y	Specialty Tier	4	11	1	1	5	1		010	01			1				30											30		31												28							28																							28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8578	004	0	1	01	01	H8578_004_0	3		Y	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					0.00	0.00	0.00							8.00																4.00				4.00			0.13	0.00				0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8578	004	0	1	01	01	H8578_004_0	3		Y	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					5.00	10.00	15.00							20.00																10.00				10.00			0.33	0.17				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8578	004	0	1	01	01	H8578_004_0	3		Y	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					40.00	80.00	120.00							90.00																45.00				45.00			1.50	1.33				1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8578	004	0	1	01	01	H8578_004_0	3		Y	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					90.00	180.00	270.00							285.00																95.00				95.00			3.17	3.00				3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8578	004	0	1	01	01	H8578_004_0	3		Y	Specialty Tier	4	11	1	1	5	1		010	01			1				30											30		31											1.00	28						1.00	28																							28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8578	012	0	1	01	01	H8578_012_0	3		Y	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					0.00	0.00	0.00							8.00																4.00				4.00			0.13	0.00				0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8578	012	0	1	01	01	H8578_012_0	3		Y	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					5.00	10.00	15.00							20.00																10.00				10.00			0.33	0.17				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8578	012	0	1	01	01	H8578_012_0	3		Y	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					40.00	80.00	120.00							90.00																45.00				45.00			1.50	1.33				1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8578	012	0	1	01	01	H8578_012_0	3		Y	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					90.00	180.00	270.00							285.00																95.00				95.00			3.17	3.00				3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8578	012	0	1	01	01	H8578_012_0	3		Y	Specialty Tier	4	11	1	1	5	1		010	01			1				30											30		31											1.00	26						1.00	26																							26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8578	017	0	1	01	01	H8578_017_0	3		Y	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					0.00	0.00	0.00							8.00																4.00				4.00			0.13	0.00				0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8578	017	0	1	01	01	H8578_017_0	3		Y	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					5.00	10.00	15.00							20.00																10.00				10.00			0.33	0.17				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8578	017	0	1	01	01	H8578_017_0	3		Y	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					40.00	80.00	120.00							90.00																45.00				45.00			1.50	1.33				1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8578	017	0	1	01	01	H8578_017_0	3		Y	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					90.00	180.00	270.00							285.00																95.00				95.00			3.17	3.00				3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8578	017	0	1	01	01	H8578_017_0	3		Y	Specialty Tier	4	11	1	1	5	1		010	01			1				30											30		31											1.00	26						1.00	26																							26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8578	018	0	1	01	01	H8578_018_0	3		Y	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					0.00	0.00	0.00							8.00																4.00				4.00			0.13	0.00				0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8578	018	0	1	01	01	H8578_018_0	3		Y	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					5.00	10.00	15.00							20.00																10.00				10.00			0.33	0.17				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8578	018	0	1	01	01	H8578_018_0	3		Y	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					40.00	80.00	120.00							90.00																45.00				45.00			1.50	1.33				1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8578	018	0	1	01	01	H8578_018_0	3		Y	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					90.00	180.00	270.00							285.00																95.00				95.00			3.17	3.00				3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8578	018	0	1	01	01	H8578_018_0	3		Y	Specialty Tier	4	11	1	1	5	1		010	01			1				30											30		31											1.00	26						1.00	26																							26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8604	010	0	1	04	01	H8604_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								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	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												
H8604	010	0	1	04	01	H8604_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								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	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												
H8604	010	0	1	04	01	H8604_010_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												
H8604	011	0	1	04	01	H8604_011_0	6			Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								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	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												
H8604	011	0	1	04	01	H8604_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				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	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												
H8604	011	0	1	04	01	H8604_011_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												
H8604	013	0	1	04	01	H8604_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												
H8604	013	0	1	04	01	H8604_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												
H8604	013	0	1	04	01	H8604_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												
H8604	013	0	1	04	01	H8604_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												
H8604	013	0	1	04	01	H8604_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												
H8634	002	0	1	04	01	H8634_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					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												
H8634	002	0	1	04	01	H8634_002_0	7			Preferred Generic	4	01	1	2	1	3		111	01		111	1				30	60	100	1	2				30	60	100	30		31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	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		
H8634	002	0	1	04	01	H8634_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											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												
H8634	002	0	1	04	01	H8634_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	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												
H8634	002	0	1	04	01	H8634_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	200.00	300.00				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	7			Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												29							29												29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8634	003	0	1	04	01	H8634_003_0	6			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											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												
H8634	003	0	1	04	01	H8634_003_0	6			Preferred Generic	4	01	1	2	1	3		111	01		111	1				30	60	100	1	2				30	60	100	30		31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	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		
H8634	003	0	1	04	01	H8634_003_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											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												
H8634	003	0	1	04	01	H8634_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	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												
H8634	003	0	1	04	01	H8634_003_0	6			Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00				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	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												
H8634	004	0	1	04	01	H8634_004_0	6			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											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												
H8634	004	0	1	04	01	H8634_004_0	6			Preferred Generic	4	01	1	2	1	3		111	01		111	1				30	60	100	1	2				30	60	100	30		31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	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		
H8634	004	0	1	04	01	H8634_004_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											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												
H8634	004	0	1	04	01	H8634_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	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												
H8634	004	0	1	04	01	H8634_004_0	6			Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00				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	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												
H8634	007	0	1	04	01	H8634_007_0	6			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											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												
H8634	007	0	1	04	01	H8634_007_0	6			Preferred Generic	4	01	1	2	1	3		111	01		111	1				30	60	100	1	2				30	60	100	30		31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	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		
H8634	007	0	1	04	01	H8634_007_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											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												
H8634	007	0	1	04	01	H8634_007_0	6			Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	94.00				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												
H8634	007	0	1	04	01	H8634_007_0	6			Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00				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	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												
H8634	008	0	1	04	01	H8634_008_0	6			Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	100	1	2				30	60	100	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												
H8634	008	0	1	04	01	H8634_008_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					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												
H8634	008	0	1	04	01	H8634_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								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												
H8634	008	0	1	04	01	H8634_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								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				85.00			3.33	2.83		3.33	2.83	2.74	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8634	008	0	1	04	01	H8634_008_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												
H8634	010	0	1	04	01	H8634_010_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					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												
H8634	010	0	1	04	01	H8634_010_0	7			Preferred Generic	4	01	1	2	1	3		111	01		111	1				30	60	100	1	2				30	60	100	30		31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	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		
H8634	010	0	1	04	01	H8634_010_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											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												
H8634	010	0	1	04	01	H8634_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	94.00				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												
H8634	010	0	1	04	01	H8634_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	300.00				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	7			Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												29							29												29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8634	011	0	1	04	01	H8634_011_0	6			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											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												
H8634	011	0	1	04	01	H8634_011_0	6			Preferred Generic	4	01	1	2	1	3		111	01		111	1				30	60	100	1	2				30	60	100	30		31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	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		
H8634	011	0	1	04	01	H8634_011_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											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												
H8634	011	0	1	04	01	H8634_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	94.00				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												
H8634	011	0	1	04	01	H8634_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				100.00	200.00	300.00				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	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												
H8634	012	0	1	04	01	H8634_012_0	6			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											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												
H8634	012	0	1	04	01	H8634_012_0	6			Preferred Generic	4	01	1	2	1	3		111	01		111	1				30	60	100	1	2				30	60	100	30		31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	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		
H8634	012	0	1	04	01	H8634_012_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											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												
H8634	012	0	1	04	01	H8634_012_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	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												
H8634	012	0	1	04	01	H8634_012_0	6			Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00				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	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												
H8634	013	0	1	04	01	H8634_013_0	6			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											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												
H8634	013	0	1	04	01	H8634_013_0	6			Preferred Generic	4	01	1	2	1	3		111	01		111	1				30	60	100	1	2				30	60	100	30		31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	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		
H8634	013	0	1	04	01	H8634_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					10.00	20.00	30.00											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												
H8634	013	0	1	04	01	H8634_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	94.00				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												
H8634	013	0	1	04	01	H8634_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	300.00				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	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												
H8634	014	0	1	04	01	H8634_014_0	5			Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	100	1	2				30	60	100	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												
H8634	014	0	1	04	01	H8634_014_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												
H8634	014	0	1	04	01	H8634_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					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												
H8634	014	0	1	04	01	H8634_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					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												
H8634	014	0	1	04	01	H8634_014_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												
H8634	015	0	1	04	01	H8634_015_0	6			Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	100	1	2				30	60	100	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												
H8634	015	0	1	04	01	H8634_015_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					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												
H8634	015	0	1	04	01	H8634_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								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												
H8634	015	0	1	04	01	H8634_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	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												
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	6			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											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												
H8634	016	0	1	04	01	H8634_016_0	6			Preferred Generic	4	01	1	2	1	3		111	01		111	1				30	60	100	1	2				30	60	100	30		31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	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		
H8634	016	0	1	04	01	H8634_016_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											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												
H8634	016	0	1	04	01	H8634_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	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												
H8634	016	0	1	04	01	H8634_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	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												
H8634	016	0	1	04	01	H8634_016_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												
H8634	017	0	1	04	01	H8634_017_0	6			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											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												
H8634	017	0	1	04	01	H8634_017_0	6			Preferred Generic	4	01	1	2	1	3		111	01		111	1				30	60	100	1	2				30	60	100	30		31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	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		
H8634	017	0	1	04	01	H8634_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											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												
H8634	017	0	1	04	01	H8634_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	94.00				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												
H8634	017	0	1	04	01	H8634_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					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												
H8634	017	0	1	04	01	H8634_017_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												
H8634	018	0	1	04	01	H8634_018_0	6			Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	100	1	2				30	60	100	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												
H8634	018	0	1	04	01	H8634_018_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					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												
H8634	018	0	1	04	01	H8634_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					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												
H8634	018	0	1	04	01	H8634_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					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												
H8634	018	0	1	04	01	H8634_018_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	020	0	1	04	01	H8634_020_0	6			Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	100	1	2				30	60	100	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												
H8634	020	0	1	04	01	H8634_020_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					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												
H8634	020	0	1	04	01	H8634_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					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												
H8634	020	0	1	04	01	H8634_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					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												
H8634	020	0	1	04	01	H8634_020_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	021	0	1	04	01	H8634_021_0	6			Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	100	1	2				30	60	100	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												
H8634	021	0	1	04	01	H8634_021_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					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												
H8634	021	0	1	04	01	H8634_021_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					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												
H8634	021	0	1	04	01	H8634_021_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					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												
H8634	021	0	1	04	01	H8634_021_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												
H8649	003	0	1	02	01	H8649_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								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					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	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		
H8649	003	0	1	02	01	H8649_003_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					10.00	20.00	20.00											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												
H8649	003	0	1	02	01	H8649_003_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					10.00	20.00	20.00											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										1		
H8649	003	0	1	02	01	H8649_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												
H8649	003	0	1	02	01	H8649_003_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												
H8649	003	0	1	02	01	H8649_003_0	5			Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1055.81	33						912.59	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8649	008	0	1	02	01	H8649_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												
H8649	008	0	1	02	01	H8649_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		
H8649	008	0	1	02	01	H8649_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	20.00											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												
H8649	008	0	1	02	01	H8649_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	20.00											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										1		
H8649	008	0	1	02	01	H8649_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												
H8649	008	0	1	02	01	H8649_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												
H8649	008	0	1	02	01	H8649_008_0	2			Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											749.15	33						801.29	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8711	004	0	1	04	01	H8711_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												
H8711	004	0	1	04	01	H8711_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												
H8711	004	0	1	04	01	H8711_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												
H8711	004	0	1	04	01	H8711_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	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, Select Care Drugs												
H8711	004	0	1	04	01	H8711_004_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												
H8711	004	0	1	04	01	H8711_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												
H8748	002	0	1	02	01	H8748_002_0	2		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8748	002	0	1	02	01	H8748_002_0	2		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H8748	002	0	1	02	01	H8748_002_0	2		Y	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												
H8748	002	0	1	02	01	H8748_002_0	2		Y	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
H8748	002	0	1	02	01	H8748_002_0	2		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8748	002	0	1	02	01	H8748_002_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8748	002	0	1	02	01	H8748_002_0	2		Y	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												
H8748	008	0	1	02	01	H8748_008_0	2		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8748	008	0	1	02	01	H8748_008_0	2		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H8748	008	0	1	02	01	H8748_008_0	2		Y	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												
H8748	008	0	1	02	01	H8748_008_0	2		Y	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
H8748	008	0	1	02	01	H8748_008_0	2		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8748	008	0	1	02	01	H8748_008_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8748	008	0	1	02	01	H8748_008_0	2		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				465.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8748	009	0	1	02	01	H8748_009_0	2		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8748	009	0	1	02	01	H8748_009_0	2		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H8748	009	0	1	02	01	H8748_009_0	2		Y	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												
H8748	009	0	1	02	01	H8748_009_0	2		Y	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
H8748	009	0	1	02	01	H8748_009_0	2		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8748	009	0	1	02	01	H8748_009_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8748	009	0	1	02	01	H8748_009_0	2		Y	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												
H8748	025	0	1	02	01	H8748_025_0	2		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8748	025	0	1	02	01	H8748_025_0	2		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H8748	025	0	1	02	01	H8748_025_0	2		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	8.00		16.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8748	025	0	1	02	01	H8748_025_0	2		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	8.00		16.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H8748	025	0	1	02	01	H8748_025_0	2		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8748	025	0	1	02	01	H8748_025_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8748	025	0	1	02	01	H8748_025_0	2		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				544.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8748	026	0	1	02	01	H8748_026_0	2		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8748	026	0	1	02	01	H8748_026_0	2		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H8748	026	0	1	02	01	H8748_026_0	2		Y	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												
H8748	026	0	1	02	01	H8748_026_0	2		Y	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
H8748	026	0	1	02	01	H8748_026_0	2		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8748	026	0	1	02	01	H8748_026_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8748	026	0	1	02	01	H8748_026_0	2		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				492.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
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		8.00																					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		8.00																					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		16.00																					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		16.00																					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		90.00																					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		190.00																					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		22.00																					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	8			Preferred Generic	4	01	1	2	1	1	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs												
H8764	002	0	1	02	01	H8764_002_0	8			Preferred Generic	4	01	1	2	1	3	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs										1		
H8764	002	0	1	02	01	H8764_002_0	8			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 Diabetic Drugs												
H8764	002	0	1	02	01	H8764_002_0	8			Generic	4	01	1	2	2	3	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 Diabetic Drugs										1		
H8764	002	0	1	02	01	H8764_002_0	8			Preferred Brand	4	10	1	2	3	1	110		01	100		1	30		90				1	2			90				30		31	42.00		84.00																					84.00																42.00				42.00		1.40						1.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs												
H8764	002	0	1	02	01	H8764_002_0	8			Non-Preferred Drug	4	11	1	2	4	1	110		01	100		1	30		90				1	2			90				30		31	90.00		180.00																					180.00																90.00				90.00		3.00						2.90	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs												
H8764	002	0	1	02	01	H8764_002_0	8			Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31					33																																					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs												
H8764	002	0	1	02	01	H8764_002_0	8			Select Diabetic Drugs	4	11	1	2	6	1	110		01	100		1	30		90				1	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 Drug, Specialty Tier, Select Diabetic Drugs												
H8764	003	0	1	01	01	H8764_003_0	9			Preferred Generic	4	01	1	2	1	1	110		01	100		1	30		90				1	2			90				30		31	9.00		18.00																					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	9			Generic	4	01	1	2	2	1	110		01	100		1	30		90				1	2			90				30		31	18.00		36.00																					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	9			Preferred Brand	4	10	1	2	3	1	110		01	100		1	30		90				1	2			90				30		31	47.00		94.00																					94.00																47.00				47.00		1.57						1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs												
H8764	003	0	1	01	01	H8764_003_0	9			Non-Preferred Drug	4	11	1	2	4	1	110		01	100		1	30		90				1	2			90				30		31	100.00		200.00																					200.00																100.00				100.00		3.33						3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs												
H8764	003	0	1	01	01	H8764_003_0	9			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	9			Select Diabetic Drugs	4	11	1	2	6	1	110		01	100		1	30		90				1	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 Drug, Specialty Tier, Select Diabetic Drugs												
H8768	003	0	1	04	01	H8768_003_0	2		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8768	003	0	1	04	01	H8768_003_0	2		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H8768	003	0	1	04	01	H8768_003_0	2		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	8.00		24.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8768	003	0	1	04	01	H8768_003_0	2		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	8.00		24.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H8768	003	0	1	04	01	H8768_003_0	2		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8768	003	0	1	04	01	H8768_003_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8768	003	0	1	04	01	H8768_003_0	2		Y	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												
H8768	005	0	1	04	01	H8768_005_0	2		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8768	005	0	1	04	01	H8768_005_0	2		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H8768	005	0	1	04	01	H8768_005_0	2		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	8.00		24.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8768	005	0	1	04	01	H8768_005_0	2		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	8.00		24.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H8768	005	0	1	04	01	H8768_005_0	2		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8768	005	0	1	04	01	H8768_005_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8768	005	0	1	04	01	H8768_005_0	2		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				419.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8768	007	0	1	04	01	H8768_007_0	2		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8768	007	0	1	04	01	H8768_007_0	2		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H8768	007	0	1	04	01	H8768_007_0	2		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	8.00		24.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8768	007	0	1	04	01	H8768_007_0	2		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	8.00		24.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H8768	007	0	1	04	01	H8768_007_0	2		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8768	007	0	1	04	01	H8768_007_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8768	007	0	1	04	01	H8768_007_0	2		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				465.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8768	008	0	1	04	01	H8768_008_0	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8768	008	0	1	04	01	H8768_008_0	3		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H8768	008	0	1	04	01	H8768_008_0	3		Y	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												
H8768	008	0	1	04	01	H8768_008_0	3		Y	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
H8768	008	0	1	04	01	H8768_008_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8768	008	0	1	04	01	H8768_008_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		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	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				398.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8768	009	0	1	04	01	H8768_009_0	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8768	009	0	1	04	01	H8768_009_0	3		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H8768	009	0	1	04	01	H8768_009_0	3		Y	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	009	0	1	04	01	H8768_009_0	3		Y	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	009	0	1	04	01	H8768_009_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8768	009	0	1	04	01	H8768_009_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		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	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				451.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8768	010	0	1	04	01	H8768_010_0	2		Y	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		100	2	2						100	30		31								10.00		30.00					0.00		0.00													30.00						0.00				10.00				10.00			0.33	0.00				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8768	010	0	1	04	01	H8768_010_0	2		Y	Preferred Generic	4	01	1	2	1	3		110	01		100	1				30		100	2	2						100	30		31								10.00		30.00					0.00		0.00													30.00						0.00				10.00				10.00			0.33	0.00				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H8768	010	0	1	04	01	H8768_010_0	2		Y	Generic	4	01	3	2	2	1		110	01		100	1				30		100	2	2						100	30		31								20.00		60.00					0.00		0.00													60.00						0.00				20.00				20.00			0.66	0.00				0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8768	010	0	1	04	01	H8768_010_0	2		Y	Generic	4	01	3	2	2	3		110	01		100	1				30		100	2	2						100	30		31								20.00		60.00					0.00		0.00													60.00						0.00				20.00				20.00			0.66	0.00				0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H8768	010	0	1	04	01	H8768_010_0	2		Y	Preferred Brand	4	11	1	2	3	1		110	01		100	1				30		100	2	2						100	30		31								47.00		141.00					47.00		131.00													141.00						131.00				47.00				47.00			1.56	1.56				1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8768	010	0	1	04	01	H8768_010_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1		110	01		100	1				30		100	2	2						100	30		31								100.00		300.00					100.00		290.00													300.00						290.00				100.00				100.00			3.33	3.33				3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8768	010	0	1	04	01	H8768_010_0	2		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											321.00	30						329.00	30												30						30					30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8768	011	0	1	04	01	H8768_011_0	2		Y	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		100	2	2						100	30		31								10.00		30.00					0.00		0.00													30.00						0.00				10.00				10.00			0.33	0.00				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8768	011	0	1	04	01	H8768_011_0	2		Y	Preferred Generic	4	01	1	2	1	3		110	01		100	1				30		100	2	2						100	30		31								10.00		30.00					0.00		0.00													30.00						0.00				10.00				10.00			0.33	0.00				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H8768	011	0	1	04	01	H8768_011_0	2		Y	Generic	4	01	3	2	2	1		110	01		100	1				30		100	2	2						100	30		31								20.00		60.00					0.00		0.00													60.00						0.00				20.00				20.00			0.66	0.00				0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8768	011	0	1	04	01	H8768_011_0	2		Y	Generic	4	01	3	2	2	3		110	01		100	1				30		100	2	2						100	30		31								20.00		60.00					0.00		0.00													60.00						0.00				20.00				20.00			0.66	0.00				0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H8768	011	0	1	04	01	H8768_011_0	2		Y	Preferred Brand	4	11	1	2	3	1		110	01		100	1				30		100	2	2						100	30		31								47.00		141.00					47.00		131.00													141.00						131.00				47.00				47.00			1.56	1.56				1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8768	011	0	1	04	01	H8768_011_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1		110	01		100	1				30		100	2	2						100	30		31								100.00		300.00					100.00		290.00													300.00						290.00				100.00				100.00			3.33	3.33				3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8768	011	0	1	04	01	H8768_011_0	2		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											461.00	33						291.00	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8768	013	0	1	04	01	H8768_013_0	2		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8768	013	0	1	04	01	H8768_013_0	2		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H8768	013	0	1	04	01	H8768_013_0	2		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8768	013	0	1	04	01	H8768_013_0	2		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H8768	013	0	1	04	01	H8768_013_0	2		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8768	013	0	1	04	01	H8768_013_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8768	013	0	1	04	01	H8768_013_0	2		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				500.00	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		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8768	014	0	1	04	01	H8768_014_0	3		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H8768	014	0	1	04	01	H8768_014_0	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8768	014	0	1	04	01	H8768_014_0	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H8768	014	0	1	04	01	H8768_014_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8768	014	0	1	04	01	H8768_014_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		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	014	0	1	04	01	H8768_014_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				608.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8768	015	0	1	04	01	H8768_015_0	2		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8768	015	0	1	04	01	H8768_015_0	2		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H8768	015	0	1	04	01	H8768_015_0	2		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8768	015	0	1	04	01	H8768_015_0	2		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H8768	015	0	1	04	01	H8768_015_0	2		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8768	015	0	1	04	01	H8768_015_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8768	015	0	1	04	01	H8768_015_0	2		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				415.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8768	016	0	1	04	01	H8768_016_0	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8768	016	0	1	04	01	H8768_016_0	3		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H8768	016	0	1	04	01	H8768_016_0	3		Y	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												
H8768	016	0	1	04	01	H8768_016_0	3		Y	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
H8768	016	0	1	04	01	H8768_016_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8768	016	0	1	04	01	H8768_016_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		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	3		Y	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												
H8768	017	1	1	04	01	H8768_017_1	4		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8768	017	1	1	04	01	H8768_017_1	4		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H8768	017	1	1	04	01	H8768_017_1	4		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8768	017	1	1	04	01	H8768_017_1	4		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H8768	017	1	1	04	01	H8768_017_1	4		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8768	017	1	1	04	01	H8768_017_1	4		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8768	017	1	1	04	01	H8768_017_1	4		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				400.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8768	017	2	1	04	01	H8768_017_2	4		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8768	017	2	1	04	01	H8768_017_2	4		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H8768	017	2	1	04	01	H8768_017_2	4		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8768	017	2	1	04	01	H8768_017_2	4		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H8768	017	2	1	04	01	H8768_017_2	4		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8768	017	2	1	04	01	H8768_017_2	4		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8768	017	2	1	04	01	H8768_017_2	4		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				400.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8768	022	0	1	04	01	H8768_022_0	2		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8768	022	0	1	04	01	H8768_022_0	2		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H8768	022	0	1	04	01	H8768_022_0	2		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8768	022	0	1	04	01	H8768_022_0	2		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H8768	022	0	1	04	01	H8768_022_0	2		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8768	022	0	1	04	01	H8768_022_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8768	022	0	1	04	01	H8768_022_0	2		Y	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												
H8768	023	0	1	04	01	H8768_023_0	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8768	023	0	1	04	01	H8768_023_0	3		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H8768	023	0	1	04	01	H8768_023_0	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	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												
H8768	023	0	1	04	01	H8768_023_0	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	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
H8768	023	0	1	04	01	H8768_023_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8768	023	0	1	04	01	H8768_023_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		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		Y	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												
H8768	024	0	1	04	01	H8768_024_0	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8768	024	0	1	04	01	H8768_024_0	3		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H8768	024	0	1	04	01	H8768_024_0	3		Y	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		Y	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		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8768	024	0	1	04	01	H8768_024_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		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		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				349.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8768	026	0	1	04	01	H8768_026_0	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8768	026	0	1	04	01	H8768_026_0	3		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H8768	026	0	1	04	01	H8768_026_0	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8768	026	0	1	04	01	H8768_026_0	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H8768	026	0	1	04	01	H8768_026_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8768	026	0	1	04	01	H8768_026_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		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		Y	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												
H8768	027	0	1	04	01	H8768_027_0	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8768	027	0	1	04	01	H8768_027_0	3		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H8768	027	0	1	04	01	H8768_027_0	3		Y	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		Y	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		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8768	027	0	1	04	01	H8768_027_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		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		Y	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	4		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8768	030	0	1	04	01	H8768_030_0	4		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H8768	030	0	1	04	01	H8768_030_0	4		Y	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	030	0	1	04	01	H8768_030_0	4		Y	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	030	0	1	04	01	H8768_030_0	4		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8768	030	0	1	04	01	H8768_030_0	4		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8768	030	0	1	04	01	H8768_030_0	4		Y	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												
H8768	032	0	1	04	01	H8768_032_0	4		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8768	032	0	1	04	01	H8768_032_0	4		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H8768	032	0	1	04	01	H8768_032_0	4		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8768	032	0	1	04	01	H8768_032_0	4		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H8768	032	0	1	04	01	H8768_032_0	4		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8768	032	0	1	04	01	H8768_032_0	4		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8768	032	0	1	04	01	H8768_032_0	4		Y	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												
H8768	033	0	1	04	01	H8768_033_0	2		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8768	033	0	1	04	01	H8768_033_0	2		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H8768	033	0	1	04	01	H8768_033_0	2		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8768	033	0	1	04	01	H8768_033_0	2		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H8768	033	0	1	04	01	H8768_033_0	2		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8768	033	0	1	04	01	H8768_033_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8768	033	0	1	04	01	H8768_033_0	2		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				460.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8768	034	0	1	04	01	H8768_034_0	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8768	034	0	1	04	01	H8768_034_0	3		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H8768	034	0	1	04	01	H8768_034_0	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8768	034	0	1	04	01	H8768_034_0	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H8768	034	0	1	04	01	H8768_034_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8768	034	0	1	04	01	H8768_034_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8768	034	0	1	04	01	H8768_034_0	3		Y	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	035	0	1	04	01	H8768_035_0	2		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8768	035	0	1	04	01	H8768_035_0	2		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H8768	035	0	1	04	01	H8768_035_0	2		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8768	035	0	1	04	01	H8768_035_0	2		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H8768	035	0	1	04	01	H8768_035_0	2		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8768	035	0	1	04	01	H8768_035_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8768	035	0	1	04	01	H8768_035_0	2		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				305.00	28																										28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8783	001	0	1	04	01	H8783_001_0	9		Y	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	9		Y	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	9		Y	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		29	31								47.00	94.00	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	9		Y	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		29	31											47.29	50	50	50				47.29	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	9		Y	Specialty Tier	4	11	1	1	5	1		111	10		111	1				30	60	90	1	2				30	60	90		29	31											2319.46	27	27	27				2319.46	27	27	27										27	27	27				27	27	27				27		27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8783	002	0	1	04	01	H8783_002_0	12		Y	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												
H8783	002	0	1	04	01	H8783_002_0	12		Y	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	20.00											20.00	40.00	60.00				10.00	20.00	30.00					20.00			20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8783	002	0	1	04	01	H8783_002_0	12		Y	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		29	31								47.00	94.00	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	002	0	1	04	01	H8783_002_0	12		Y	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		29	31											81.26	50	50	50				81.26	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	12		Y	Specialty Tier	4	11	1	1	5	1		111	10		111	1				30	60	90	1	2				30	60	90		29	31											3039.84	33	33	33				3039.84	33	33	33										33	33	33				33	33	33				33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8783	003	0	1	04	01	H8783_003_0	10		Y	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	10		Y	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	10		Y	Preferred Brand	4	11	1	1	3	1		111	10		111	1				30	60	90	1	2				30	60	90		29	31											77.40	25	25	25				52.63	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	10		Y	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		29	31											84.05	50	50	50				84.05	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	10		Y	Specialty Tier	4	11	1	1	5	1		111	10		111	1				30	60	90	1	2				30	60	90		29	31											2099.38	25	25	25				2099.38	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	10.35			0.00	10.35	0.00	10.35			
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	4		Y	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	4		Y	Generic	4	01	1	2	2	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	15.00	30.00	45.00																			15.00	30.00	45.00																	15.00			15.00		0.50			0.50			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8797	002	0	1	01	01	H8797_002_0	4		Y	Preferred Brand	4	10	1	2	3	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	45.00	90.00	135.00																			45.00	90.00	135.00																	45.00			45.00		1.50			1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8797	002	0	1	01	01	H8797_002_0	4		Y	Non-Preferred Brand	4	10	1	2	4	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	95.00	190.00	285.00																			95.00	190.00	285.00																	95.00			95.00		3.17			3.17			3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8797	002	0	1	01	01	H8797_002_0	4		Y	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												
H8797	003	0	1	01	01	H8797_003_0	4		N	Preferred Generic	4	01	1	2	1	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	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	003	0	1	01	01	H8797_003_0	4		N	Generic	4	01	1	2	2	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	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	003	0	1	01	01	H8797_003_0	4		N	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	003	0	1	01	01	H8797_003_0	4		N	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	003	0	1	01	01	H8797_003_0	4		N	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												
H8845	002	0	1	01	01	H8845_002_0	7		Y	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												
H8845	002	0	1	01	01	H8845_002_0	7		Y	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												
H8845	002	0	1	01	01	H8845_002_0	7		Y	Preferred Brand	4	11	1	2	3	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31	47.00	94.00	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												
H8845	002	0	1	01	01	H8845_002_0	7		Y	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												
H8845	002	0	1	01	01	H8845_002_0	7		Y	Specialty Tier	4	11	1	1	5	1	010		01	010		1	31								31						31		31				818.29	31																				31																	31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8845	002	0	1	01	01	H8845_002_0	7		Y	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												
H8845	003	0	1	01	01	H8845_003_0	7		Y	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												
H8845	003	0	1	01	01	H8845_003_0	7		Y	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												
H8845	003	0	1	01	01	H8845_003_0	7		Y	Preferred Brand	4	11	1	2	3	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31	47.00	94.00	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												
H8845	003	0	1	01	01	H8845_003_0	7		Y	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												
H8845	003	0	1	01	01	H8845_003_0	7		Y	Specialty Tier	4	11	1	1	5	1	010		01	010		1	31								31						31		31				732.63	27																				27																	27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8845	003	0	1	01	01	H8845_003_0	7		Y	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												
H8849	001	0	1	01	01	H8849_001_0	5		Y	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								5.00	10.00	15.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.15	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8849	001	0	1	01	01	H8849_001_0	5		Y	Preferred Generic	4	01	1	2	1	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								5.00	10.00	15.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.15	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H8849	001	0	1	01	01	H8849_001_0	5		Y	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	5		Y	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	5		Y	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	5		Y	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	5		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								95.00	190.00	285.00					85.00	170.00	255.00					85.00	170.00	170.00																95.00				95.00			3.17	2.83	2.83			2.79	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8849	001	0	1	01	01	H8849_001_0	5		Y	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8849	001	0	1	01	01	H8849_001_0	5		Y	Select Care Drugs	4	11	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8849	001	0	1	01	01	H8849_001_0	5		Y	Select Care Drugs	4	11	1	2	6	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	3	
H8849	002	0	1	01	01	H8849_002_0	5		N	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		34	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8849	002	0	1	01	01	H8849_002_0	5		N	Preferred Generic	4	01	1	2	1	3	111		01	111		1	30	60	90				1	2	30	60	90				30		34	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H8849	002	0	1	01	01	H8849_002_0	5		N	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				2	2	30	60	90				30		34	7.50	15.00	22.50																			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	5		N	Generic	4	01	1	2	2	3	111		01	111		1	30	60	90				2	2	30	60	90				30		34	7.50	15.00	22.50																			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	5		N	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				2	2	30	60	90				30		34	40.00	80.00	120.00																			40.00	80.00	80.00																40.00				40.00		1.33			1.33			1.18	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8849	002	0	1	01	01	H8849_002_0	5		N	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	90				2	2	30	60	90				30		34	85.00	170.00	255.00																			85.00	170.00	170.00																85.00				85.00		2.83			2.83			2.50	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8849	002	0	1	01	01	H8849_002_0	5		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		34					33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8849	002	0	1	01	01	H8849_002_0	5		N	Select Care Drugs	4	11	1	2	6	1	111		01	111		1	30	60	100				1	2	30	60	100				30		34	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8849	002	0	1	01	01	H8849_002_0	5		N	Select Care Drugs	4	11	1	2	6	3	111		01	111		1	30	60	100				1	2	30	60	100				30		34	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	3	
H8849	003	0	1	01	01	H8849_003_0	5		Y	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								5.00	10.00	15.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.15	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8849	003	0	1	01	01	H8849_003_0	5		Y	Preferred Generic	4	01	1	2	1	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								5.00	10.00	15.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.15	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H8849	003	0	1	01	01	H8849_003_0	5		Y	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	5		Y	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	5		Y	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	5		Y	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	5		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								95.00	190.00	285.00					85.00	170.00	255.00					85.00	170.00	170.00																95.00				95.00			3.17	2.83	2.83			2.79	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8849	003	0	1	01	01	H8849_003_0	5		Y	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8849	003	0	1	01	01	H8849_003_0	5		Y	Select Care Drugs	4	11	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8849	003	0	1	01	01	H8849_003_0	5		Y	Select Care Drugs	4	11	1	2	6	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H8849	004	0	1	01	01	H8849_004_0	5		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								5.00	10.00	15.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.15	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8849	004	0	1	01	01	H8849_004_0	5		N	Preferred Generic	4	01	1	2	1	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								5.00	10.00	15.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.15	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H8849	004	0	1	01	01	H8849_004_0	5		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								12.50	25.00	37.50					7.50	15.00	22.50					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	5		N	Generic	4	01	1	2	2	3		111	01	111		1				30	60	90	2	2	30	60	90				30		34								12.50	25.00	37.50					7.50	15.00	22.50					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	5		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								45.00	90.00	135.00					40.00	80.00	120.00					40.00	80.00	80.00																45.00				45.00			1.50	1.33	1.33			1.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8849	004	0	1	01	01	H8849_004_0	5		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								95.00	190.00	285.00					85.00	170.00	255.00					85.00	170.00	170.00																95.00				95.00			3.17	2.83	2.83			2.79	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8849	004	0	1	01	01	H8849_004_0	5		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8849	004	0	1	01	01	H8849_004_0	5		N	Select Care Drugs	4	11	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8849	004	0	1	01	01	H8849_004_0	5		N	Select Care Drugs	4	11	1	2	6	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H8849	005	0	1	01	01	H8849_005_0	5		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								5.00	10.00	15.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.15	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8849	005	0	1	01	01	H8849_005_0	5		N	Preferred Generic	4	01	1	2	1	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								5.00	10.00	15.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.15	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H8849	005	0	1	01	01	H8849_005_0	5		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								12.50	25.00	37.50					7.50	15.00	22.50					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	5		N	Generic	4	01	1	2	2	3		111	01	111		1				30	60	90	2	2	30	60	90				30		34								12.50	25.00	37.50					7.50	15.00	22.50					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	5		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								45.00	90.00	135.00					40.00	80.00	120.00					40.00	80.00	80.00																45.00				45.00			1.50	1.33	1.33			1.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8849	005	0	1	01	01	H8849_005_0	5		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								95.00	190.00	285.00					85.00	170.00	255.00					85.00	170.00	170.00																95.00				95.00			3.17	2.83	2.83			2.79	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8849	005	0	1	01	01	H8849_005_0	5		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8849	005	0	1	01	01	H8849_005_0	5		N	Select Care Drugs	4	11	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8849	005	0	1	01	01	H8849_005_0	5		N	Select Care Drugs	4	11	1	2	6	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H8849	006	0	1	01	01	H8849_006_0	5		N	Preferred Generic	4	01	3	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								8.00	16.00	24.00					3.00	6.00	9.00					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	5		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								15.00	30.00	45.00					10.00	20.00	30.00					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	5		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00	84.00	84.00																47.00				47.00			1.57	1.40	1.40			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8849	006	0	1	01	01	H8849_006_0	5		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	190.00	190.00																100.00				100.00			3.33	3.17	3.17			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8849	006	0	1	01	01	H8849_006_0	5		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8849	006	0	1	01	01	H8849_006_0	5		N	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8849	006	0	1	01	01	H8849_006_0	5		N	Select Care Drugs	4	01	1	2	6	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H8849	008	1	1	01	01	H8849_008_1	6		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								10.00	20.00	30.00					5.00	10.00	15.00					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	6		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								17.00	34.00	51.00					12.00	24.00	36.00					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	6		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00	126.00	126.00																47.00				47.00			1.57	1.40	1.40			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8849	008	1	1	01	01	H8849_008_1	6		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	285.00	285.00																100.00				100.00			3.33	3.17	3.17			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8849	008	1	1	01	01	H8849_008_1	6		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8849	008	1	1	01	01	H8849_008_1	6		N	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8849	008	1	1	01	01	H8849_008_1	6		N	Select Care Drugs	4	01	1	2	6	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H8849	008	2	1	01	01	H8849_008_2	6		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								10.00	20.00	30.00					5.00	10.00	15.00					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	6		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								17.00	34.00	51.00					12.00	24.00	36.00					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	6		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00	126.00	126.00																47.00				47.00			1.57	1.40	1.40			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8849	008	2	1	01	01	H8849_008_2	6		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	285.00	285.00																100.00				100.00			3.33	3.17	3.17			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8849	008	2	1	01	01	H8849_008_2	6		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8849	008	2	1	01	01	H8849_008_2	6		N	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8849	008	2	1	01	01	H8849_008_2	6		N	Select Care Drugs	4	01	1	2	6	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H8849	008	3	1	01	01	H8849_008_3	6		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								10.00	20.00	30.00					5.00	10.00	15.00					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	6		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								17.00	34.00	51.00					12.00	24.00	36.00					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	6		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00	126.00	126.00																47.00				47.00			1.57	1.40	1.40			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8849	008	3	1	01	01	H8849_008_3	6		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	285.00	285.00																100.00				100.00			3.33	3.17	3.17			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8849	008	3	1	01	01	H8849_008_3	6		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8849	008	3	1	01	01	H8849_008_3	6		N	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8849	008	3	1	01	01	H8849_008_3	6		N	Select Care Drugs	4	01	1	2	6	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H8849	008	4	1	01	01	H8849_008_4	6		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								10.00	20.00	30.00					5.00	10.00	15.00					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	6		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								17.00	34.00	51.00					12.00	24.00	36.00					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	6		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00	126.00	126.00																47.00				47.00			1.57	1.40	1.40			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8849	008	4	1	01	01	H8849_008_4	6		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	285.00	285.00																100.00				100.00			3.33	3.17	3.17			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8849	008	4	1	01	01	H8849_008_4	6		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8849	008	4	1	01	01	H8849_008_4	6		N	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8849	008	4	1	01	01	H8849_008_4	6		N	Select Care Drugs	4	01	1	2	6	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H8849	008	5	1	01	01	H8849_008_5	7		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								10.00	20.00	30.00					5.00	10.00	15.00					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	7		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								17.00	34.00	51.00					12.00	24.00	36.00					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	7		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00	126.00	126.00																47.00				47.00			1.57	1.40	1.40			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8849	008	5	1	01	01	H8849_008_5	7		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	285.00	285.00																100.00				100.00			3.33	3.17	3.17			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8849	008	5	1	01	01	H8849_008_5	7		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8849	008	5	1	01	01	H8849_008_5	7		N	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8849	008	5	1	01	01	H8849_008_5	7		N	Select Care Drugs	4	01	1	2	6	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H8849	008	6	1	01	01	H8849_008_6	6		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								10.00	20.00	30.00					5.00	10.00	15.00					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	6		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								17.00	34.00	51.00					12.00	24.00	36.00					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	6		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00	126.00	126.00																47.00				47.00			1.57	1.40	1.40			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8849	008	6	1	01	01	H8849_008_6	6		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	285.00	285.00																100.00				100.00			3.33	3.17	3.17			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8849	008	6	1	01	01	H8849_008_6	6		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8849	008	6	1	01	01	H8849_008_6	6		N	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8849	008	6	1	01	01	H8849_008_6	6		N	Select Care Drugs	4	01	1	2	6	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H8849	009	0	1	01	01	H8849_009_0	6		N	Preferred Generic	4	01	3	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								8.00	16.00	24.00					3.00	6.00	9.00					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	6		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								15.00	30.00	45.00					10.00	20.00	30.00					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	6		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00	84.00	84.00																47.00				47.00			1.57	1.40	1.40			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8849	009	0	1	01	01	H8849_009_0	6		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	190.00	190.00																100.00				100.00			3.33	3.17	3.17			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8849	009	0	1	01	01	H8849_009_0	6		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8849	009	0	1	01	01	H8849_009_0	6		N	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8849	009	0	1	01	01	H8849_009_0	6		N	Select Care Drugs	4	01	1	2	6	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H8849	010	1	1	01	01	H8849_010_1	6		N	Preferred Generic	4	01	3	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								18.00	36.00	54.00					18.00	36.00	54.00					18.00	54.00	54.00																18.00				18.00			0.60	0.60	0.60			0.53	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8849	010	1	1	01	01	H8849_010_1	6		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								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		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								47.00	94.00	141.00					47.00	94.00	141.00					47.00	141.00	141.00																47.00				47.00			1.57	1.57	1.57			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8849	010	1	1	01	01	H8849_010_1	6		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	285.00	285.00																100.00				100.00			3.33	3.17	3.17			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8849	010	1	1	01	01	H8849_010_1	6		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												25							25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8849	010	1	1	01	01	H8849_010_1	6		N	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								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	5		N	Preferred Generic	4	01	3	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								18.00	36.00	54.00					18.00	36.00	54.00					18.00	54.00	54.00																18.00				18.00			0.60	0.60	0.60			0.53	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8849	010	2	1	01	01	H8849_010_2	5		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								20.00	40.00	60.00					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	5		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								47.00	94.00	141.00					47.00	94.00	141.00					47.00	141.00	141.00																47.00				47.00			1.57	1.57	1.57			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8849	010	2	1	01	01	H8849_010_2	5		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	285.00	285.00																100.00				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	5		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												25							25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8849	010	2	1	01	01	H8849_010_2	5		N	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								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	5		N	Preferred Generic	4	01	3	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								18.00	36.00	54.00					18.00	36.00	54.00					18.00	54.00	54.00																18.00				18.00			0.60	0.60	0.60			0.53	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8849	010	3	1	01	01	H8849_010_3	5		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								20.00	40.00	60.00					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	5		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								47.00	94.00	141.00					47.00	94.00	141.00					47.00	141.00	141.00																47.00				47.00			1.57	1.57	1.57			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8849	010	3	1	01	01	H8849_010_3	5		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	285.00	285.00																100.00				100.00			3.33	3.17	3.17			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8849	010	3	1	01	01	H8849_010_3	5		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												25							25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8849	010	3	1	01	01	H8849_010_3	5		N	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								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	5		N	Preferred Generic	4	01	3	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								18.00	36.00	54.00					18.00	36.00	54.00					18.00	54.00	54.00																18.00				18.00			0.60	0.60	0.60			0.53	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8849	010	4	1	01	01	H8849_010_4	5		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								20.00	40.00	60.00					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	5		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								47.00	94.00	141.00					47.00	94.00	141.00					47.00	141.00	141.00																47.00				47.00			1.57	1.57	1.57			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8849	010	4	1	01	01	H8849_010_4	5		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	285.00	285.00																100.00				100.00			3.33	3.17	3.17			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8849	010	4	1	01	01	H8849_010_4	5		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												25							25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8849	010	4	1	01	01	H8849_010_4	5		N	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								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	5		N	Preferred Generic	4	01	3	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								18.00	36.00	54.00					18.00	36.00	54.00					18.00	54.00	54.00																18.00				18.00			0.60	0.60	0.60			0.53	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8849	010	5	1	01	01	H8849_010_5	5		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								20.00	40.00	60.00					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	5		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								47.00	94.00	141.00					47.00	94.00	141.00					47.00	141.00	141.00																47.00				47.00			1.57	1.57	1.57			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8849	010	5	1	01	01	H8849_010_5	5		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	285.00	285.00																100.00				100.00			3.33	3.17	3.17			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8849	010	5	1	01	01	H8849_010_5	5		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												25							25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8849	010	5	1	01	01	H8849_010_5	5		N	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								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	5		N	Preferred Generic	4	01	3	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								18.00	36.00	54.00					18.00	36.00	54.00					18.00	54.00	54.00																18.00				18.00			0.60	0.60	0.60			0.53	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8849	010	6	1	01	01	H8849_010_6	5		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								20.00	40.00	60.00					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	5		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								47.00	94.00	141.00					47.00	94.00	141.00					47.00	141.00	141.00																47.00				47.00			1.57	1.57	1.57			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8849	010	6	1	01	01	H8849_010_6	5		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	285.00	285.00																100.00				100.00			3.33	3.17	3.17			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8849	010	6	1	01	01	H8849_010_6	5		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												25							25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8849	010	6	1	01	01	H8849_010_6	5		N	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								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	5		N	Preferred Generic	4	01	3	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								10.00	20.00	30.00					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	5		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								20.00	40.00	60.00					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	5		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								47.00	94.00	141.00					47.00	94.00	141.00					47.00	141.00	141.00																47.00				47.00			1.57	1.57	1.57			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8849	011	1	1	01	01	H8849_011_1	5		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	285.00	285.00																100.00				100.00			3.33	3.17	3.17			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8849	011	1	1	01	01	H8849_011_1	5		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												25							25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8849	011	1	1	01	01	H8849_011_1	5		N	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								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	5		N	Preferred Generic	4	01	3	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								10.00	20.00	30.00					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	5		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								20.00	40.00	60.00					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	5		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								47.00	94.00	141.00					47.00	94.00	141.00					47.00	141.00	141.00																47.00				47.00			1.57	1.57	1.57			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8849	011	2	1	01	01	H8849_011_2	5		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	285.00	285.00																100.00				100.00			3.33	3.17	3.17			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8849	011	2	1	01	01	H8849_011_2	5		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												25							25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8849	011	2	1	01	01	H8849_011_2	5		N	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								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	5		N	Preferred Generic	4	01	3	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								10.00	20.00	30.00					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	5		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								20.00	40.00	60.00					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	5		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								47.00	94.00	141.00					47.00	94.00	141.00					47.00	141.00	141.00																47.00				47.00			1.57	1.57	1.57			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8849	011	3	1	01	01	H8849_011_3	5		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	285.00	285.00																100.00				100.00			3.33	3.17	3.17			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8849	011	3	1	01	01	H8849_011_3	5		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												25							25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8849	011	3	1	01	01	H8849_011_3	5		N	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								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	5		N	Preferred Generic	4	01	3	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								10.00	20.00	30.00					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	5		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								20.00	40.00	60.00					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	5		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								47.00	94.00	141.00					47.00	94.00	141.00					47.00	141.00	141.00																47.00				47.00			1.57	1.57	1.57			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8849	011	4	1	01	01	H8849_011_4	5		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	285.00	285.00																100.00				100.00			3.33	3.17	3.17			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8849	011	4	1	01	01	H8849_011_4	5		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												25							25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8849	011	4	1	01	01	H8849_011_4	5		N	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								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	5		N	Preferred Generic	4	01	3	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								10.00	20.00	30.00					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	5		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								20.00	40.00	60.00					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	5		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								47.00	94.00	141.00					47.00	94.00	141.00					47.00	141.00	141.00																47.00				47.00			1.57	1.57	1.57			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8849	011	5	1	01	01	H8849_011_5	5		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	285.00	285.00																100.00				100.00			3.33	3.17	3.17			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8849	011	5	1	01	01	H8849_011_5	5		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												25							25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8849	011	5	1	01	01	H8849_011_5	5		N	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								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	5		N	Preferred Generic	4	01	3	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								10.00	20.00	30.00					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	5		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								20.00	40.00	60.00					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	5		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								47.00	94.00	141.00					47.00	94.00	141.00					47.00	141.00	141.00																47.00				47.00			1.57	1.57	1.57			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8849	011	6	1	01	01	H8849_011_6	5		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	285.00	285.00																100.00				100.00			3.33	3.17	3.17			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8849	011	6	1	01	01	H8849_011_6	5		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												25							25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8849	011	6	1	01	01	H8849_011_6	5		N	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								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	5		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								5.00	10.00	15.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.15	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8849	012	0	1	01	01	H8849_012_0	5		N	Preferred Generic	4	01	1	2	1	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								5.00	10.00	15.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.15	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H8849	012	0	1	01	01	H8849_012_0	5		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								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	5		N	Generic	4	01	1	2	2	3		111	01	111		1				30	60	90	2	2	30	60	90				30		34								12.50	25.00	37.50					7.50	15.00	22.50					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	5		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								45.00	90.00	135.00					40.00	80.00	120.00					40.00	80.00	80.00																45.00				45.00			1.50	1.33	1.33			1.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8849	012	0	1	01	01	H8849_012_0	5		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								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	5		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8849	012	0	1	01	01	H8849_012_0	5		N	Select Care Drugs	4	11	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8849	012	0	1	01	01	H8849_012_0	5		N	Select Care Drugs	4	11	1	2	6	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	3	
H8849	013	0	1	01	01	H8849_013_0	5		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								5.00	10.00	15.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.15	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8849	013	0	1	01	01	H8849_013_0	5		N	Preferred Generic	4	01	1	2	1	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								5.00	10.00	15.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.15	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H8849	013	0	1	01	01	H8849_013_0	5		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								12.50	25.00	37.50					7.50	15.00	22.50					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	5		N	Generic	4	01	1	2	2	3		111	01	111		1				30	60	90	2	2	30	60	90				30		34								12.50	25.00	37.50					7.50	15.00	22.50					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	5		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								45.00	90.00	135.00					40.00	80.00	120.00					40.00	80.00	80.00																45.00				45.00			1.50	1.33	1.33			1.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8849	013	0	1	01	01	H8849_013_0	5		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								95.00	190.00	285.00					85.00	170.00	255.00					85.00	170.00	170.00																95.00				95.00			3.17	2.83	2.83			2.79	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8849	013	0	1	01	01	H8849_013_0	5		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8849	013	0	1	01	01	H8849_013_0	5		N	Select Care Drugs	4	11	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8849	013	0	1	01	01	H8849_013_0	5		N	Select Care Drugs	4	11	1	2	6	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	3	
H8889	001	0	1	04	01	H8889_001_0	7		Y	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	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	7		Y	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					8.00	16.00	24.00											20.00	40.00	60.00				8.00	16.00	0.00				20.00				8.00			0.67	0.27		0.67	0.27	0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8889	001	0	1	04	01	H8889_001_0	7		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	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	7		Y	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											110.92	50	50	50				96.08	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	7		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												29							29												29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8889	002	0	1	04	01	H8889_002_0	7		Y	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	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	7		Y	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					10.00	20.00	30.00											20.00	40.00	60.00				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	7		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	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	7		Y	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											97.30	49	49	49				100.49	49	49	49										49	49	49				49	49	49			49			49								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8889	002	0	1	04	01	H8889_002_0	7		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												29							29												29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8889	003	0	1	04	01	H8889_003_0	7		Y	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	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	7		Y	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					8.00	16.00	24.00											20.00	40.00	60.00				8.00	16.00	0.00				20.00				8.00			0.67	0.27		0.67	0.27	0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8889	003	0	1	04	01	H8889_003_0	7		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					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	7		Y	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											68.50	50	50	50				60.22	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	7		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8889	004	0	1	04	01	H8889_004_0	7		Y	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	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	7		Y	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					10.00	20.00	30.00											20.00	40.00	60.00				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	004	0	1	04	01	H8889_004_0	7		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	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	7		Y	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											83.44	50	50	50				84.49	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	7		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												28							28												28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8889	005	0	1	04	01	H8889_005_0	6		Y	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	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	6		Y	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					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												
H8889	005	0	1	04	01	H8889_005_0	6		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					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	6		Y	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											94.09	50	50	50				87.43	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	6		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												27							27												27						27					27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8889	008	0	1	04	01	H8889_008_0	6		Y	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	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	6		Y	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					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												
H8889	008	0	1	04	01	H8889_008_0	6		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					47.00	94.00	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	6		Y	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											103.55	50	50	50				97.26	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	6		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												26							26												26						26					26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8902	001	0	1	01	01	H8902_001_0	8		Y	Preferred Generic	4	11	3	2	1	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8902	001	0	1	01	01	H8902_001_0	8		Y	Preferred Generic	4	11	3	2	1	3		111	01		111	1				30	60	100	1	2				30	60	100	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H8902	001	0	1	01	01	H8902_001_0	8		Y	Generic	4	11	1	2	2	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												
H8902	001	0	1	01	01	H8902_001_0	8		Y	Generic	4	11	1	2	2	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		
H8902	001	0	1	01	01	H8902_001_0	8		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								40.00	80.00	100.00					35.00	70.00	85.00											40.00	80.00	100.00				35.00	70.00	85.00				40.00				40.00			1.33	1.17		1.33	1.17	1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8902	001	0	1	01	01	H8902_001_0	8		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								100.00	200.00	280.00					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												
H8902	001	0	1	01	01	H8902_001_0	8		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8902	002	0	1	01	01	H8902_002_0	8		Y	Preferred Generic	4	11	1	2	1	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8902	002	0	1	01	01	H8902_002_0	8		Y	Preferred Generic	4	11	1	2	1	3		111	01		111	1				30	60	100	1	2				30	60	100	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H8902	002	0	1	01	01	H8902_002_0	8		Y	Generic	4	11	1	2	2	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												
H8902	002	0	1	01	01	H8902_002_0	8		Y	Generic	4	11	1	2	2	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		
H8902	002	0	1	01	01	H8902_002_0	8		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								40.00	80.00	100.00					35.00	70.00	85.00											40.00	80.00	100.00				35.00	70.00	85.00				40.00				40.00			1.33	1.17		1.33	1.17	1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8902	002	0	1	01	01	H8902_002_0	8		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								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												
H8902	002	0	1	01	01	H8902_002_0	8		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8902	003	0	1	01	01	H8902_003_0	8		Y	Preferred Generic	4	11	1	2	1	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8902	003	0	1	01	01	H8902_003_0	8		Y	Preferred Generic	4	11	1	2	1	3		111	01		111	1				30	60	100	1	2				30	60	100	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H8902	003	0	1	01	01	H8902_003_0	8		Y	Generic	4	11	1	2	2	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												
H8902	003	0	1	01	01	H8902_003_0	8		Y	Generic	4	11	1	2	2	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		
H8902	003	0	1	01	01	H8902_003_0	8		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								40.00	80.00	100.00					35.00	70.00	85.00											40.00	80.00	100.00				35.00	70.00	85.00				40.00				40.00			1.33	1.17		1.33	1.17	1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8902	003	0	1	01	01	H8902_003_0	8		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								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												
H8902	003	0	1	01	01	H8902_003_0	8		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8902	004	0	1	01	01	H8902_004_0	11		Y	Preferred Generic	4	11	3	2	1	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8902	004	0	1	01	01	H8902_004_0	11		Y	Preferred Generic	4	11	3	2	1	3		111	01		111	1				30	60	100	1	2				30	60	100	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H8902	004	0	1	01	01	H8902_004_0	11		Y	Generic	4	11	1	2	2	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												
H8902	004	0	1	01	01	H8902_004_0	11		Y	Generic	4	11	1	2	2	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		
H8902	004	0	1	01	01	H8902_004_0	11		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								47.00	94.00	121.00					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												
H8902	004	0	1	01	01	H8902_004_0	11		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								100.00	200.00	280.00					95.00	190.00	265.00											100.00	200.00	280.00				95.00	190.00	265.00				100.00				100.00			3.33	3.17		3.33	3.17	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8902	004	0	1	01	01	H8902_004_0	11		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8902	005	0	1	01	01	H8902_005_0	8		Y	Preferred Generic	4	11	3	2	1	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8902	005	0	1	01	01	H8902_005_0	8		Y	Preferred Generic	4	11	3	2	1	3		111	01		111	1				30	60	100	1	2				30	60	100	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H8902	005	0	1	01	01	H8902_005_0	8		Y	Generic	4	11	1	2	2	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												
H8902	005	0	1	01	01	H8902_005_0	8		Y	Generic	4	11	1	2	2	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		
H8902	005	0	1	01	01	H8902_005_0	8		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								40.00	80.00	100.00					35.00	70.00	85.00											40.00	80.00	100.00				35.00	70.00	85.00				40.00				40.00			1.33	1.17		1.33	1.17	1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8902	005	0	1	01	01	H8902_005_0	8		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								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												
H8902	005	0	1	01	01	H8902_005_0	8		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8902	006	0	1	01	01	H8902_006_0	8		Y	Preferred Generic	4	11	1	2	1	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8902	006	0	1	01	01	H8902_006_0	8		Y	Preferred Generic	4	11	1	2	1	3		111	01		111	1				30	60	100	1	2				30	60	100	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H8902	006	0	1	01	01	H8902_006_0	8		Y	Generic	4	11	1	2	2	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												
H8902	006	0	1	01	01	H8902_006_0	8		Y	Generic	4	11	1	2	2	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		
H8902	006	0	1	01	01	H8902_006_0	8		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								40.00	80.00	100.00					35.00	70.00	85.00											40.00	80.00	100.00				35.00	70.00	85.00				40.00				40.00			1.33	1.17		1.33	1.17	1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8902	006	0	1	01	01	H8902_006_0	8		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								100.00	200.00	280.00					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												
H8902	006	0	1	01	01	H8902_006_0	8		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8902	007	0	1	01	01	H8902_007_0	8		Y	Preferred Generic	4	11	1	2	1	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8902	007	0	1	01	01	H8902_007_0	8		Y	Preferred Generic	4	11	1	2	1	3		111	01		111	1				30	60	100	1	2				30	60	100	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H8902	007	0	1	01	01	H8902_007_0	8		Y	Generic	4	11	1	2	2	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												
H8902	007	0	1	01	01	H8902_007_0	8		Y	Generic	4	11	1	2	2	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		
H8902	007	0	1	01	01	H8902_007_0	8		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								40.00	80.00	100.00					35.00	70.00	85.00											40.00	80.00	100.00				35.00	70.00	85.00				40.00				40.00			1.33	1.17		1.33	1.17	1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8902	007	0	1	01	01	H8902_007_0	8		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								100.00	200.00	280.00					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												
H8902	007	0	1	01	01	H8902_007_0	8		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8902	008	0	1	01	01	H8902_008_0	11		Y	Preferred Generic	4	11	3	2	1	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8902	008	0	1	01	01	H8902_008_0	11		Y	Preferred Generic	4	11	3	2	1	3		111	01		111	1				30	60	100	1	2				30	60	100	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H8902	008	0	1	01	01	H8902_008_0	11		Y	Generic	4	11	1	2	2	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												
H8902	008	0	1	01	01	H8902_008_0	11		Y	Generic	4	11	1	2	2	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		
H8902	008	0	1	01	01	H8902_008_0	11		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								47.00	94.00	121.00					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												
H8902	008	0	1	01	01	H8902_008_0	11		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								100.00	200.00	280.00					95.00	190.00	265.00											100.00	200.00	280.00				95.00	190.00	265.00				100.00				100.00			3.33	3.17		3.33	3.17	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8902	008	0	1	01	01	H8902_008_0	11		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8908	001	0	1	02	01	H8908_001_0	4		Y	Preferred Generic	4	11	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8908	001	0	1	02	01	H8908_001_0	4		Y	Preferred Generic	4	11	1	2	1	3	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H8908	001	0	1	02	01	H8908_001_0	4		Y	Generic	4	11	1	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	5.00		15.00																									20.00		60.00				5.00		0.00				5.00				5.00		0.17				0.67	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8908	001	0	1	02	01	H8908_001_0	4		Y	Generic	4	11	1	2	2	3	110		01		110	1	30		90				2	2				30		90	30		31	5.00		15.00																									20.00		60.00				5.00		0.00				5.00				5.00		0.17				0.67	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H8908	001	0	1	02	01	H8908_001_0	4		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8908	001	0	1	02	01	H8908_001_0	4		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		290.00				100.00				100.00		3.33				3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8908	001	0	1	02	01	H8908_001_0	4		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8908	002	0	1	01	01	H8908_002_0	5		Y	Preferred Generic	4	11	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	6.00		18.00																									10.00		30.00				6.00		0.00				6.00				6.00		0.20				0.33	0.20	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8908	002	0	1	01	01	H8908_002_0	5		Y	Generic	4	11	1	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	15.00		45.00																									20.00		60.00				15.00		0.00				15.00				15.00		0.50				0.67	0.50	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8908	002	0	1	01	01	H8908_002_0	5		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		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		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	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												
H8908	002	0	1	01	01	H8908_002_0	5		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8908	004	0	1	02	01	H8908_004_0	5		Y	Preferred Generic	4	11	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8908	004	0	1	02	01	H8908_004_0	5		Y	Preferred Generic	4	11	1	2	1	3	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H8908	004	0	1	02	01	H8908_004_0	5		Y	Generic	4	11	1	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	0.00		0.00																									20.00		60.00				0.00		0.00				0.00				0.00		0				0.67	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8908	004	0	1	02	01	H8908_004_0	5		Y	Generic	4	11	1	2	2	3	110		01		110	1	30		90				2	2				30		90	30		31	0.00		0.00																									20.00		60.00				0.00		0.00				0.00				0.00		0				0.67	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H8908	004	0	1	02	01	H8908_004_0	5		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8908	004	0	1	02	01	H8908_004_0	5		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	100.00		300.00																									100.00		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												
H8908	004	0	1	02	01	H8908_004_0	5		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8961	001	0	1	01	01	H8961_001_0	8			Preferred Generic	4	11	3	2	1	1	110		01	110		1	30		90				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	8			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	8			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	8			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	8			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	8			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	8			Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				886.08	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8961	002	0	1	01	01	H8961_002_0	8			Preferred Generic	4	11	3	2	1	1	110		01	110		1	30		90				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	8			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	8			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	8			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	8			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	8			Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				944.38	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8961	003	0	1	01	01	H8961_003_0	8			Preferred Generic	4	11	3	2	1	1	110		01	110		1	30		90				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	8			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	8			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	8			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	8			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	8			Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				711.11	25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8967	002	0	1	01	01	H8967_002_0	6			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	6			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	6			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	6			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	6			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												
H8998	001	0	1	04	01	H8998_001_0	4		N	Preferred Generic	4	11	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								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												
H8998	001	0	1	04	01	H8998_001_0	4		N	Preferred Generic	4	11	1	2	1	3		111	01	111		1				30	60	90	1	2	30	60	90				30		31								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		
H8998	001	0	1	04	01	H8998_001_0	4		N	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					5.00	10.00	15.00					0.00	0.00	0.00																20.00				20.00			0.67	0.17	0.00			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8998	001	0	1	04	01	H8998_001_0	4		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					47.00	94.00	141.00					47.00	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												
H8998	001	0	1	04	01	H8998_001_0	4		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	300.00					100.00	200.00	300.00					100.00	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												
H8998	001	0	1	04	01	H8998_001_0	4		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											830.00	33						830.00	33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9001	030	15	1	01	01	H9001_030_15	8			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	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	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	8			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	8			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	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												
H9001	030	15	1	01	01	H9001_030_15	8			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	6			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	6			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	6			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	6			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	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												
H9001	030	16	1	01	01	H9001_030_16	6			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	18	1	01	01	H9001_030_18	6			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	18	1	01	01	H9001_030_18	6			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	18	1	01	01	H9001_030_18	6			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	18	1	01	01	H9001_030_18	6			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	18	1	01	01	H9001_030_18	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												
H9001	030	18	1	01	01	H9001_030_18	6			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	7			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	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			0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9001	031	15	1	01	01	H9001_031_15	7			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	7			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	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												
H9001	031	15	1	01	01	H9001_031_15	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9001	031	16	1	01	01	H9001_031_16	6			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	6			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	6			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	6			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	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 Brand, Specialty Tier, Select Care Drugs												
H9001	031	16	1	01	01	H9001_031_16	6			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	18	1	01	01	H9001_031_18	6			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	18	1	01	01	H9001_031_18	6			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	18	1	01	01	H9001_031_18	6			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	18	1	01	01	H9001_031_18	6			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	18	1	01	01	H9001_031_18	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 Brand, Specialty Tier, Select Care Drugs												
H9001	031	18	1	01	01	H9001_031_18	6			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	5			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	5			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	5			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	5			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	5			Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31					33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9001	035	0	1	01	01	H9001_035_0	5			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	5			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	5			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	5			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	5			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	5			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												
H9001	036	0	1	01	01	H9001_036_0	5			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	038	0	1	01	01	H9001_038_0	6			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	038	0	1	01	01	H9001_038_0	6			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	038	0	1	01	01	H9001_038_0	6			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	038	0	1	01	01	H9001_038_0	6			Non-Preferred Brand	4	11	1	2	4	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31	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	038	0	1	01	01	H9001_038_0	6			Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31					29																				29																	29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9001	038	0	1	01	01	H9001_038_0	6			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	040	0	1	01	01	H9001_040_0	6			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	040	0	1	01	01	H9001_040_0	6			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	040	0	1	01	01	H9001_040_0	6			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	040	0	1	01	01	H9001_040_0	6			Non-Preferred Brand	4	11	1	2	4	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31	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	040	0	1	01	01	H9001_040_0	6			Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31					25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9001	040	0	1	01	01	H9001_040_0	6			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	02	01	H9003_001_0	6			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												
H9003	001	0	1	02	01	H9003_001_0	6			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		
H9003	001	0	1	02	01	H9003_001_0	6			Generic	4	11	1	2	2	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31	10.00	20.00	30.00																			10.00	20.00	20.00																10.00				10.00		0.33			0.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H9003	001	0	1	02	01	H9003_001_0	6			Generic	4	11	1	2	2	3	111		01	111		1	30	60	90				2	2	30	60	90				30		31	10.00	20.00	30.00																			10.00	20.00	20.00																10.00				10.00		0.33			0.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H9003	001	0	1	02	01	H9003_001_0	6			Preferred Brand	4	10	1	2	3	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31	45.00	90.00	135.00																			45.00	90.00	90.00																45.00				45.00		1.50			1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H9003	001	0	1	02	01	H9003_001_0	6			Non-Preferred Brand	4	11	1	2	4	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31	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	02	01	H9003_001_0	6			Specialty Tier	4	11	1	1	5	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31					33	33	33																		33	33	33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H9003	001	0	1	02	01	H9003_001_0	6			Vaccines	4	10	1	2	6	1	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H9003	001	0	1	02	01	H9003_001_0	6			Vaccines	4	10	1	2	6	3	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H9003	006	0	1	02	01	H9003_006_0	6			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												
H9003	006	0	1	02	01	H9003_006_0	6			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		
H9003	006	0	1	02	01	H9003_006_0	6			Generic	4	11	1	2	2	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31	10.00	20.00	30.00																			10.00	20.00	20.00																10.00				10.00		0.33			0.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H9003	006	0	1	02	01	H9003_006_0	6			Generic	4	11	1	2	2	3	111		01	111		1	30	60	90				2	2	30	60	90				30		31	10.00	20.00	30.00																			10.00	20.00	20.00																10.00				10.00		0.33			0.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H9003	006	0	1	02	01	H9003_006_0	6			Preferred Brand	4	10	1	2	3	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31	45.00	90.00	135.00																			45.00	90.00	90.00																45.00				45.00		1.50			1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H9003	006	0	1	02	01	H9003_006_0	6			Non-Preferred Brand	4	11	1	2	4	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31	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	02	01	H9003_006_0	6			Specialty Tier	4	11	1	1	5	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31					33	33	33																		33	33	33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H9003	006	0	1	02	01	H9003_006_0	6			Vaccines	4	10	1	2	6	1	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H9003	006	0	1	02	01	H9003_006_0	6			Vaccines	4	10	1	2	6	3	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H9003	007	0	1	02	01	H9003_007_0	5			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					0.00	0.00	0.00																19.00				19.00			0.63	0.00	0.00			0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H9003	007	0	1	02	01	H9003_007_0	5			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					0.00	0.00	0.00					0.00	0.00	0.00																19.00				19.00			0.63	0.00	0.00			0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H9003	007	0	1	02	01	H9003_007_0	5			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					10.00	20.00	20.00																20.00				20.00			0.66	0.33	0.33			0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H9003	007	0	1	02	01	H9003_007_0	5			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					10.00	20.00	20.00																20.00				20.00			0.66	0.33	0.33			0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H9003	007	0	1	02	01	H9003_007_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					40.00	80.00	120.00					40.00	80.00	80.00																47.00				47.00			1.56	1.33	1.33			1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H9003	007	0	1	02	01	H9003_007_0	5			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					93.00	186.00	186.00																100.00				100.00			3.33	3.10	3.10			3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H9003	007	0	1	02	01	H9003_007_0	5			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								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H9003	007	0	1	02	01	H9003_007_0	5			Vaccines	4	10	1	2	6	1		010	01			1				30											30		31								0.00							0.00																									0.00				0.00			0.00	0.00				0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H9003	007	0	1	02	01	H9003_007_0	5			Vaccines	4	10	1	2	6	3		010	01			1				30											30		31								0.00							0.00																									0.00				0.00			0.00	0.00				0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H9003	008	0	1	02	01	H9003_008_0	5			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					0.00	0.00	0.00																19.00				19.00			0.63	0.00	0.00			0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H9003	008	0	1	02	01	H9003_008_0	5			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					0.00	0.00	0.00					0.00	0.00	0.00																19.00				19.00			0.63	0.00	0.00			0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H9003	008	0	1	02	01	H9003_008_0	5			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					10.00	20.00	20.00																20.00				20.00			0.66	0.33	0.33			0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H9003	008	0	1	02	01	H9003_008_0	5			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					10.00	20.00	20.00																20.00				20.00			0.66	0.33	0.33			0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H9003	008	0	1	02	01	H9003_008_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					40.00	80.00	120.00					40.00	80.00	80.00																47.00				47.00			1.56	1.33	1.33			1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H9003	008	0	1	02	01	H9003_008_0	5			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					93.00	186.00	186.00																100.00				100.00			3.33	3.10	3.10			3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H9003	008	0	1	02	01	H9003_008_0	5			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								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H9003	008	0	1	02	01	H9003_008_0	5			Vaccines	4	10	1	2	6	1		010	01			1				30											30		31								0.00							0.00																									0.00				0.00			0.00	0.00				0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H9003	008	0	1	02	01	H9003_008_0	5			Vaccines	4	10	1	2	6	3		010	01			1				30											30		31								0.00							0.00																									0.00				0.00			0.00	0.00				0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H9003	009	0	1	02	01	H9003_009_0	6			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												
H9003	009	0	1	02	01	H9003_009_0	6			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		
H9003	009	0	1	02	01	H9003_009_0	6			Generic	4	11	1	2	2	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31	10.00	20.00	30.00																			10.00	20.00	20.00																10.00				10.00		0.33			0.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H9003	009	0	1	02	01	H9003_009_0	6			Generic	4	11	1	2	2	3	111		01	111		1	30	60	90				2	2	30	60	90				30		31	10.00	20.00	30.00																			10.00	20.00	20.00																10.00				10.00		0.33			0.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H9003	009	0	1	02	01	H9003_009_0	6			Preferred Brand	4	10	1	2	3	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31	45.00	90.00	135.00																			45.00	90.00	90.00																45.00				45.00		1.50			1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H9003	009	0	1	02	01	H9003_009_0	6			Non-Preferred Brand	4	11	1	2	4	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31	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	02	01	H9003_009_0	6			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	02	01	H9003_009_0	6			Vaccines	4	10	1	2	6	1	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H9003	009	0	1	02	01	H9003_009_0	6			Vaccines	4	10	1	2	6	3	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H9042	001	1	1	04	01	H9042_001_1	9		Y	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, Select Care Drugs												
H9042	001	1	1	04	01	H9042_001_1	9		Y	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, Select Care Drugs												
H9042	001	1	1	04	01	H9042_001_1	9		Y	Preferred Brand	4	11	1	2	3	1		111	10	111		1				30	60	90	1	2	30	60	90					10	31								47.00	94.00	141.00					42.00	84.00	126.00					47.00	94.00	141.00																	47.00			47.00			1.57	1.40	1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9042	001	1	1	04	01	H9042_001_1	9		Y	Non-Preferred Drug	4	11	1	2	4	1		111	10	111		1				30	60	90	1	2	30	60	90					10	31								100.00	200.00	300.00					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, Select Care Drugs												
H9042	001	1	1	04	01	H9042_001_1	9		Y	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, Select Care Drugs												
H9042	001	1	1	04	01	H9042_001_1	9		Y	Select Care Drugs	4	11	1	2	6	1		111	10	111		1				30	60	90	1	2	30	60	90					10	31								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																	0.00			0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9042	001	2	1	04	01	H9042_001_2	10		Y	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, Select Care Drugs												
H9042	001	2	1	04	01	H9042_001_2	10		Y	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, Select Care Drugs												
H9042	001	2	1	04	01	H9042_001_2	10		Y	Preferred Brand	4	11	1	2	3	1		111	10	111		1				30	60	90	1	2	30	60	90					10	31								47.00	94.00	141.00					42.00	84.00	126.00					47.00	94.00	141.00																	47.00			47.00			1.57	1.40	1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9042	001	2	1	04	01	H9042_001_2	10		Y	Non-Preferred Drug	4	11	1	2	4	1		111	10	111		1				30	60	90	1	2	30	60	90					10	31								100.00	200.00	300.00					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, Select Care Drugs												
H9042	001	2	1	04	01	H9042_001_2	10		Y	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, Select Care Drugs												
H9042	001	2	1	04	01	H9042_001_2	10		Y	Select Care Drugs	4	11	1	2	6	1		111	10	111		1				30	60	90	1	2	30	60	90					10	31								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																	0.00			0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9042	002	1	1	04	01	H9042_002_1	5		Y	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, Select Care Drugs												
H9042	002	1	1	04	01	H9042_002_1	5		Y	Generic	4	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					8.00	16.00	0.00																	10.00			10.00			0.33	0.17	0.27			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9042	002	1	1	04	01	H9042_002_1	5		Y	Preferred Brand	4	11	1	2	3	1		111	10	111		1				30	60	90	1	2	30	60	90					10	31								47.00	94.00	141.00					37.00	74.00	111.00					47.00	94.00	141.00																	47.00			47.00			1.57	1.23	1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9042	002	1	1	04	01	H9042_002_1	5		Y	Non-Preferred Drug	4	11	1	2	4	1		111	10	111		1				30	60	90	1	2	30	60	90					10	31								100.00	200.00	300.00					90.00	180.00	270.00					100.00	200.00	300.00																	100.00			100.00			3.33	3.00	3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9042	002	1	1	04	01	H9042_002_1	5		Y	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, Select Care Drugs												
H9042	002	1	1	04	01	H9042_002_1	5		Y	Select Care Drugs	4	11	1	2	6	1		111	10	111		1				30	60	90	1	2	30	60	90					10	31								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																	0.00			0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9042	002	2	1	04	01	H9042_002_2	5		Y	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, Select Care Drugs												
H9042	002	2	1	04	01	H9042_002_2	5		Y	Generic	4	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					8.00	16.00	0.00																	10.00			10.00			0.33	0.17	0.27			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9042	002	2	1	04	01	H9042_002_2	5		Y	Preferred Brand	4	11	1	2	3	1		111	10	111		1				30	60	90	1	2	30	60	90					10	31								47.00	94.00	141.00					37.00	74.00	111.00					47.00	94.00	141.00																	47.00			47.00			1.57	1.23	1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9042	002	2	1	04	01	H9042_002_2	5		Y	Non-Preferred Drug	4	11	1	2	4	1		111	10	111		1				30	60	90	1	2	30	60	90					10	31								100.00	200.00	300.00					90.00	180.00	270.00					100.00	200.00	300.00																	100.00			100.00			3.33	3.00	3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9042	002	2	1	04	01	H9042_002_2	5		Y	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, Select Care Drugs												
H9042	002	2	1	04	01	H9042_002_2	5		Y	Select Care Drugs	4	11	1	2	6	1		111	10	111		1				30	60	90	1	2	30	60	90					10	31								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																	0.00			0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9047	013	0	2	01	01	H9047_013_0	10		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								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	10		N	Preferred Generic	4	01	1	2	1	3		111	01	111		1				30	60	90	1	2	30	60	90				30		31								12.00	24.00	36.00					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	10		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								20.00	40.00	60.00					12.00	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	10		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					47.00	94.00	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	10		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	300.00					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	10		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											1346.59	33						1346.59	33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H9047	013	0	2	01	01	H9047_013_0	10		N	Vaccines	4	10	1	2	6	1		010	01	010		1				30					30						30		31								0.00							0.00							0.00																		0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H9047	013	0	2	01	01	H9047_013_0	10		N	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		
H9047	037	0	1	01	01	H9047_037_0	15		Y	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								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	15		Y	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								20.00	40.00	60.00					10.00	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	15		Y	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					47.00	94.00	141.00					47.00	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	15		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	300.00					100.00	200.00	300.00					100.00	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	15		Y	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											1009.45	30						1009.45	30						30																	30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H9047	037	0	1	01	01	H9047_037_0	15		Y	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	15		Y	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		
H9047	054	0	1	01	01	H9047_054_0	12		Y	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								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	12		Y	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								20.00	40.00	60.00					10.00	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	12		Y	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					47.00	94.00	141.00					47.00	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	12		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	300.00					100.00	200.00	300.00					100.00	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	12		Y	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											1259.67	33						1259.67	33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H9047	054	0	1	01	01	H9047_054_0	12		Y	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	12		Y	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		
H9047	059	0	1	02	01	H9047_059_0	16		Y	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	16		Y	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								20.00	40.00	60.00					10.00	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	16		Y	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					47.00	94.00	141.00					47.00	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	16		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	300.00					100.00	200.00	300.00					100.00	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	16		Y	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											1577.77	33						1577.77	33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H9047	059	0	1	02	01	H9047_059_0	16		Y	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	16		Y	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		
H9047	062	0	1	02	01	H9047_062_0	15		Y	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								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	15		Y	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								20.00	40.00	60.00					10.00	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	15		Y	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					47.00	94.00	141.00					47.00	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	15		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	300.00					100.00	200.00	300.00					100.00	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	15		Y	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											1151.67	33						1151.67	33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H9047	062	0	1	02	01	H9047_062_0	15		Y	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	15		Y	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		
H9047	063	0	1	01	01	H9047_063_0	12		Y	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								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	12		Y	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								20.00	40.00	60.00					10.00	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	12		Y	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					47.00	94.00	141.00					47.00	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	12		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	300.00					100.00	200.00	300.00					100.00	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	12		Y	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											844.41	33						844.41	33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H9047	063	0	1	01	01	H9047_063_0	12		Y	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	12		Y	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		
H9047	064	0	1	01	01	H9047_064_0	12		Y	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								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	064	0	1	01	01	H9047_064_0	12		Y	Preferred Generic	4	01	1	2	1	3		111	01	111		1				30	60	90	1	2	30	60	90				30		31								12.00	24.00	36.00					0.00	0.00	0.00					0.00	0.00	0.00																12.00				12.00			0.40	0.00	0.00			0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines										1		
H9047	064	0	1	01	01	H9047_064_0	12		Y	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								20.00	40.00	60.00					10.00	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	064	0	1	01	01	H9047_064_0	12		Y	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					45.00	90.00	90.00					45.00	90.00	90.00																47.00				47.00			1.57	1.50	1.50			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H9047	064	0	1	01	01	H9047_064_0	12		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	300.00					90.00	180.00	180.00					90.00	180.00	180.00																100.00				100.00			3.33	3.00	3.00			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H9047	064	0	1	01	01	H9047_064_0	12		Y	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											1063.16	33						1063.16	33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H9047	064	0	1	01	01	H9047_064_0	12		Y	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	064	0	1	01	01	H9047_064_0	12		Y	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		
H9047	065	0	1	02	01	H9047_065_0	15		Y	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								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	065	0	1	02	01	H9047_065_0	15		Y	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	065	0	1	02	01	H9047_065_0	15		Y	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								20.00	40.00	60.00					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	065	0	1	02	01	H9047_065_0	15		Y	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					47.00	94.00	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	065	0	1	02	01	H9047_065_0	15		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	300.00					100.00	200.00	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	065	0	1	02	01	H9047_065_0	15		Y	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											1028.20	29						1028.20	29						29																	29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H9047	065	0	1	02	01	H9047_065_0	15		Y	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	065	0	1	02	01	H9047_065_0	15		Y	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		
H9047	066	0	1	01	01	H9047_066_0	12		Y	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								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	066	0	1	01	01	H9047_066_0	12		Y	Preferred Generic	4	01	1	2	1	3		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										1		
H9047	066	0	1	01	01	H9047_066_0	12		Y	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								20.00	40.00	60.00					10.00	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	066	0	1	01	01	H9047_066_0	12		Y	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					47.00	94.00	141.00					47.00	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	066	0	1	01	01	H9047_066_0	12		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	300.00					100.00	200.00	300.00					100.00	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	066	0	1	01	01	H9047_066_0	12		Y	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											1356.47	33						1356.47	33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H9047	066	0	1	01	01	H9047_066_0	12		Y	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	066	0	1	01	01	H9047_066_0	12		Y	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		
H9065	001	0	1	01	01	H9065_001_0	5		N	Preferred Generic	4	01	3	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								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												
H9065	001	0	1	01	01	H9065_001_0	5		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								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	5		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								47.00	94.00	141.00					47.00	94.00	141.00					47.00	141.00	141.00																47.00				47.00			1.57	1.57	1.57			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9065	001	0	1	01	01	H9065_001_0	5		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	285.00	285.00																100.00				100.00			3.33	3.17	3.17			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9065	001	0	1	01	01	H9065_001_0	5		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												25							25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9065	001	0	1	01	01	H9065_001_0	5		N	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								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	5		Y	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	5		Y	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	5		Y	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	5		Y	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	5		Y	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	5		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				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	5		Y	Specialty Tier	4	11	1	1	5	1		010	01	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	5		Y	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				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	5		Y	Select Care Drugs	4	01	1	2	6	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				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	5		N	Preferred Generic	4	01	3	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								9.00	18.00	27.00					4.00	8.00	12.00					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	5		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								15.00	30.00	45.00					10.00	20.00	30.00					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	5		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00	84.00	84.00																47.00				47.00			1.57	1.40	1.40			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9065	003	0	1	02	01	H9065_003_0	5		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	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	5		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9065	003	0	1	02	01	H9065_003_0	5		N	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9065	003	0	1	02	01	H9065_003_0	5		N	Select Care Drugs	4	01	1	2	6	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H9065	004	0	1	02	01	H9065_004_0	5		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								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	5		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								15.00	30.00	45.00					10.00	20.00	30.00					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	5		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								47.00	94.00	141.00					37.00	74.00	111.00					37.00	74.00	74.00																47.00				47.00			1.57	1.23	1.23			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9065	004	0	1	02	01	H9065_004_0	5		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	190.00	190.00																100.00				100.00			3.33	3.17	3.17			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9065	004	0	1	02	01	H9065_004_0	5		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9065	004	0	1	02	01	H9065_004_0	5		N	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9065	004	0	1	02	01	H9065_004_0	5		N	Select Care Drugs	4	01	1	2	6	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H9065	006	0	1	01	01	H9065_006_0	7		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				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	7		N	Preferred Generic	4	01	1	2	1	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H9065	006	0	1	01	01	H9065_006_0	7		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								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	7		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								47.00	94.00	141.00					47.00	94.00	141.00					47.00	141.00	141.00																47.00				47.00			1.57	1.57	1.57			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9065	006	0	1	01	01	H9065_006_0	7		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	285.00	285.00																100.00				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	7		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												28							28						28																	28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9065	006	0	1	01	01	H9065_006_0	7		N	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9065	006	0	1	01	01	H9065_006_0	7		N	Select Care Drugs	4	01	1	2	6	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H9065	007	0	1	01	01	H9065_007_0	5		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9065	007	0	1	01	01	H9065_007_0	5		N	Preferred Generic	4	01	1	2	1	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H9065	007	0	1	01	01	H9065_007_0	5		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								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	5		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								47.00	94.00	141.00					47.00	94.00	141.00					47.00	141.00	141.00																47.00				47.00			1.57	1.57	1.57			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9065	007	0	1	01	01	H9065_007_0	5		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	285.00	285.00																100.00				100.00			3.33	3.17	3.17			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9065	007	0	1	01	01	H9065_007_0	5		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												28							28						28																	28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9065	007	0	1	01	01	H9065_007_0	5		N	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9065	007	0	1	01	01	H9065_007_0	5		N	Select Care Drugs	4	01	1	2	6	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H9065	008	0	1	01	01	H9065_008_0	7		Y	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		Y	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		Y	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		Y	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		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				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		Y	Specialty Tier	4	11	1	1	5	1		010	01	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		Y	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				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		Y	Select Care Drugs	4	01	1	2	6	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				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	003	0	1	04	01	H9070_003_0	3		Y	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	7.00		21.00																									10.00		30.00				7.00		0.00				7.00				7.00		0.23				0.33	0.23	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9070	003	0	1	04	01	H9070_003_0	3		Y	Generic	4	11	3	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	12.00		36.00																									20.00		60.00				12.00		0.00				12.00				12.00		0.40				0.67	0.40	0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9070	003	0	1	04	01	H9070_003_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9070	003	0	1	04	01	H9070_003_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	99.00		297.00																									100.00		300.00				99.00		287.00				99.00				99.00		3.30				3.33	3.30	3.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9070	003	0	1	04	01	H9070_003_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9070	004	0	1	04	01	H9070_004_0	3		Y	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	8.00		24.00																									10.00		30.00				8.00		0.00				8.00				8.00		0.27				0.33	0.27	0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9070	004	0	1	04	01	H9070_004_0	3		Y	Generic	4	11	3	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	15.00		45.00																									20.00		60.00				15.00		0.00				15.00				15.00		0.50				0.67	0.50	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9070	004	0	1	04	01	H9070_004_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9070	004	0	1	04	01	H9070_004_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	99.00		297.00																									100.00		300.00				99.00		287.00				99.00				99.00		3.30				3.33	3.30	3.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9070	004	0	1	04	01	H9070_004_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9070	005	0	1	04	01	H9070_005_0	3		Y	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	7.00		21.00																									10.00		30.00				7.00		0.00				7.00				7.00		0.23				0.33	0.23	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9070	005	0	1	04	01	H9070_005_0	3		Y	Generic	4	11	3	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	12.00		36.00																									20.00		60.00				12.00		0.00				12.00				12.00		0.40				0.67	0.40	0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9070	005	0	1	04	01	H9070_005_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		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	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		290.00				100.00				100.00		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	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9070	006	1	1	04	01	H9070_006_1	3		Y	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	7.00		21.00																									10.00		30.00				7.00		0.00				7.00				7.00		0.23				0.33	0.23	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9070	006	1	1	04	01	H9070_006_1	3		Y	Generic	4	11	3	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	12.00		36.00																									20.00		60.00				12.00		0.00				12.00				12.00		0.40				0.67	0.40	0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9070	006	1	1	04	01	H9070_006_1	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		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	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	99.00		297.00																									100.00		300.00				99.00		287.00				99.00				99.00		3.30				3.33	3.30	3.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9070	006	1	1	04	01	H9070_006_1	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9070	006	2	1	04	01	H9070_006_2	3		Y	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	7.00		21.00																									10.00		30.00				7.00		0.00				7.00				7.00		0.23				0.33	0.23	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9070	006	2	1	04	01	H9070_006_2	3		Y	Generic	4	11	3	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	12.00		36.00																									20.00		60.00				12.00		0.00				12.00				12.00		0.40				0.67	0.40	0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9070	006	2	1	04	01	H9070_006_2	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9070	006	2	1	04	01	H9070_006_2	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	99.00		297.00																									100.00		300.00				99.00		287.00				99.00				99.00		3.30				3.33	3.30	3.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9070	006	2	1	04	01	H9070_006_2	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9070	006	3	1	04	01	H9070_006_3	3		Y	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	7.00		21.00																									10.00		30.00				7.00		0.00				7.00				7.00		0.23				0.33	0.23	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9070	006	3	1	04	01	H9070_006_3	3		Y	Generic	4	11	3	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	12.00		36.00																									20.00		60.00				12.00		0.00				12.00				12.00		0.40				0.67	0.40	0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9070	006	3	1	04	01	H9070_006_3	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9070	006	3	1	04	01	H9070_006_3	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	99.00		297.00																									100.00		300.00				99.00		287.00				99.00				99.00		3.30				3.33	3.30	3.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9070	006	3	1	04	01	H9070_006_3	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9082	010	0	1	01	01	H9082_010_0	7		Y	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	7		Y	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	7		Y	Preferred Brand	4	11	1	2	3	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31	47.00	94.00	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	7		Y	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	7		Y	Specialty Tier	4	11	1	1	5	1	010		01	010		1	31								31						31		31				936.56	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	7		Y	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	7		Y	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	7		Y	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	7		Y	Preferred Brand	4	11	1	2	3	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31	47.00	94.00	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	7		Y	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	7		Y	Specialty Tier	4	11	1	1	5	1	010		01	010		1	31								31						31		31				704.58	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	7		Y	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	8		Y	Preferred Generic	4	01	1	2	1	1		111	10	111		1				30	60	100	1	2	30	60	100					29	31								7.00	14.00	7.00					2.00	4.00	2.00					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, Vaccines												
H9096	001	0	1	02	01	H9096_001_0	8		Y	Generic	4	11	1	2	2	1		111	10	111		1				30	60	100	1	2	30	60	100					29	31								15.00	30.00	30.00					10.00	20.00	20.00					10.00	20.00	0.00																	15.00			15.00			0.50	0.33	0.33			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H9096	001	0	1	02	01	H9096_001_0	8		Y	Preferred Brand	4	11	1	2	3	1		111	10	111		1				30	60	100	1	2	30	60	100					29	31								47.00	94.00	130.00					42.00	84.00	117.50					42.00	84.00	117.50																	47.00			47.00			1.57	1.40	1.40			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H9096	001	0	1	02	01	H9096_001_0	8		Y	Non-Preferred Drug	4	11	1	2	4	1		111	10	111		1				30	60	100	1	2	30	60	100					29	31								100.00	200.00	300.00					95.00	190.00	285.00					95.00	190.00	285.00																	100.00			100.00			3.33	3.17	3.17			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H9096	001	0	1	02	01	H9096_001_0	8		Y	Specialty Tier	4	11	1	1	5	1		010	10	010		1				30					30							29	31												30							30						30																		30		30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H9096	001	0	1	02	01	H9096_001_0	8		Y	Vaccines	4	11	1	2	6	1		010	10			1				30												29	31								0.00							0.00																										0.00			0.00			0.00	0.00				0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H9096	001	0	1	02	01	H9096_001_0	8		Y	Vaccines	4	11	1	2	6	3		010	10			1				30												29	31								0.00							0.00																										0.00			0.00			0.00	0.00				0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines										1		
H9096	002	0	1	02	01	H9096_002_0	7		Y	Preferred Generic	4	01	1	2	1	1		111	10	111		1				30	60	100	1	2	30	60	100					29	31								7.00	14.00	7.00					2.00	4.00	2.00					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, Vaccines												
H9096	002	0	1	02	01	H9096_002_0	7		Y	Generic	4	11	1	2	2	1		111	10	111		1				30	60	100	1	2	30	60	100					29	31								15.00	30.00	30.00					10.00	20.00	20.00					10.00	20.00	0.00																	15.00			15.00			0.50	0.33	0.33			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H9096	002	0	1	02	01	H9096_002_0	7		Y	Preferred Brand	4	11	1	2	3	1		111	10	111		1				30	60	100	1	2	30	60	100					29	31								47.00	94.00	130.00					42.00	84.00	117.50					42.00	84.00	117.50																	47.00			47.00			1.57	1.40	1.40			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H9096	002	0	1	02	01	H9096_002_0	7		Y	Non-Preferred Drug	4	11	1	2	4	1		111	10	111		1				30	60	100	1	2	30	60	100					29	31								100.00	200.00	300.00					95.00	190.00	285.00					95.00	190.00	285.00																	100.00			100.00			3.33	3.17	3.17			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H9096	002	0	1	02	01	H9096_002_0	7		Y	Specialty Tier	4	11	1	1	5	1		010	10	010		1				30					30							29	31												31							31						31																		31		31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H9096	002	0	1	02	01	H9096_002_0	7		Y	Vaccines	4	11	1	2	6	1		010	10			1				30												29	31								0.00							0.00																										0.00			0.00			0.00	0.00				0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H9096	002	0	1	02	01	H9096_002_0	7		Y	Vaccines	4	11	1	2	6	3		010	10			1				30												29	31								0.00							0.00																										0.00			0.00			0.00	0.00				0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines										1		
H9096	004	0	1	01	01	H9096_004_0	7		Y	Preferred Generic	4	01	1	2	1	1		111	10	111		1				30	60	100	1	2	30	60	100					29	31								7.00	14.00	7.00					2.00	4.00	2.00					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, Vaccines												
H9096	004	0	1	01	01	H9096_004_0	7		Y	Generic	4	11	1	2	2	1		111	10	111		1				30	60	100	1	2	30	60	100					29	31								15.00	30.00	30.00					10.00	20.00	20.00					10.00	20.00	0.00																	15.00			15.00			0.50	0.33	0.33			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H9096	004	0	1	01	01	H9096_004_0	7		Y	Preferred Brand	4	11	1	2	3	1		111	10	111		1				30	60	100	1	2	30	60	100					29	31								47.00	94.00	130.00					42.00	84.00	117.50					42.00	84.00	117.50																	47.00			47.00			1.57	1.40	1.40			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H9096	004	0	1	01	01	H9096_004_0	7		Y	Non-Preferred Drug	4	11	1	2	4	1		111	10	111		1				30	60	100	1	2	30	60	100					29	31								100.00	200.00	300.00					95.00	190.00	285.00					95.00	190.00	285.00																	100.00			100.00			3.33	3.17	3.17			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H9096	004	0	1	01	01	H9096_004_0	7		Y	Specialty Tier	4	11	1	1	5	1		010	10	010		1				30					30							29	31												29							29						29																		29		29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H9096	004	0	1	01	01	H9096_004_0	7		Y	Vaccines	4	11	1	2	6	1		010	10			1				30												29	31								0.00							0.00																										0.00			0.00			0.00	0.00				0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H9096	004	0	1	01	01	H9096_004_0	7		Y	Vaccines	4	11	1	2	6	3		010	10			1				30												29	31								0.00							0.00																										0.00			0.00			0.00	0.00				0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines										1		
H9096	005	0	1	01	01	H9096_005_0	7		Y	Preferred Generic	4	01	1	2	1	1		111	10	111		1				30	60	100	1	2	30	60	100					29	31								7.00	14.00	7.00					2.00	4.00	2.00					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, Vaccines												
H9096	005	0	1	01	01	H9096_005_0	7		Y	Generic	4	11	1	2	2	1		111	10	111		1				30	60	100	1	2	30	60	100					29	31								15.00	30.00	30.00					10.00	20.00	20.00					10.00	20.00	0.00																	15.00			15.00			0.50	0.33	0.33			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H9096	005	0	1	01	01	H9096_005_0	7		Y	Preferred Brand	4	11	1	2	3	1		111	10	111		1				30	60	100	1	2	30	60	100					29	31								47.00	94.00	130.00					42.00	84.00	117.50					42.00	84.00	117.50																	47.00			47.00			1.57	1.40	1.40			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H9096	005	0	1	01	01	H9096_005_0	7		Y	Non-Preferred Drug	4	11	1	2	4	1		111	10	111		1				30	60	100	1	2	30	60	100					29	31								100.00	200.00	300.00					95.00	190.00	285.00					95.00	190.00	285.00																	100.00			100.00			3.33	3.17	3.17			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H9096	005	0	1	01	01	H9096_005_0	7		Y	Specialty Tier	4	11	1	1	5	1		010	10	010		1				30					30							29	31												33							33						33																		33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H9096	005	0	1	01	01	H9096_005_0	7		Y	Vaccines	4	11	1	2	6	1		010	10			1				30												29	31								0.00							0.00																										0.00			0.00			0.00	0.00				0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H9096	005	0	1	01	01	H9096_005_0	7		Y	Vaccines	4	11	1	2	6	3		010	10			1				30												29	31								0.00							0.00																										0.00			0.00			0.00	0.00				0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines										1		
H9096	006	0	1	02	01	H9096_006_0	8		Y	Preferred Generic	4	01	1	2	1	1		111	10	111		1				30	60	100	1	2	30	60	100					29	31								7.00	14.00	7.00					2.00	4.00	2.00					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, Vaccines												
H9096	006	0	1	02	01	H9096_006_0	8		Y	Generic	4	11	1	2	2	1		111	10	111		1				30	60	100	1	2	30	60	100					29	31								10.00	20.00	20.00					5.00	10.00	10.00					10.00	20.00	0.00																	10.00			10.00			0.33	0.17	0.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H9096	006	0	1	02	01	H9096_006_0	8		Y	Preferred Brand	4	11	1	2	3	1		111	10	111		1				30	60	100	1	2	30	60	100					29	31								47.00	94.00	130.00					42.00	84.00	117.50					42.00	84.00	117.50																	47.00			47.00			1.57	1.40	1.40			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H9096	006	0	1	02	01	H9096_006_0	8		Y	Non-Preferred Drug	4	11	1	2	4	1		111	10	111		1				30	60	100	1	2	30	60	100					29	31								100.00	200.00	300.00					95.00	190.00	285.00					95.00	190.00	285.00																	100.00			100.00			3.33	3.17	3.17			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H9096	006	0	1	02	01	H9096_006_0	8		Y	Specialty Tier	4	11	1	1	5	1		010	10	010		1				30					30							29	31												29							29						29																		29		29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H9096	006	0	1	02	01	H9096_006_0	8		Y	Vaccines	4	11	1	2	6	1		010	10			1				30												29	31								0.00							0.00																										0.00			0.00			0.00	0.00				0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H9096	006	0	1	02	01	H9096_006_0	8		Y	Vaccines	4	11	1	2	6	3		010	10			1				30												29	31								0.00							0.00																										0.00			0.00			0.00	0.00				0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines										1		
H9096	012	0	1	02	01	H9096_012_0	7		Y	Preferred Generic	4	01	1	2	1	1		111	10	111		1				30	60	100	1	2	30	60	100					29	31								7.00	14.00	7.00					2.00	4.00	2.00					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, Vaccines												
H9096	012	0	1	02	01	H9096_012_0	7		Y	Generic	4	11	1	2	2	1		111	10	111		1				30	60	100	1	2	30	60	100					29	31								15.00	30.00	30.00					10.00	20.00	20.00					10.00	20.00	0.00																	15.00			15.00			0.50	0.33	0.33			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H9096	012	0	1	02	01	H9096_012_0	7		Y	Preferred Brand	4	11	1	2	3	1		111	10	111		1				30	60	100	1	2	30	60	100					29	31								47.00	94.00	130.00					42.00	84.00	117.50					42.00	84.00	117.50																	47.00			47.00			1.57	1.40	1.40			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H9096	012	0	1	02	01	H9096_012_0	7		Y	Non-Preferred Drug	4	11	1	2	4	1		111	10	111		1				30	60	100	1	2	30	60	100					29	31								100.00	200.00	300.00					95.00	190.00	285.00					95.00	190.00	285.00																	100.00			100.00			3.33	3.17	3.17			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H9096	012	0	1	02	01	H9096_012_0	7		Y	Specialty Tier	4	11	1	1	5	1		010	10	010		1				30					30							29	31												29							29						29																		29		29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H9096	012	0	1	02	01	H9096_012_0	7		Y	Vaccines	4	11	1	2	6	1		010	10			1				30												29	31								0.00							0.00																										0.00			0.00			0.00	0.00				0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H9096	012	0	1	02	01	H9096_012_0	7		Y	Vaccines	4	11	1	2	6	3		010	10			1				30												29	31								0.00							0.00																										0.00			0.00			0.00	0.00				0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines										1		
H9096	013	0	1	02	01	H9096_013_0	7		Y	Preferred Generic	4	01	1	2	1	1		111	10	111		1				30	60	100	1	2	30	60	100					29	31								7.00	14.00	7.00					2.00	4.00	2.00					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, Vaccines												
H9096	013	0	1	02	01	H9096_013_0	7		Y	Generic	4	11	1	2	2	1		111	10	111		1				30	60	100	1	2	30	60	100					29	31								10.00	20.00	20.00					5.00	10.00	10.00					10.00	20.00	0.00																	10.00			10.00			0.33	0.17	0.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H9096	013	0	1	02	01	H9096_013_0	7		Y	Preferred Brand	4	11	1	2	3	1		111	10	111		1				30	60	100	1	2	30	60	100					29	31								47.00	94.00	130.00					42.00	84.00	117.50					42.00	84.00	117.50																	47.00			47.00			1.57	1.40	1.40			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H9096	013	0	1	02	01	H9096_013_0	7		Y	Non-Preferred Drug	4	11	1	2	4	1		111	10	111		1				30	60	100	1	2	30	60	100					29	31								100.00	200.00	300.00					95.00	190.00	285.00					95.00	190.00	285.00																	100.00			100.00			3.33	3.17	3.17			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H9096	013	0	1	02	01	H9096_013_0	7		Y	Specialty Tier	4	11	1	1	5	1		010	10	010		1				30					30							29	31												29							29						29																		29		29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H9096	013	0	1	02	01	H9096_013_0	7		Y	Vaccines	4	11	1	2	6	1		010	10			1				30												29	31								0.00							0.00																										0.00			0.00			0.00	0.00				0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H9096	013	0	1	02	01	H9096_013_0	7		Y	Vaccines	4	11	1	2	6	3		010	10			1				30												29	31								0.00							0.00																										0.00			0.00			0.00	0.00				0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines										1		
H9104	006	0	1	01	01	H9104_006_0	11		Y	Preferred Generic	4	11	1	2	1	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00				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	11		Y	Preferred Generic	4	11	1	2	1	3		111	01		111	1				30	60	100	1	2				30	60	100	30		31								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00				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	11		Y	Generic	4	11	1	2	2	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								12.00	24.00	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	11		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				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	11		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								100.00	200.00	300.00					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	11		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9147	001	0	1	01	01	H9147_001_0	7		N	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00				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	7		N	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					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	7		N	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					40.00	80.00	120.00											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	7		N	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	300.00					95.00	190.00	285.00											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	7		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9147	001	0	1	01	01	H9147_001_0	7		N	Select Care Drugs	4	01	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9147	001	0	1	01	01	H9147_001_0	7		N	Select Care Drugs	4	01	1	2	6	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H9207	002	0	1	02	01	H9207_002_0	10		Y	Preferred Generic	4	11	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	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	10		Y	Generic	4	11	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	10.00	20.00	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												
H9207	002	0	1	02	01	H9207_002_0	10		Y	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	47.00	94.00	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												
H9207	002	0	1	02	01	H9207_002_0	10		Y	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	100.00	200.00	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												
H9207	002	0	1	02	01	H9207_002_0	10		Y	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				1060.99	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9207	012	0	1	02	01	H9207_012_0	10		Y	Preferred Generic	4	11	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	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	10		Y	Generic	4	11	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	10.00	20.00	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												
H9207	012	0	1	02	01	H9207_012_0	10		Y	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	47.00	94.00	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												
H9207	012	0	1	02	01	H9207_012_0	10		Y	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	100.00	200.00	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												
H9207	012	0	1	02	01	H9207_012_0	10		Y	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				996.28	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9207	013	0	1	02	01	H9207_013_0	10		Y	Preferred Generic	4	11	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	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	013	0	1	02	01	H9207_013_0	10		Y	Generic	4	11	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	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												
H9207	013	0	1	02	01	H9207_013_0	10		Y	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	47.00	94.00	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												
H9207	013	0	1	02	01	H9207_013_0	10		Y	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	100.00	200.00	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												
H9207	013	0	1	02	01	H9207_013_0	10		Y	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				1073.97	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9207	014	0	1	02	01	H9207_014_0	10		Y	Preferred Generic	4	11	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	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	014	0	1	02	01	H9207_014_0	10		Y	Generic	4	11	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	10.00	20.00	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												
H9207	014	0	1	02	01	H9207_014_0	10		Y	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	47.00	94.00	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												
H9207	014	0	1	02	01	H9207_014_0	10		Y	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	100.00	200.00	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												
H9207	014	0	1	02	01	H9207_014_0	10		Y	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				1068.05	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	5			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	5			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	5			Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00	84.00	84.00																47.00				47.00			1.57	1.40	1.40			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9219	002	0	1	04	01	H9219_002_0	5			Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		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	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												
H9219	002	0	1	04	01	H9219_002_0	5			Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9219	002	0	1	04	01	H9219_002_0	5			Select Care Drugs	4	01	1	2	6	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H9231	001	0	1	04	01	H9231_001_0	11		Y	Preferred Generic	4	11	1	2	1	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9231	001	0	1	04	01	H9231_001_0	11		Y	Preferred Generic	4	11	1	2	1	3	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H9231	001	0	1	04	01	H9231_001_0	11		Y	Generic	4	11	3	2	2	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	2.00	4.00	6.00																			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												
H9231	001	0	1	04	01	H9231_001_0	11		Y	Generic	4	11	3	2	2	3	111		01	111		1	30	60	100				1	2	30	60	100				30		31	2.00	4.00	6.00																			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										2	2	2
H9231	001	0	1	04	01	H9231_001_0	11		Y	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	47.00	94.00	141.00																			47.00	94.00	117.50																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9231	001	0	1	04	01	H9231_001_0	11		Y	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	100.00	200.00	300.00																			100.00	200.00	300.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9231	001	0	1	04	01	H9231_001_0	11		Y	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												
H9239	001	0	1	48	05	H9239_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			
H9239	001	0	1	48	05	H9239_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			
H9239	001	0	1	48	05	H9239_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			
H9258	001	0	1	01	01	H9258_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												
H9258	001	0	1	01	01	H9258_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												
H9258	001	0	1	01	01	H9258_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												
H9258	001	0	1	01	01	H9258_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											91.94	47	47	47				88.03	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	4			Specialty Tier	4	11	1	1	5	1		010	01		010	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	4			Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9302	007	0	1	01	01	H9302_007_0	6		Y	Preferred Generic	4	11	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	2.00	4.00	6.00																			2.00	4.00	0.00																2.00				2.00		0.07			0.07			0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9302	007	0	1	01	01	H9302_007_0	6		Y	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												
H9302	007	0	1	01	01	H9302_007_0	6		Y	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	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												
H9302	007	0	1	01	01	H9302_007_0	6		Y	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	100.00	200.00	300.00																			100.00	200.00	300.00																100.00				100.00		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	6		Y	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												
H9302	011	0	1	01	01	H9302_011_0	7		Y	Preferred Generic	4	11	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	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												
H9302	011	0	1	01	01	H9302_011_0	7		Y	Generic	4	11	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	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												
H9302	011	0	1	01	01	H9302_011_0	7		Y	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	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												
H9302	011	0	1	01	01	H9302_011_0	7		Y	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	100.00	200.00	300.00																			100.00	200.00	300.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9302	011	0	1	01	01	H9302_011_0	7		Y	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				1.00	30																				30																	30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9306	001	0	1	01	01	H9306_001_0	6		N	Preferred Generic	4	11	1	2	1	1	111		10	111		1	30	60	90				2	2	30	60	90					10	31	3.00	3.00	0.00																			3.00	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		N	Generic	4	11	1	2	2	1	111		10	111		1	30	60	90				2	2	30	60	90					10	31	8.00	8.00	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		N	Preferred Brand	4	11	1	2	3	1	111		10	111		1	30	60	90				2	2	30	60	90					10	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												
H9306	001	0	1	01	01	H9306_001_0	6		N	Non-Preferred Drug	4	11	1	2	4	1	111		10	111		1	30	60	90				2	2	30	60	90					10	31	100.00	200.00	300.00																			100.00	200.00	300.00																	100.00			100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9306	001	0	1	01	01	H9306_001_0	6		N	Specialty Tier	4	11	1	1	5	1	010		10	010		1	30								30							10	31				205.05	33																				33																		33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9306	002	0	1	01	01	H9306_002_0	5		N	Preferred Generic	4	11	1	2	1	1	111		10	111		1	30	60	90				2	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, Supplemental Drugs												
H9306	002	0	1	01	01	H9306_002_0	5		N	Generic	4	11	1	2	2	1	111		10	111		1	30	60	90				2	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, Supplemental Drugs												
H9306	002	0	1	01	01	H9306_002_0	5		N	Preferred Brand	4	11	1	2	3	1	111		10	111		1	30	60	90				2	2	30	60	90					10	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, Supplemental Drugs												
H9306	002	0	1	01	01	H9306_002_0	5		N	Non-Preferred Drug	4	11	1	2	4	1	111		10	111		1	30	60	90				2	2	30	60	90					10	31	100.00	200.00	300.00																			100.00	200.00	300.00																	100.00			100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Supplemental Drugs												
H9306	002	0	1	01	01	H9306_002_0	5		N	Specialty Tier	4	11	1	1	5	1	010		10	010		1	30								30							10	31				207.57	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	5		N	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												
H9306	005	0	1	01	01	H9306_005_0	8		N	Preferred Generic	4	11	1	2	1	1	111		10	111		1	30	60	90				2	2	30	60	90					10	31	3.00	3.00	0.00																			3.00	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	005	0	1	01	01	H9306_005_0	8		N	Generic	4	11	1	2	2	1	111		10	111		1	30	60	90				2	2	30	60	90					10	31	8.00	8.00	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	005	0	1	01	01	H9306_005_0	8		N	Preferred Brand	4	11	1	2	3	1	111		10	111		1	30	60	90				2	2	30	60	90					10	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												
H9306	005	0	1	01	01	H9306_005_0	8		N	Non-Preferred Drug	4	11	1	2	4	1	111		10	111		1	30	60	90				2	2	30	60	90					10	31	100.00	200.00	300.00																			100.00	200.00	300.00																	100.00			100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9306	005	0	1	01	01	H9306_005_0	8		N	Specialty Tier	4	11	1	1	5	1	010		10	010		1	30								30							10	31				197.98	28																				28																		28		28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
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											85.61	47	47	47				81.97	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	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											85.74	50	50	50				82.31	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	3	11	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								19.00	38.00	57.00					0.00	0.00	0.00											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												
H9335	006	0	1	01	01	H9335_006_0	4			Generic	3	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					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												
H9335	006	0	1	01	01	H9335_006_0	4			Preferred Brand	3	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	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, Select Care Drugs												
H9335	006	0	1	01	01	H9335_006_0	4			Non-Preferred Drug	3	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											99.50	44	44	44				99.50	44	44	44										44	44	44				44	44	44			44			44								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9335	006	0	1	01	01	H9335_006_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, Select Care Drugs												
H9335	006	0	1	01	01	H9335_006_0	4			Select Care Drugs	3	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			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	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												
H9357	001	0	1	04	01	H9357_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												
H9357	001	0	1	04	01	H9357_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												
H9357	001	0	1	04	01	H9357_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												
H9357	001	0	1	04	01	H9357_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												
H9357	001	0	1	04	01	H9357_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												
H9357	002	0	1	04	01	H9357_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								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00				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	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												
H9357	002	0	1	04	01	H9357_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												
H9357	002	0	1	04	01	H9357_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												
H9357	002	0	1	04	01	H9357_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												
H9357	002	0	1	04	01	H9357_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												
H9357	003	0	1	04	01	H9357_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								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00				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	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												
H9357	003	0	1	04	01	H9357_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												
H9357	003	0	1	04	01	H9357_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												
H9357	003	0	1	04	01	H9357_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												
H9357	003	0	1	04	01	H9357_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												
H9357	004	0	1	04	01	H9357_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												
H9357	004	0	1	04	01	H9357_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												
H9357	004	0	1	04	01	H9357_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												
H9357	004	0	1	04	01	H9357_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												
H9357	004	0	1	04	01	H9357_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												
H9357	004	0	1	04	01	H9357_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												
H9364	001	0	1	01	01	H9364_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												
H9364	001	0	1	01	01	H9364_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												
H9364	001	0	1	01	01	H9364_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												
H9364	001	0	1	01	01	H9364_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											77.58	46	46	46				74.21	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	4			Specialty Tier	4	11	1	1	5	1		010	01		010	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	4			Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			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	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												
H9364	004	0	1	01	01	H9364_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												
H9364	004	0	1	01	01	H9364_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												
H9364	004	0	1	01	01	H9364_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											84.52	50	50	50				81.14	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	4			Specialty Tier	4	11	1	1	5	1		010	01		010	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	4			Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			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	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												
H9387	001	0	1	04	01	H9387_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												
H9387	001	0	1	04	01	H9387_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												
H9387	001	0	1	04	01	H9387_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												
H9387	001	0	1	04	01	H9387_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												
H9387	001	0	1	04	01	H9387_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												
H9403	003	0	1	01	01	H9403_003_0	5		Y	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	5		Y	Generic	4	01	3	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	5		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	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	5		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								100.00	200.00	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	5		Y	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		Y	Preferred Generic	4	01	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		Y	Generic	4	01	3	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		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	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		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								100.00	200.00	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		Y	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												
H9414	001	0	1	04	01	H9414_001_0	5		Y	Preferred Generic	4	01	1	2	1	1	111		01	111		1	31	60	100				1	2	31	60	100				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	5		Y	Generic	4	01	1	2	2	1	111		01	111		1	31	60	100				1	2	31	60	100				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	5		Y	Preferred Brand	4	10	1	2	3	1	111		01	111		1	31	60	100				1	2	31	60	100				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	5		Y	Non-Preferred Brand	4	11	1	2	4	1	111		01	111		1	31	60	100				1	2	31	60	100				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	5		Y	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	5		N	Preferred Generic	4	01	1	2	1	1	111		01	111		1	31	60	100				1	2	31	60	100				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	002	0	1	04	01	H9414_002_0	5		N	Generic	4	01	1	2	2	1	111		01	111		1	31	60	100				1	2	31	60	100				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	002	0	1	04	01	H9414_002_0	5		N	Preferred Brand	4	10	1	2	3	1	111		01	111		1	31	60	100				1	2	31	60	100				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	5		N	Non-Preferred Brand	4	11	1	2	4	1	111		01	111		1	31	60	100				1	2	31	60	100				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	5		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	31								31						31		31					25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9414	003	0	1	04	01	H9414_003_0	4		Y	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	003	0	1	04	01	H9414_003_0	4		Y	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												
H9414	003	0	1	04	01	H9414_003_0	4		Y	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	141.00																47.00				47.00		1.52			1.52			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9414	003	0	1	04	01	H9414_003_0	4		Y	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	300.00																100.00				100.00		3.23			3.23			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9414	003	0	1	04	01	H9414_003_0	4		Y	Specialty Tier	4	11	1	1	5	1	010		01	010		1	31								31						31		31					25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9428	001	0	1	04	01	H9428_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												
H9428	001	0	1	04	01	H9428_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												
H9428	001	0	1	04	01	H9428_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												
H9428	001	0	1	04	01	H9428_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											94.05	50	50	50				90.28	48	48	48										50	50	50				48	48	48			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9428	001	0	1	04	01	H9428_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												
H9428	001	0	1	04	01	H9428_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												
H9428	001	0	1	04	01	H9428_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	
H9428	002	0	1	04	01	H9428_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												
H9428	002	0	1	04	01	H9428_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												
H9428	002	0	1	04	01	H9428_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												
H9428	002	0	1	04	01	H9428_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											98.61	48	48	48				94.50	46	46	46										48	48	48				46	46	46			48			48								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9428	002	0	1	04	01	H9428_002_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												
H9428	002	0	1	04	01	H9428_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												
H9428	002	0	1	04	01	H9428_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	
H9431	001	0	1	04	01	H9431_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												
H9431	001	0	1	04	01	H9431_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		
H9431	001	0	1	04	01	H9431_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	20.00											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												
H9431	001	0	1	04	01	H9431_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	20.00											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										1		
H9431	001	0	1	04	01	H9431_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												
H9431	001	0	1	04	01	H9431_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												
H9431	001	0	1	04	01	H9431_001_0	2			Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											785.66	28						483.51	28												28						28						28		28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9431	002	0	1	04	01	H9431_002_0	3			Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					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	20.00											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												
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	20.00											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										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											1099.08	33						638.31	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	20.00											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												
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	20.00											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										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											712.46	33						460.26	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9431	005	0	1	04	01	H9431_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												
H9431	005	0	1	04	01	H9431_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		
H9431	005	0	1	04	01	H9431_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	20.00											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												
H9431	005	0	1	04	01	H9431_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	20.00											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										1		
H9431	005	0	1	04	01	H9431_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												
H9431	005	0	1	04	01	H9431_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												
H9431	005	0	1	04	01	H9431_005_0	2			Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											909.98	33						664.44	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9431	006	0	1	04	01	H9431_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												
H9431	006	0	1	04	01	H9431_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		
H9431	006	0	1	04	01	H9431_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					10.00	20.00	20.00											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												
H9431	006	0	1	04	01	H9431_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					10.00	20.00	20.00											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										1		
H9431	006	0	1	04	01	H9431_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												
H9431	006	0	1	04	01	H9431_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												
H9431	006	0	1	04	01	H9431_006_0	2			Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											890.25	33						605.83	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								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00					5.00			5.00			0.17	0.00		0.17	0.00	0.16	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								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00					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		
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								12.00	24.00	36.00					10.00	20.00	20.00											12.00	24.00	36.00				10.00	20.00	20.00					12.00			12.00			0.40	0.33		0.40	0.33	0.39	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								12.00	24.00	36.00					10.00	20.00	20.00											12.00	24.00	36.00				10.00	20.00	20.00					12.00			12.00			0.40	0.33		0.40	0.33	0.39	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											949.47	33						557.88	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								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												
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								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		
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								12.00	24.00	36.00					10.00	20.00	20.00											12.00	24.00	36.00				10.00	20.00	20.00					12.00			12.00			0.40	0.33		0.40	0.33	0.39	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								12.00	24.00	36.00					10.00	20.00	20.00											12.00	24.00	36.00				10.00	20.00	20.00					12.00			12.00			0.40	0.33		0.40	0.33	0.39	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											792.89	33						627.32	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9460	001	0	1	01	01	H9460_001_0	4			Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								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	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												
H9460	001	0	1	01	01	H9460_001_0	4			Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9460	001	0	1	01	01	H9460_001_0	4			Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											99.12	45	45	45				87.00	45	45	45										45	45	45				45	45	45			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9460	001	0	1	01	01	H9460_001_0	4			Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											754.54	33						700.13	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9469	001	0	1	04	01	H9469_001_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												
H9469	001	0	1	04	01	H9469_001_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
H9469	001	0	1	04	01	H9469_001_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												
H9469	001	0	1	04	01	H9469_001_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												
H9469	001	0	1	04	01	H9469_001_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												
H9469	001	0	1	04	01	H9469_001_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												
H9469	002	0	1	04	01	H9469_002_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												
H9469	002	0	1	04	01	H9469_002_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
H9469	002	0	1	04	01	H9469_002_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												
H9469	002	0	1	04	01	H9469_002_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												
H9469	002	0	1	04	01	H9469_002_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												
H9469	002	0	1	04	01	H9469_002_0	6			Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		34					30																				30																	30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9469	003	0	1	04	01	H9469_003_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												
H9469	003	0	1	04	01	H9469_003_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
H9469	003	0	1	04	01	H9469_003_0	8			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												
H9469	003	0	1	04	01	H9469_003_0	8			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												
H9469	003	0	1	04	01	H9469_003_0	8			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												
H9469	003	0	1	04	01	H9469_003_0	8			Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		34					30																				30																	30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9469	004	0	1	04	01	H9469_004_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												
H9469	004	0	1	04	01	H9469_004_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												
H9469	004	0	1	04	01	H9469_004_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												
H9469	004	0	1	04	01	H9469_004_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												
H9469	004	0	1	04	01	H9469_004_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												
H9469	005	0	1	04	01	H9469_005_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												
H9469	005	0	1	04	01	H9469_005_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												
H9469	005	0	1	04	01	H9469_005_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												
H9469	005	0	1	04	01	H9469_005_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												
H9469	005	0	1	04	01	H9469_005_0	6			Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		34					30																				30																	30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9469	006	0	1	04	01	H9469_006_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												
H9469	006	0	1	04	01	H9469_006_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
H9469	006	0	1	04	01	H9469_006_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												
H9469	006	0	1	04	01	H9469_006_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												
H9469	006	0	1	04	01	H9469_006_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												
H9469	006	0	1	04	01	H9469_006_0	6			Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		34					30																				30																	30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9469	007	0	1	04	01	H9469_007_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												
H9469	007	0	1	04	01	H9469_007_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
H9469	007	0	1	04	01	H9469_007_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												
H9469	007	0	1	04	01	H9469_007_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												
H9469	007	0	1	04	01	H9469_007_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												
H9469	007	0	1	04	01	H9469_007_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												
H9469	008	0	1	04	01	H9469_008_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												
H9469	008	0	1	04	01	H9469_008_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
H9469	008	0	1	04	01	H9469_008_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												
H9469	008	0	1	04	01	H9469_008_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												
H9469	008	0	1	04	01	H9469_008_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												
H9469	008	0	1	04	01	H9469_008_0	6			Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		34					30																				30																	30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9469	009	0	1	04	01	H9469_009_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												
H9469	009	0	1	04	01	H9469_009_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
H9469	009	0	1	04	01	H9469_009_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												
H9469	009	0	1	04	01	H9469_009_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												
H9469	009	0	1	04	01	H9469_009_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												
H9469	009	0	1	04	01	H9469_009_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												
H9485	001	0	1	04	01	H9485_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	0.00	0.00	0.00																			0.00	0.00	0.00																	0.00			0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9485	001	0	1	04	01	H9485_001_0	5			Generic	4	01	1	2	2	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	3.00	6.00	9.00																			3.00	6.00	6.00																	3.00			3.00		0.10			0.10			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9485	001	0	1	04	01	H9485_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	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 Drug, Specialty Tier												
H9485	001	0	1	04	01	H9485_001_0	5			Non-Preferred Drug	4	11	1	2	4	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	100.00	200.00	300.00																			100.00	200.00	200.00																	100.00			100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9485	001	0	1	04	01	H9485_001_0	5			Specialty Tier	4	11	1	1	5	1	010		10	010		1	30								30							10	31				250.00	28																				28																		28		28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9485	002	0	1	04	01	H9485_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												
H9485	002	0	1	04	01	H9485_002_0	5			Generic	4	01	1	2	2	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	3.00	6.00	9.00																			3.00	6.00	6.00																	3.00			3.00		0.10			0.10			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9485	002	0	1	04	01	H9485_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	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 Drug, Specialty Tier												
H9485	002	0	1	04	01	H9485_002_0	5			Non-Preferred Drug	4	11	1	2	4	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	100.00	200.00	300.00																			100.00	200.00	200.00																	100.00			100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9485	002	0	1	04	01	H9485_002_0	5			Specialty Tier	4	11	1	1	5	1	010		10	010		1	30								30							10	31				250.00	33																				33																		33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9489	001	0	1	01	01	H9489_001_0	10		Y	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								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, Select Care Drugs												
H9489	001	0	1	01	01	H9489_001_0	10		Y	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								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, Select Care Drugs												
H9489	001	0	1	01	01	H9489_001_0	10		Y	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	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, Select Care Drugs												
H9489	001	0	1	01	01	H9489_001_0	10		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	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, Select Care Drugs												
H9489	001	0	1	01	01	H9489_001_0	10		Y	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											806.98	29						806.98	29						29																	29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9489	001	0	1	01	01	H9489_001_0	10		Y	Select Care Drugs	4	11	1	2	6	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9525	003	0	1	01	01	H9525_003_0	5		N	Preferred Generic	4	01	1	2	1	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	5		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								15.00	30.00	45.00					15.00	30.00	45.00					15.00	45.00	45.00																15.00				15.00			0.50	0.50	0.50			0.44	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9525	003	0	1	01	01	H9525_003_0	5		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								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	5		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	285.00	285.00																100.00				100.00			3.33	3.17	3.17			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9525	003	0	1	01	01	H9525_003_0	5		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												25							25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9525	003	0	1	01	01	H9525_003_0	5		N	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								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	5		Y	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												
H9525	004	0	1	01	01	H9525_004_0	5		Y	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		
H9525	004	0	1	01	01	H9525_004_0	5		Y	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	5		Y	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00	84.00	84.00																47.00				47.00			1.57	1.40	1.40			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9525	004	0	1	01	01	H9525_004_0	5		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	190.00	190.00																100.00				100.00			3.33	3.17	3.17			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9525	004	0	1	01	01	H9525_004_0	5		Y	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												30							30						30																	30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9525	004	0	1	01	01	H9525_004_0	5		Y	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9525	004	0	1	01	01	H9525_004_0	5		Y	Select Care Drugs	4	01	1	2	6	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H9525	006	0	1	01	01	H9525_006_0	5		Y	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												
H9525	006	0	1	01	01	H9525_006_0	5		Y	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		
H9525	006	0	1	01	01	H9525_006_0	5		Y	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	5		Y	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00	84.00	84.00																47.00				47.00			1.57	1.40	1.40			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9525	006	0	1	01	01	H9525_006_0	5		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	190.00	190.00																100.00				100.00			3.33	3.17	3.17			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9525	006	0	1	01	01	H9525_006_0	5		Y	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												30							30						30																	30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9525	006	0	1	01	01	H9525_006_0	5		Y	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9525	006	0	1	01	01	H9525_006_0	5		Y	Select Care Drugs	4	01	1	2	6	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				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	6		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								15.00	30.00	45.00					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	007	0	1	01	01	H9525_007_0	6		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								20.00	40.00	60.00					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	6		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								47.00	94.00	141.00					47.00	94.00	141.00					47.00	141.00	141.00																47.00				47.00			1.57	1.57	1.57			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9525	007	0	1	01	01	H9525_007_0	6		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	285.00	285.00																100.00				100.00			3.33	3.17	3.17			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9525	007	0	1	01	01	H9525_007_0	6		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												25							25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9525	007	0	1	01	01	H9525_007_0	6		N	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								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	6		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								10.00	20.00	30.00					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	6		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								20.00	40.00	60.00					20.00	40.00	60.00					20.00	60.00	60.00																20.00				20.00			0.67	0.67	0.67			0.59	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9525	010	0	1	01	01	H9525_010_0	6		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								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	6		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	285.00	285.00																100.00				100.00			3.33	3.17	3.17			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9525	010	0	1	01	01	H9525_010_0	6		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												25							25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9525	010	0	1	01	01	H9525_010_0	6		N	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								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	7		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								7.00	14.00	21.00					2.00	4.00	6.00					0.00	0.00	0.00																7.00				7.00			0.23	0.07	0.00			0.21	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9525	011	0	1	01	01	H9525_011_0	7		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								14.00	28.00	42.00					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	7		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00	84.00	84.00																47.00				47.00			1.57	1.40	1.40			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9525	011	0	1	01	01	H9525_011_0	7		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	190.00	190.00																100.00				100.00			3.33	3.17	3.17			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9525	011	0	1	01	01	H9525_011_0	7		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9525	011	0	1	01	01	H9525_011_0	7		N	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9525	011	0	1	01	01	H9525_011_0	7		N	Select Care Drugs	4	01	1	2	6	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H9525	012	0	1	01	01	H9525_012_0	5		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								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	012	0	1	01	01	H9525_012_0	5		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								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	012	0	1	01	01	H9525_012_0	5		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								47.00	94.00	141.00					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	012	0	1	01	01	H9525_012_0	5		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	285.00	285.00																100.00				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	5		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												25							25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9525	012	0	1	01	01	H9525_012_0	5		N	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								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	013	1	1	01	01	H9525_013_1	5		Y	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	5		Y	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	5		Y	Preferred Brand	4	11	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	5		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				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	5		Y	Specialty Tier	4	11	1	1	5	1		010	01	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	5		Y	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				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	5		Y	Select Care Drugs	4	01	1	2	6	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				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	5		Y	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	5		Y	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	5		Y	Preferred Brand	4	11	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	5		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				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	5		Y	Specialty Tier	4	11	1	1	5	1		010	01	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	5		Y	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				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	5		Y	Select Care Drugs	4	01	1	2	6	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				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	5		Y	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	5		Y	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	5		Y	Preferred Brand	4	11	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	5		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				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	5		Y	Specialty Tier	4	11	1	1	5	1		010	01	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	5		Y	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				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	5		Y	Select Care Drugs	4	01	1	2	6	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				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	5		Y	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	5		Y	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	5		Y	Preferred Brand	4	11	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	5		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				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	5		Y	Specialty Tier	4	11	1	1	5	1		010	01	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	5		Y	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				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	5		Y	Select Care Drugs	4	01	1	2	6	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				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	015	0	1	01	01	H9525_015_0	5		Y	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												
H9525	015	0	1	01	01	H9525_015_0	5		Y	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		
H9525	015	0	1	01	01	H9525_015_0	5		Y	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	015	0	1	01	01	H9525_015_0	5		Y	Preferred Brand	4	11	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	015	0	1	01	01	H9525_015_0	5		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				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	015	0	1	01	01	H9525_015_0	5		Y	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	015	0	1	01	01	H9525_015_0	5		Y	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9525	015	0	1	01	01	H9525_015_0	5		Y	Select Care Drugs	4	01	1	2	6	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				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		116.00				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											76.00	48		48				76.00	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		116.00				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											76.00	48		48				76.00	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		116.00				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											76.00	48		48				76.00	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		116.00				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											76.00	48		48				76.00	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		116.00				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											76.00	48		48				76.00	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		116.00				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											74.00	50		50				70.00	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		116.00				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											74.00	50		50				70.00	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		116.00				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											74.00	50		50				70.00	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		116.00				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											74.00	50		50				70.00	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	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	002	6	1	04	01	H9572_002_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	002	6	1	04	01	H9572_002_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	002	6	1	04	01	H9572_002_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		116.00				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	8			Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				31		90	1	2				31		90	31		31											74.00	50		50				70.00	50		50										50		50				50		50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9572	002	6	1	04	01	H9572_002_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												
H9572	003	1	1	04	01	H9572_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												
H9572	003	1	1	04	01	H9572_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		
H9572	003	1	1	04	01	H9572_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												
H9572	003	1	1	04	01	H9572_003_1	8			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		101.00				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	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				74.00	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	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	003	2	1	04	01	H9572_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												
H9572	003	2	1	04	01	H9572_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		
H9572	003	2	1	04	01	H9572_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												
H9572	003	2	1	04	01	H9572_003_2	8			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		101.00				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	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				74.00	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	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	003	3	1	04	01	H9572_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												
H9572	003	3	1	04	01	H9572_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		
H9572	003	3	1	04	01	H9572_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												
H9572	003	3	1	04	01	H9572_003_3	8			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		101.00				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	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				74.00	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	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	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		101.00				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											65.00	45		45				74.00	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		101.00				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											65.00	45		45				74.00	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	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	004	1	1	04	01	H9572_004_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	004	1	1	04	01	H9572_004_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	004	1	1	04	01	H9572_004_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		116.00				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	7			Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				31		90	1	2				31		90	31		31											77.00	50		50				74.00	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	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	2	1	04	01	H9572_004_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	004	2	1	04	01	H9572_004_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	004	2	1	04	01	H9572_004_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	004	2	1	04	01	H9572_004_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		116.00				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	7			Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				31		90	1	2				31		90	31		31											77.00	50		50				74.00	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	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	3	1	04	01	H9572_004_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	004	3	1	04	01	H9572_004_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	004	3	1	04	01	H9572_004_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	004	3	1	04	01	H9572_004_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		116.00				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	7			Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				31		90	1	2				31		90	31		31											77.00	50		50				74.00	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	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	4	1	04	01	H9572_004_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	004	4	1	04	01	H9572_004_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	004	4	1	04	01	H9572_004_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	004	4	1	04	01	H9572_004_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		116.00				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	7			Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				31		90	1	2				31		90	31		31											77.00	50		50				74.00	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	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	6	1	04	01	H9572_004_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	004	6	1	04	01	H9572_004_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	004	6	1	04	01	H9572_004_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	004	6	1	04	01	H9572_004_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		116.00				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	7			Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				31		90	1	2				31		90	31		31											77.00	50		50				74.00	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	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												
H9576	001	0	1	48	05	H9576_001_0	3			Generic Drugs	4	01			1	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31																																																					Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	1	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H9576	001	0	1	48	05	H9576_001_0	3			Brand Drugs	4	10			2	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31																																																					Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	1	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H9576	001	0	1	48	05	H9576_001_0	3			Non-Medicare Rx/OTC Drugs	4	11			3	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31																																																					Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	2	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H9589	003	0	1	04	01	H9589_003_0	5		Y	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	5		Y	Generic	4	01	3	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	5		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	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	5		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								100.00	200.00	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	5		Y	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	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, Select Care Drugs												
H9614	001	0	1	04	01	H9614_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, Select Care Drugs										1		
H9614	001	0	1	04	01	H9614_001_0	5			Generic	4	01	1	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	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	5			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	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	5			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	300.00																			100.00	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	5			Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				854.71	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	5			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	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	5			Select Care Drugs	4	01	1	2	6	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, Select Care Drugs										1		
H9615	007	0	1	04	01	H9615_007_0	8		Y	Preferred Generic	4	01	1	2	1	1	110		01	110		1	30		90				1	2	30		90				30		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9615	007	0	1	04	01	H9615_007_0	8		Y	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	8		Y	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	8		Y	Preferred Brand	4	11	1	2	3	1	110		01	110		1	30		90				2	2	30		90				30		31	35.00		105.00																			35.00		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	8		Y	Non-Preferred Drug	4	11	1	1	4	1	110		01	110		1	30		90				2	2	30		90				30		31				98.08	25		25																		25		25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9615	007	0	1	04	01	H9615_007_0	8		Y	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	8		Y	Preferred Generic	4	01	1	2	1	1	110		01	110		1	30		90				1	2	30		90				30		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9615	008	0	1	04	01	H9615_008_0	8		Y	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	8		Y	Preferred Brand	4	11	1	2	3	1	110		01	110		1	30		90				2	2	30		90				30		31	47.00		141.00																			47.00		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	8		Y	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	8		Y	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	8		Y	Preferred Generic	4	01	1	2	1	1	110		01	110		1	30		90				1	2	30		90				30		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9615	009	0	1	04	01	H9615_009_0	8		Y	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	8		Y	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	8		Y	Preferred Brand	4	11	1	2	3	1	110		01	110		1	30		90				2	2	30		90				30		31	35.00		105.00																			35.00		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	8		Y	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	8		Y	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	8		Y	Preferred Generic	4	01	1	2	1	1	110		01	110		1	30		90				1	2	30		90				30		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9615	010	0	1	04	01	H9615_010_0	8		Y	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	8		Y	Preferred Brand	4	11	1	2	3	1	110		01	110		1	30		90				2	2	30		90				30		31	47.00		141.00																			47.00		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	8		Y	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	8		Y	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	8		Y	Preferred Generic	4	01	1	2	1	1	110		01	110		1	30		90				1	2	30		90				30		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9615	012	0	1	04	01	H9615_012_0	8		Y	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	8		Y	Preferred Brand	4	11	1	2	3	1	110		01	110		1	30		90				2	2	30		90				30		31	47.00		141.00																			47.00		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	8		Y	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	8		Y	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	8		Y	Preferred Generic	4	01	1	2	1	1	110		01	110		1	30		90				1	2	30		90				30		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9615	014	0	1	04	01	H9615_014_0	8		Y	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	8		Y	Preferred Brand	4	11	1	2	3	1	110		01	110		1	30		90				2	2	30		90				30		31	45.00		135.00																			45.00		90.00																45.00				45.00		1.50			1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9615	014	0	1	04	01	H9615_014_0	8		Y	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	8		Y	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	9		Y	Preferred Generic	4	01	1	2	1	1	110		01	110		1	30		90				1	2	30		90				30		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9615	015	0	1	04	01	H9615_015_0	9		Y	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	9		Y	Preferred Brand	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	9		Y	Non-Preferred Drug	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	9		Y	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	9		Y	Preferred Generic	4	01	1	2	1	1	110		01	110		1	30		90				1	2	30		90				30		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9615	016	0	1	04	01	H9615_016_0	9		Y	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	9		Y	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	9		Y	Non-Preferred Drug	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	9		Y	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	9		Y	Preferred Generic	4	01	1	2	1	1	110		01	110		1	30		90				1	2	30		90				30		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9615	017	0	1	04	01	H9615_017_0	9		Y	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	9		Y	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	9		Y	Non-Preferred Drug	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	9		Y	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	018	0	1	04	01	H9615_018_0	7		Y	Preferred Generic	4	01	1	2	1	1	110		01	110		1	30		90				1	2	30		90				30		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9615	018	0	1	04	01	H9615_018_0	7		Y	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	018	0	1	04	01	H9615_018_0	7		Y	Preferred Brand	4	11	1	2	3	1	110		01	110		1	30		90				2	2	30		90				30		31	45.00		135.00																			45.00		90.00																45.00				45.00		1.50			1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9615	018	0	1	04	01	H9615_018_0	7		Y	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	018	0	1	04	01	H9615_018_0	7		Y	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	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	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					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												
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					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	84.00				47.00				47.00			1.57	1.4		1.57	1.4	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, 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					95.00	190.00	285.00											100.00	200.00	300.00				95.00	190.00	190.00				100.00				100.00			3.33	3.17		3.33	3.17	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												29							29												29						29					29			29								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	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	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					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												
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					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	84.00				47.00				47.00			1.57	1.4		1.57	1.4	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, 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					95.00	190.00	285.00											100.00	200.00	300.00				95.00	190.00	190.00				100.00				100.00			3.33	3.17		3.33	3.17	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												29							29												29						29					29			29								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	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	3	11	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								19.00	38.00	57.00					0.00	0.00	0.00											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												
H9630	005	0	1	01	01	H9630_005_0	5			Generic	3	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					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												
H9630	005	0	1	01	01	H9630_005_0	5			Preferred Brand	3	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	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, Select Care Drugs												
H9630	005	0	1	01	01	H9630_005_0	5			Non-Preferred Drug	3	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											89.55	50	50	50				89.55	50	50	50										50	50	50				50	50	50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9630	005	0	1	01	01	H9630_005_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												
H9630	005	0	1	01	01	H9630_005_0	5			Select Care Drugs	3	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			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	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					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												
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					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	84.00				47.00				47.00			1.57	1.4		1.57	1.4	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, 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					95.00	190.00	285.00											100.00	200.00	300.00				95.00	190.00	190.00				100.00				100.00			3.33	3.17		3.33	3.17	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			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	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9630	013	0	1	01	01	H9630_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												
H9630	013	0	1	01	01	H9630_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
H9630	013	0	1	01	01	H9630_013_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												
H9630	013	0	1	01	01	H9630_013_0	5			Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	84.00				47.00				47.00			1.57	1.4		1.57	1.4	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9630	013	0	1	01	01	H9630_013_0	5			Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	300.00					95.00	190.00	285.00											100.00	200.00	300.00				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 Drug, Specialty Tier, Select Care Drugs												
H9630	013	0	1	01	01	H9630_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												
H9630	013	0	1	01	01	H9630_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												
H9630	013	0	1	01	01	H9630_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	
H9678	001	0	1	04	01	H9678_001_0	10		Y	Preferred Generic	4	11	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	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												
H9678	001	0	1	04	01	H9678_001_0	10		Y	Generic	4	11	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	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												
H9678	001	0	1	04	01	H9678_001_0	10		Y	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	47.00	94.00	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												
H9678	001	0	1	04	01	H9678_001_0	10		Y	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	100.00	200.00	300.00																			100.00	200.00	300.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Supplemental Drugs												
H9678	001	0	1	04	01	H9678_001_0	10		Y	Specialty Tier	4	11	1	1	5	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31					26	26	26																		26	26	26															26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Supplemental Drugs												
H9678	001	0	1	04	01	H9678_001_0	10		Y	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			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Supplemental Drugs												
H9678	001	0	1	04	01	H9678_001_0	10		Y	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			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Supplemental Drugs										1		
H9686	001	0	1	01	01	H9686_001_0	4		N	Preferred Generic	4	11	1	2	1	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																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	4		N	Preferred Generic	4	11	1	2	1	3	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H9686	001	0	1	01	01	H9686_001_0	4		N	Generic	4	01	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9686	001	0	1	01	01	H9686_001_0	4		N	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	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	4		N	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	300.00																			100.00	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	001	0	1	01	01	H9686_001_0	4		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				927.98	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	4		N	Select Care Drugs	4	01	1	2	6	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	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	4		N	Select Care Drugs	4	01	1	2	6	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, Select Care Drugs										1		
H9686	003	0	1	01	01	H9686_003_0	7		N	Preferred Generic	4	11	1	2	1	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																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		N	Preferred Generic	4	11	1	2	1	3	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H9686	003	0	1	01	01	H9686_003_0	7		N	Generic	4	01	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9686	003	0	1	01	01	H9686_003_0	7		N	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	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		N	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	300.00																			100.00	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	003	0	1	01	01	H9686_003_0	7		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				959.29	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		N	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	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		N	Select Care Drugs	4	01	1	2	6	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, Select Care Drugs										1		
H9686	004	0	1	01	01	H9686_004_0	5		Y	Preferred Generic	4	11	1	2	1	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9686	004	0	1	01	01	H9686_004_0	5		Y	Preferred Generic	4	11	1	2	1	3	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H9686	004	0	1	01	01	H9686_004_0	5		Y	Generic	4	01	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9686	004	0	1	01	01	H9686_004_0	5		Y	Preferred Brand	4	11	3	2	3	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	40.00	80.00	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	5		Y	Non-Preferred Drug	4	11	3	2	4	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	100.00	200.00	300.00																			100.00	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	5		Y	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				859.09	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	5		Y	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	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	5		Y	Select Care Drugs	4	01	1	2	6	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, Select Care Drugs										1		
H9686	005	0	1	01	01	H9686_005_0	3		N	Preferred Generic	4	11	1	2	1	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9686	005	0	1	01	01	H9686_005_0	3		N	Generic	4	01	1	2	2	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	20.00	40.00	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	3		N	Preferred Brand	4	11	3	1	3	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31				82.21	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	3		N	Non-Preferred Drug	4	11	3	1	4	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31				58.35	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	3		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				548.43	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	3		N	Select Care Drugs	4	01	1	2	6	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	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	3			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	3			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	3			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	3			Non-Preferred Drug	4	11	1	1	4	1	110		01	110		1	30		100				1	2	30		100				30		31				97.03	31		31																		31		31															31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9699	004	1	1	01	01	H9699_004_1	3			Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				794.60	29																				29																	29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9699	004	1	1	01	01	H9699_004_1	3			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	3			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	3			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	3			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	3			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	3			Non-Preferred Drug	4	11	1	1	4	1	110		01	110		1	30		100				1	2	30		100				30		31				97.03	31		31																		31		31															31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9699	004	2	1	01	01	H9699_004_2	3			Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				794.60	29																				29																	29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9699	004	2	1	01	01	H9699_004_2	3			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	3			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	3			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	3			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	3			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	3			Non-Preferred Drug	4	11	1	1	4	1	110		01	110		1	30		100				1	2	30		100				30		31				97.03	31		31																		31		31															31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9699	004	3	1	01	01	H9699_004_3	3			Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				794.60	29																				29																	29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9699	004	3	1	01	01	H9699_004_3	3			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	3			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	3		Y	Preferred Generic	4	01	1	2	1	1	110		01	110		1	30		100				1	2	30		100				30		31	3.00		6.00																			3.00		6.00																3.00				3.00		0.10			0.10			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9699	006	0	1	01	01	H9699_006_0	3		Y	Generic	4	01	1	2	2	1	110		01	110		1	30		100				1	2	30		100				30		31	10.00		20.00																			10.00		20.00																10.00				10.00		0.33			0.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9699	006	0	1	01	01	H9699_006_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01	110		1	30		100				1	2	30		100				30		31	47.00		94.00																			47.00		94.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9699	006	0	1	01	01	H9699_006_0	3		Y	Non-Preferred Drug	4	11	1	1	4	1	110		01	110		1	30		100				1	2	30		100				30		31				97.48	36		36																		36		36															36			36								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9699	006	0	1	01	01	H9699_006_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				854.75	29																				29																	29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9699	006	0	1	01	01	H9699_006_0	3		Y	Select Care Drugs	4	01	3	2	6	1	110		01	110		1	30		100				1	2	30		100				30		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9699	006	0	1	01	01	H9699_006_0	3		Y	Select Care Drugs	4	01	3	2	6	3	110		01	110		1	30		100				1	2	30		100				30		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		3
H9706	001	0	1	01	01	H9706_001_0	7			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											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												
H9706	001	0	1	01	01	H9706_001_0	7			Preferred Generic	4	01	1	2	1	3		111	01		111	1				30	60	100	1	2				30	60	100	30		31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	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		
H9706	001	0	1	01	01	H9706_001_0	7			Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					10.00	20.00	30.00											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												
H9706	001	0	1	01	01	H9706_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					47.00	94.00	141.00											47.00	94.00	94.00				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												
H9706	001	0	1	01	01	H9706_001_0	7			Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00				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	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												
H9706	003	0	1	01	01	H9706_003_0	7			Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	100	1	2				30	60	100	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												
H9706	003	0	1	01	01	H9706_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					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												
H9706	003	0	1	01	01	H9706_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					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												
H9706	003	0	1	01	01	H9706_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					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												
H9706	003	0	1	01	01	H9706_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												
H9706	005	0	1	01	01	H9706_005_0	7			Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	100	1	2				30	60	100	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												
H9706	005	0	1	01	01	H9706_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					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												
H9706	005	0	1	01	01	H9706_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					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												
H9706	005	0	1	01	01	H9706_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					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												
H9706	005	0	1	01	01	H9706_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												
H9706	006	0	1	01	01	H9706_006_0	7			Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	100	1	2				30	60	100	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												
H9706	006	0	1	01	01	H9706_006_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					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												
H9706	006	0	1	01	01	H9706_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	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												
H9706	006	0	1	01	01	H9706_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					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												
H9706	006	0	1	01	01	H9706_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												
H9706	007	0	1	01	01	H9706_007_0	7			Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	100	1	2				30	60	100	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												
H9706	007	0	1	01	01	H9706_007_0	7			Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					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												
H9706	007	0	1	01	01	H9706_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					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												
H9706	007	0	1	01	01	H9706_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					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												
H9706	007	0	1	01	01	H9706_007_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												
H9706	008	0	1	01	01	H9706_008_0	7			Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	100	1	2				30	60	100	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												
H9706	008	0	1	01	01	H9706_008_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					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												
H9706	008	0	1	01	01	H9706_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					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												
H9706	008	0	1	01	01	H9706_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					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												
H9706	008	0	1	01	01	H9706_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												
H9706	009	0	1	01	01	H9706_009_0	6			Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	100	1	2				30	60	100	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												
H9706	009	0	1	01	01	H9706_009_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					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												
H9706	009	0	1	01	01	H9706_009_0	6			Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					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												
H9706	009	0	1	01	01	H9706_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					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												
H9706	009	0	1	01	01	H9706_009_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												
H9712	001	0	1	48	05	H9712_001_0	10			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	10			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	006	0	1	01	01	H9725_006_0	4		Y	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00				15.00				15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9725	006	0	1	01	01	H9725_006_0	4		Y	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	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												
H9725	006	0	1	01	01	H9725_006_0	4		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00				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		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9725	006	0	1	01	01	H9725_006_0	4		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											882.04	33						715.46	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		Y	Preferred Generic	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		Y	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	40.00					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		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9725	008	0	1	01	01	H9725_008_0	4		Y	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											95.50	50	50	50				91.66	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		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											896.99	33						788.82	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9725	009	1	1	01	01	H9725_009_1	4		Y	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00				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	009	1	1	01	01	H9725_009_1	4		Y	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	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												
H9725	009	1	1	01	01	H9725_009_1	4		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9725	009	1	1	01	01	H9725_009_1	4		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9725	009	1	1	01	01	H9725_009_1	4		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											728.37	33						754.13	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9725	009	2	1	01	01	H9725_009_2	4		Y	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00				10.00				10.00			0.33	0.00		0.33	0.00	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9725	009	2	1	01	01	H9725_009_2	4		Y	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	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												
H9725	009	2	1	01	01	H9725_009_2	4		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9725	009	2	1	01	01	H9725_009_2	4		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9725	009	2	1	01	01	H9725_009_2	4		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											728.37	33						754.13	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9725	010	0	1	01	01	H9725_010_0	5		Y	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								5.00	10.00	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												
H9725	010	0	1	01	01	H9725_010_0	5		Y	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								15.00	30.00	30.00					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												
H9725	010	0	1	01	01	H9725_010_0	5		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9725	010	0	1	01	01	H9725_010_0	5		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								100.00	200.00	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	010	0	1	01	01	H9725_010_0	5		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											754.05	33						763.73	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9725	011	0	1	01	01	H9725_011_0	4		Y	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								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												
H9725	011	0	1	01	01	H9725_011_0	4		Y	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								15.00	30.00	30.00					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												
H9725	011	0	1	01	01	H9725_011_0	4		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9725	011	0	1	01	01	H9725_011_0	4		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								100.00	200.00	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	011	0	1	01	01	H9725_011_0	4		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											754.05	33						763.73	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9725	012	0	1	01	01	H9725_012_0	5		Y	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00				10.00				10.00			0.33	0.00		0.33	0.00	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9725	012	0	1	01	01	H9725_012_0	5		Y	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	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												
H9725	012	0	1	01	01	H9725_012_0	5		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					38.00	76.00	114.00											47.00	94.00	141.00				38.00	76.00	114.00				47.00				47.00			1.57	1.27		1.57	1.27	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9725	012	0	1	01	01	H9725_012_0	5		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9725	012	0	1	01	01	H9725_012_0	5		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											594.38	28						621.03	28												28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9725	014	0	1	01	01	H9725_014_0	4		Y	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00				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	014	0	1	01	01	H9725_014_0	4		Y	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	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												
H9725	014	0	1	01	01	H9725_014_0	4		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9725	014	0	1	01	01	H9725_014_0	4		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9725	014	0	1	01	01	H9725_014_0	4		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											637.68	30						676.00	30												30						30					30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
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											83.91	49	49	49				80.49	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											75.12	50	50	50				72.12	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								3.00	6.00	9.00					1.00	2.00	3.00											3.00	6.00	9.00				1.00	2.00	0.00				3.00				3.00			0.1	0.03		0.1	0.03	0.1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9730	009	0	1	01	01	H9730_009_0	5			Generic	4	11	1	2	2	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								3.00	6.00	9.00					1.00	2.00	3.00											3.00	6.00	9.00				1.00	2.00	0.00				3.00				3.00			0.10	0.03		0.10	0.03	0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
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											82.43	48	48	48				78.99	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	3	11	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								19.00	38.00	57.00					0.00	0.00	0.00											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												
H9730	010	0	1	01	01	H9730_010_0	5			Generic	3	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					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												
H9730	010	0	1	01	01	H9730_010_0	5			Preferred Brand	3	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	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, Select Care Drugs												
H9730	010	0	1	01	01	H9730_010_0	5			Non-Preferred Drug	3	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											98.19	48	48	48				98.19	48	48	48										48	48	48				48	48	48			48			48								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	3	11	1	1	5	1		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												
H9730	010	0	1	01	01	H9730_010_0	5			Select Care Drugs	3	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			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	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												
H9761	001	0	1	04	01	H9761_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					3.00	6.00	9.00											10.00	20.00	30.00				3.00	6.00	0.00				10.00				10.00			0.33	0.1		0.33	0.1	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9761	001	0	1	04	01	H9761_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												
H9761	001	0	1	04	01	H9761_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											86.92	45	45	45				83.05	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	4			Specialty Tier	4	11	1	1	5	1		010	01		010	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	4			Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			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	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												
H9761	002	0	1	04	01	H9761_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												
H9761	002	0	1	04	01	H9761_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												
H9761	002	0	1	04	01	H9761_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											91.24	50	50	50				87.59	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	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												
H9761	002	0	1	04	01	H9761_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												
H9761	002	0	1	04	01	H9761_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	
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								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00				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												
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								10.00	20.00	30.00					1.00	2.00	3.00											10.00	20.00	30.00				1.00	2.00	0.00				10.00				10.00			0.33	0.03		0.33	0.03	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
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											77.78	45	45	45				74.32	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	002	0	1	02	01	H9763_002_0	6		Y	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	6		Y	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	6		Y	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	6		Y	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	6		Y	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	6		Y	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	6		Y	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	003	1	1	01	01	H9763_003_1	6		Y	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	003	1	1	01	01	H9763_003_1	6		Y	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	003	1	1	01	01	H9763_003_1	6		Y	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	003	1	1	01	01	H9763_003_1	6		Y	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	003	1	1	01	01	H9763_003_1	6		Y	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	003	1	1	01	01	H9763_003_1	6		Y	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	003	1	1	01	01	H9763_003_1	6		Y	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	003	2	1	01	01	H9763_003_2	6		Y	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	003	2	1	01	01	H9763_003_2	6		Y	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	003	2	1	01	01	H9763_003_2	6		Y	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	003	2	1	01	01	H9763_003_2	6		Y	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	003	2	1	01	01	H9763_003_2	6		Y	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	003	2	1	01	01	H9763_003_2	6		Y	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	003	2	1	01	01	H9763_003_2	6		Y	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	7			Preferred Generic	4	01	1	2	1	1	111		10	111		1	30	60	90				1	1	30	60	90					29	31	5.00	10.00	10.00																			5.00	10.00	10.00																	5.00			5.00		0.17			0.17			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9808	004	0	1	04	01	H9808_004_0	7			Preferred Generic	4	01	1	2	1	3	111		10	111		1	30	60	90				1	1	30	60	90					29	31	5.00	10.00	10.00																			5.00	10.00	10.00																	5.00			5.00		0.17			0.17			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H9808	004	0	1	04	01	H9808_004_0	7			Generic	4	11	1	2	2	1	111		10	111		1	30	60	90				1	1	30	60	90					29	31	15.00	30.00	30.00																			15.00	30.00	30.00																	15.00			15.00		0.50			0.50			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9808	004	0	1	04	01	H9808_004_0	7			Preferred Brand	4	11	1	2	3	1	111		10	111		1	30	60	90				1	1	30	60	90					29	31	45.00	90.00	90.00																			45.00	90.00	90.00																	45.00			45.00		1.50			1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9808	004	0	1	04	01	H9808_004_0	7			Non-Preferred Drug	4	11	1	2	4	1	111		10	111		1	30	60	90				1	1	30	60	90					29	31	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	7			Specialty Tier	4	11	1	1	5	1	111		10	111		1	30	60	90				1	1	30	60	90					29	31				813.47	33	33	33																		33	33	33																33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9808	005	0	1	04	01	H9808_005_0	7			Preferred Generic	4	01	1	2	1	1	111		10	111		1	30	60	90				1	1	30	60	90					29	31	0.00	0.00	0.00																			0.00	0.00	0.00																	0.00			0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9808	005	0	1	04	01	H9808_005_0	7			Preferred Generic	4	01	1	2	1	3	111		10	111		1	30	60	90				1	1	30	60	90					29	31	0.00	0.00	0.00																			0.00	0.00	0.00																	0.00			0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H9808	005	0	1	04	01	H9808_005_0	7			Generic	4	11	1	2	2	1	111		10	111		1	30	60	90				1	1	30	60	90					29	31	12.00	24.00	24.00																			12.00	24.00	24.00																	12.00			12.00		0.40			0.40			0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9808	005	0	1	04	01	H9808_005_0	7			Preferred Brand	4	11	1	2	3	1	111		10	111		1	30	60	90				1	1	30	60	90					29	31	40.00	80.00	80.00																			40.00	80.00	80.00																	40.00			40.00		1.33			1.33			1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9808	005	0	1	04	01	H9808_005_0	7			Non-Preferred Drug	4	11	1	2	4	1	111		10	111		1	30	60	90				1	1	30	60	90					29	31	80.00	160.00	160.00																			80.00	160.00	160.00																	80.00			80.00		2.67			2.67			2.58	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9808	005	0	1	04	01	H9808_005_0	7			Specialty Tier	4	11	1	1	5	1	111		10	111		1	30	60	90				1	1	30	60	90					29	31				802.30	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								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00				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												
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								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00				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
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	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								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00				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												
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	3	11	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								19.00	38.00	57.00					0.00	0.00	0.00											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												
H9811	009	0	1	01	01	H9811_009_0	5			Generic	3	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					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												
H9811	009	0	1	01	01	H9811_009_0	5			Preferred Brand	3	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	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, Select Care Drugs												
H9811	009	0	1	01	01	H9811_009_0	5			Non-Preferred Drug	3	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											98.30	45	45	45				98.30	45	45	45										45	45	45				45	45	45			45			45								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	3	11	1	1	5	1		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	009	0	1	01	01	H9811_009_0	5			Select Care Drugs	3	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			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	4		Y	Preferred Generic	4	11	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9827	001	0	1	01	01	H9827_001_0	4		Y	Preferred Generic	4	11	1	2	1	3	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H9827	001	0	1	01	01	H9827_001_0	4		Y	Generic	4	11	3	2	2	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31	5.00	10.00	15.00																			0.00	0.00	0.00																5.00				5.00		0.17			0.00			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9827	001	0	1	01	01	H9827_001_0	4		Y	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	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	4		Y	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	100.00	200.00	300.00																			100.00	200.00	200.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9827	001	0	1	01	01	H9827_001_0	4		Y	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	4		Y	Preferred Generic	4	11	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9827	002	0	1	01	01	H9827_002_0	4		Y	Preferred Generic	4	11	1	2	1	3	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H9827	002	0	1	01	01	H9827_002_0	4		Y	Generic	4	11	3	2	2	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31	5.00	10.00	15.00																			0.00	0.00	0.00																5.00				5.00		0.17			0.00			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9827	002	0	1	01	01	H9827_002_0	4		Y	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	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	4		Y	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	100.00	200.00	300.00																			100.00	200.00	200.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9827	002	0	1	01	01	H9827_002_0	4		Y	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	004	0	1	01	01	H9827_004_0	4		N	Preferred Generic	4	11	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	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	004	0	1	01	01	H9827_004_0	4		N	Preferred Generic	4	11	1	2	1	3	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H9827	004	0	1	01	01	H9827_004_0	4		N	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	004	0	1	01	01	H9827_004_0	4		N	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	94.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9827	004	0	1	01	01	H9827_004_0	4		N	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	100.00	200.00	300.00																			100.00	200.00	200.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9827	004	0	1	01	01	H9827_004_0	4		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				830.00	28																				28																	28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9828	001	0	1	01	01	H9828_001_0	3			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	3			Generic	4	01	1	2	2	1	110		01	100		1	30		90				1	2			90				30		31	8.00		24.00																					24.00																8.00				8.00		0.27						0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9828	001	0	1	01	01	H9828_001_0	3			Preferred Brand	4	10	1	2	3	1	110		01	100		1	30		90				1	2			90				30		31	45.00		135.00																					135.00																45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9828	001	0	1	01	01	H9828_001_0	3			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	3			Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31					33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9828	001	0	1	01	01	H9828_001_0	3			Select Care Drugs	4	01	1	2	6	1	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9828	001	0	1	01	01	H9828_001_0	3			Select Care Drugs	4	01	1	2	6	3	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H9828	002	0	1	01	01	H9828_002_0	3			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	3			Generic	4	01	1	2	2	1	110		01	100		1	30		90				1	2			90				30		31	6.00		18.00																					18.00																6.00				6.00		0.20						0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9828	002	0	1	01	01	H9828_002_0	3			Preferred Brand	4	10	1	2	3	1	110		01	100		1	30		90				1	2			90				30		31	37.00		111.00																					111.00																37.00				37.00		1.23						1.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9828	002	0	1	01	01	H9828_002_0	3			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	3			Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31					33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9828	002	0	1	01	01	H9828_002_0	3			Select Care Drugs	4	01	1	2	6	1	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9828	002	0	1	01	01	H9828_002_0	3			Select Care Drugs	4	01	1	2	6	3	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H9828	003	0	1	01	01	H9828_003_0	3			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	3			Generic	4	01	1	2	2	1	110		01	100		1	30		90				1	2			90				30		31	8.00		24.00																					24.00																8.00				8.00		0.27						0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9828	003	0	1	01	01	H9828_003_0	3			Preferred Brand	4	10	1	2	3	1	110		01	100		1	30		90				1	2			90				30		31	45.00		135.00																					135.00																45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9828	003	0	1	01	01	H9828_003_0	3			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	3			Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31					33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9828	003	0	1	01	01	H9828_003_0	3			Select Care Drugs	4	01	1	2	6	1	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9828	003	0	1	01	01	H9828_003_0	3			Select Care Drugs	4	01	1	2	6	3	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H9834	001	0	1	01	01	H9834_001_0	3		Y	Preferred Generic	4	01	1	2	1	1	111		01	100		1	30	60	90				1	2			90				30		31	2.00	4.00	6.00																					5.00																2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H9834	001	0	1	01	01	H9834_001_0	3		Y	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	3		Y	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	3		Y	Non-Preferred Drug	4	11	1	2	4	1	111		01	100		1	30	60	90				1	2			90				30		31	100.00	200.00	300.00																					300.00																100.00				100.00		3.33						3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H9834	001	0	1	01	01	H9834_001_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31					33																																					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H9834	001	0	1	01	01	H9834_001_0	3		Y	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	3		Y	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	3		Y	Preferred Generic	4	01	1	2	1	1	111		01	100		1	30	60	90				1	2			90				30		31	2.00	4.00	6.00																					5.00																2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H9834	003	0	1	01	01	H9834_003_0	3		Y	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	3		Y	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	3		Y	Non-Preferred Drug	4	11	1	2	4	1	111		01	100		1	30	60	90				1	2			90				30		31	100.00	200.00	300.00																					300.00																100.00				100.00		3.33						3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H9834	003	0	1	01	01	H9834_003_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31					33																																					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H9834	003	0	1	01	01	H9834_003_0	3		Y	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	3		Y	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	3		Y	Preferred Generic	4	01	1	2	1	1	111		01	100		1	30	60	90				1	2			90				30		31	2.00	4.00	6.00																					5.00																2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H9834	006	0	1	01	01	H9834_006_0	3		Y	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	3		Y	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	3		Y	Non-Preferred Drug	4	11	1	2	4	1	111		01	100		1	30	60	90				1	2			90				30		31	100.00	200.00	300.00																					300.00																100.00				100.00		3.33						3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H9834	006	0	1	01	01	H9834_006_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31					33																																					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H9834	006	0	1	01	01	H9834_006_0	3		Y	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	3		Y	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	6		Y	Preferred Generic	4	01	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								6.00		18.00					0.00		0.00											6.00		18.00				0.00		0.00				0.00				0.00			0.20	0.00		0.20	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9861	001	0	1	01	01	H9861_001_0	6		Y	Preferred Generic	4	01	1	1	1	3		110	01		110	1				30		90	1	2				30		90	30		31											1.54	15		15				0.00	0		0										15		15				0		0			15			0								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H9861	001	0	1	01	01	H9861_001_0	6		Y	Generic	4	01	1	2	2	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				0.00				0.00			0.50	0.00		0.50	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9861	001	0	1	01	01	H9861_001_0	6		Y	Generic	4	01	1	1	2	3		110	01		110	1				30		90	1	2				30		90	30		31											4.28	15		15				0.00	0		0										15		15				0		0			15			0								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H9861	001	0	1	01	01	H9861_001_0	6		Y	Preferred Brand	4	10	1	2	3	1		110	01		110	1				30		90	1	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		141.00				47.00				47.00			1.57	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	6		Y	Non-Preferred Drug	4	10	1	2	4	1		110	01		110	1				30		90	1	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		300.00				100.00				100.00			3.33	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	6		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											704.06	30						704.06	30												30						30					30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9861	002	0	1	01	01	H9861_002_0	6		Y	Preferred Generic	4	01	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								6.00		18.00					0.00		0.00											6.00		18.00				0.00		0.00				0.00				0.00			0.20	0.00		0.20	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9861	002	0	1	01	01	H9861_002_0	6		Y	Preferred Generic	4	01	1	1	1	3		110	01		110	1				30		90	1	2				30		90	30		31											1.54	15		15				0.00	0		0										15		15				0		0			15			0								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H9861	002	0	1	01	01	H9861_002_0	6		Y	Generic	4	01	1	2	2	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				0.00				0.00			0.50	0.00		0.50	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9861	002	0	1	01	01	H9861_002_0	6		Y	Generic	4	01	1	1	2	3		110	01		110	1				30		90	1	2				30		90	30		31											4.28	15		15				0.00	0		0										15		15				0		0			15			0								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H9861	002	0	1	01	01	H9861_002_0	6		Y	Preferred Brand	4	10	1	2	3	1		110	01		110	1				30		90	1	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		141.00				47.00				47.00			1.57	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	6		Y	Non-Preferred Drug	4	10	1	2	4	1		110	01		110	1				30		90	1	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		300.00				100.00				100.00			3.33	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	6		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											704.06	30						704.06	30												30						30					30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9861	003	0	1	01	01	H9861_003_0	6		N	Preferred Generic	4	01	1	1	1	1	110		01	110		1	30		90				1	2	30		90				30		31				4.49	20		20																		20		20															20			20								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9861	003	0	1	01	01	H9861_003_0	6		N	Generic	4	01	1	1	2	1	110		01	110		1	30		90				1	2	30		90				30		31				4.49	20		20																		20		20															20			20								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9861	003	0	1	01	01	H9861_003_0	6		N	Preferred Brand	4	10	1	1	3	1	110		01	110		1	30		90				1	2	30		90				30		31				72.62	20		20																		20		20															20			20								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9861	003	0	1	01	01	H9861_003_0	6		N	Non-Preferred Drug	4	10	1	1	4	1	110		01	110		1	30		90				1	2	30		90				30		31				72.62	20		20																		20		20															20			20								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9861	003	0	1	01	01	H9861_003_0	6		N	Specialty Tier	4	01	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												
H9869	001	0	1	48	05	H9869_001_0	3			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	3			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	3			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	6		Y	Preferred Generic	4	01	1	2	1	1	111		01	111		1	31	60	100				1	2	31	60	100				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	6		Y	Preferred Generic	4	01	1	2	1	3	111		01	111		1	31	60	100				1	2	31	60	100				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										1		
H9876	001	0	1	04	01	H9876_001_0	6		Y	Generic	4	01	1	2	2	1	111		01	111		1	31	60	100				1	2	31	60	100				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	6		Y	Preferred Brand	4	10	1	2	3	1	111		01	111		1	31	60	100				1	2	31	60	100				31		31	47.00	94.00	141.00																			47.00	94.00	118.00																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	6		Y	Non-Preferred Brand	4	11	1	2	4	1	111		01	111		1	31	60	100				1	2	31	60	100				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	6		Y	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	7		N	Preferred Generic	4	01	1	2	1	1	111		01	111		1	31	60	100				1	2	31	60	100				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	002	0	1	04	01	H9876_002_0	7		N	Preferred Generic	4	01	1	2	1	3	111		01	111		1	31	60	100				1	2	31	60	100				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										1		
H9876	002	0	1	04	01	H9876_002_0	7		N	Generic	4	01	1	2	2	1	111		01	111		1	31	60	100				1	2	31	60	100				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	002	0	1	04	01	H9876_002_0	7		N	Preferred Brand	4	10	1	2	3	1	111		01	111		1	31	60	100				1	2	31	60	100				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	7		N	Non-Preferred Brand	4	11	1	2	4	1	111		01	111		1	31	60	100				1	2	31	60	100				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	7		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	31								31						31		31					25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9884	001	0	1	04	01	H9884_001_0	10		Y	Preferred Generic	4	11	1	2	1	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9884	001	0	1	04	01	H9884_001_0	10		Y	Preferred Generic	4	11	1	2	1	3	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H9884	001	0	1	04	01	H9884_001_0	10		Y	Generic	4	11	3	2	2	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9884	001	0	1	04	01	H9884_001_0	10		Y	Generic	4	11	3	2	2	3	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	3
H9884	001	0	1	04	01	H9884_001_0	10		Y	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	47.00	94.00	141.00																			47.00	94.00	117.50																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9884	001	0	1	04	01	H9884_001_0	10		Y	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	100.00	200.00	300.00																			100.00	200.00	300.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9884	001	0	1	04	01	H9884_001_0	10		Y	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												
H9884	003	0	1	04	01	H9884_003_0	9		Y	Preferred Generic	4	11	1	2	1	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9884	003	0	1	04	01	H9884_003_0	9		Y	Preferred Generic	4	11	1	2	1	3	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H9884	003	0	1	04	01	H9884_003_0	9		Y	Generic	4	11	3	2	2	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9884	003	0	1	04	01	H9884_003_0	9		Y	Generic	4	11	3	2	2	3	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	3
H9884	003	0	1	04	01	H9884_003_0	9		Y	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	47.00	94.00	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	9		Y	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	100.00	200.00	300.00																			100.00	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	9		Y	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												
H9884	004	0	1	04	01	H9884_004_0	9		Y	Preferred Generic	4	11	1	2	1	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9884	004	0	1	04	01	H9884_004_0	9		Y	Preferred Generic	4	11	1	2	1	3	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H9884	004	0	1	04	01	H9884_004_0	9		Y	Generic	4	11	3	2	2	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9884	004	0	1	04	01	H9884_004_0	9		Y	Generic	4	11	3	2	2	3	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	3
H9884	004	0	1	04	01	H9884_004_0	9		Y	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	47.00	94.00	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	9		Y	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	100.00	200.00	300.00																			100.00	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	9		Y	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												
H9884	005	0	1	04	01	H9884_005_0	10		Y	Preferred Generic	4	11	1	2	1	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9884	005	0	1	04	01	H9884_005_0	10		Y	Preferred Generic	4	11	1	2	1	3	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H9884	005	0	1	04	01	H9884_005_0	10		Y	Generic	4	11	3	2	2	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9884	005	0	1	04	01	H9884_005_0	10		Y	Generic	4	11	3	2	2	3	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	2	2
H9884	005	0	1	04	01	H9884_005_0	10		Y	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	47.00	94.00	141.00																			47.00	94.00	117.50																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9884	005	0	1	04	01	H9884_005_0	10		Y	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	100.00	200.00	300.00																			100.00	200.00	300.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9884	005	0	1	04	01	H9884_005_0	10		Y	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												
H9884	006	0	1	04	01	H9884_006_0	10		Y	Preferred Generic	4	11	1	2	1	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9884	006	0	1	04	01	H9884_006_0	10		Y	Preferred Generic	4	11	1	2	1	3	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H9884	006	0	1	04	01	H9884_006_0	10		Y	Generic	4	11	3	2	2	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9884	006	0	1	04	01	H9884_006_0	10		Y	Generic	4	11	3	2	2	3	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	2	2
H9884	006	0	1	04	01	H9884_006_0	10		Y	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	47.00	94.00	141.00																			47.00	94.00	117.50																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9884	006	0	1	04	01	H9884_006_0	10		Y	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	100.00	200.00	300.00																			100.00	200.00	300.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9884	006	0	1	04	01	H9884_006_0	10		Y	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												
H9884	007	0	1	04	01	H9884_007_0	9		Y	Preferred Generic	4	11	1	2	1	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9884	007	0	1	04	01	H9884_007_0	9		Y	Preferred Generic	4	11	1	2	1	3	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H9884	007	0	1	04	01	H9884_007_0	9		Y	Generic	4	11	3	2	2	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9884	007	0	1	04	01	H9884_007_0	9		Y	Generic	4	11	3	2	2	3	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	3
H9884	007	0	1	04	01	H9884_007_0	9		Y	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	47.00	94.00	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	9		Y	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	100.00	200.00	300.00																			100.00	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	9		Y	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												
H9884	008	0	1	04	01	H9884_008_0	9		Y	Preferred Generic	4	11	1	2	1	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9884	008	0	1	04	01	H9884_008_0	9		Y	Preferred Generic	4	11	1	2	1	3	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H9884	008	0	1	04	01	H9884_008_0	9		Y	Generic	4	11	3	2	2	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	5.00	10.00	15.00																			5.00	10.00	12.50																5.00				5.00		0.17			0.17			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9884	008	0	1	04	01	H9884_008_0	9		Y	Generic	4	11	3	2	2	3	111		01	111		1	30	60	100				1	2	30	60	100				30		31	5.00	10.00	15.00																			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										2	3	3
H9884	008	0	1	04	01	H9884_008_0	9		Y	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	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												
H9884	008	0	1	04	01	H9884_008_0	9		Y	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	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												
H9884	008	0	1	04	01	H9884_008_0	9		Y	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												
H9884	011	0	1	04	01	H9884_011_0	10		Y	Preferred Generic	4	11	1	2	1	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9884	011	0	1	04	01	H9884_011_0	10		Y	Preferred Generic	4	11	1	2	1	3	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H9884	011	0	1	04	01	H9884_011_0	10		Y	Generic	4	11	3	2	2	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	5.00	10.00	15.00																			5.00	10.00	12.50																5.00				5.00		0.17			0.17			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9884	011	0	1	04	01	H9884_011_0	10		Y	Generic	4	11	3	2	2	3	111		01	111		1	30	60	100				1	2	30	60	100				30		31	5.00	10.00	15.00																			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										2	3	3
H9884	011	0	1	04	01	H9884_011_0	10		Y	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	47.00	94.00	141.00																			47.00	94.00	117.50																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9884	011	0	1	04	01	H9884_011_0	10		Y	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	100.00	200.00	300.00																			100.00	200.00	300.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9884	011	0	1	04	01	H9884_011_0	10		Y	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												
H9884	012	0	1	04	01	H9884_012_0	10		Y	Preferred Generic	4	11	1	2	1	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9884	012	0	1	04	01	H9884_012_0	10		Y	Preferred Generic	4	11	1	2	1	3	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H9884	012	0	1	04	01	H9884_012_0	10		Y	Generic	4	11	3	2	2	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9884	012	0	1	04	01	H9884_012_0	10		Y	Generic	4	11	3	2	2	3	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	3
H9884	012	0	1	04	01	H9884_012_0	10		Y	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	47.00	94.00	141.00																			47.00	94.00	117.50																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9884	012	0	1	04	01	H9884_012_0	10		Y	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	100.00	200.00	300.00																			100.00	200.00	300.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9884	012	0	1	04	01	H9884_012_0	10		Y	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												
H9888	001	0	1	04	01	H9888_001_0	9		Y	Preferred Generic	4	11	1	2	1	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9888	001	0	1	04	01	H9888_001_0	9		Y	Preferred Generic	4	11	1	2	1	3	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H9888	001	0	1	04	01	H9888_001_0	9		Y	Generic	4	11	3	2	2	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	5.00	10.00	15.00																			5.00	10.00	12.50																5.00				5.00		0.17			0.17			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9888	001	0	1	04	01	H9888_001_0	9		Y	Generic	4	11	3	2	2	3	111		01	111		1	30	60	100				1	2	30	60	100				30		31	5.00	10.00	15.00																			5.00	10.00	12.50																5.00				5.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	3
H9888	001	0	1	04	01	H9888_001_0	9		Y	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	47.00	94.00	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												
H9888	001	0	1	04	01	H9888_001_0	9		Y	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	100.00	200.00	300.00																			100.00	200.00	300.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9888	001	0	1	04	01	H9888_001_0	9		Y	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												
H9888	002	0	1	04	01	H9888_002_0	9		Y	Preferred Generic	4	11	1	2	1	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9888	002	0	1	04	01	H9888_002_0	9		Y	Preferred Generic	4	11	1	2	1	3	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H9888	002	0	1	04	01	H9888_002_0	9		Y	Generic	4	11	3	2	2	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	5.00	10.00	15.00																			5.00	10.00	12.50																5.00				5.00		0.17			0.17			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9888	002	0	1	04	01	H9888_002_0	9		Y	Generic	4	11	3	2	2	3	111		01	111		1	30	60	100				1	2	30	60	100				30		31	5.00	10.00	15.00																			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										2	3	3
H9888	002	0	1	04	01	H9888_002_0	9		Y	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	47.00	94.00	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												
H9888	002	0	1	04	01	H9888_002_0	9		Y	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	100.00	200.00	300.00																			100.00	200.00	300.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9888	002	0	1	04	01	H9888_002_0	9		Y	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												
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	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								3.00	6.00	9.00					1.00	2.00	3.00											3.00	6.00	9.00				1.00	2.00	0.00				3.00				3.00			0.1	0.03		0.1	0.03	0.1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9900	004	0	1	01	01	H9900_004_0	5			Generic	4	11	1	2	2	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								3.00	6.00	9.00					1.00	2.00	3.00											3.00	6.00	9.00				1.00	2.00	0.00				3.00				3.00			0.10	0.03		0.10	0.03	0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
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	3	11	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								19.00	38.00	57.00					0.00	0.00	0.00											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												
H9900	006	0	1	01	01	H9900_006_0	5			Generic	3	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					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												
H9900	006	0	1	01	01	H9900_006_0	5			Preferred Brand	3	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	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, Select Care Drugs												
H9900	006	0	1	01	01	H9900_006_0	5			Non-Preferred Drug	3	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											99.30	45	45	45				99.30	45	45	45										45	45	45				45	45	45			45			45								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	3	11	1	1	5	1		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												
H9900	006	0	1	01	01	H9900_006_0	5			Select Care Drugs	3	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			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	3	11	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								19.00	38.00	57.00					0.00	0.00	0.00											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												
H9900	007	0	1	01	01	H9900_007_0	5			Generic	3	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					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												
H9900	007	0	1	01	01	H9900_007_0	5			Preferred Brand	3	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	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, Select Care Drugs												
H9900	007	0	1	01	01	H9900_007_0	5			Non-Preferred Drug	3	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											98.86	45	45	45				98.86	45	45	45										45	45	45				45	45	45			45			45								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	3	11	1	1	5	1		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												
H9900	007	0	1	01	01	H9900_007_0	5			Select Care Drugs	3	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			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	7		N	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	4.00																			2.00	4.00	4.00																2.00				2.00		0.07			0.07			0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9904	001	0	1	04	01	H9904_001_0	7		N	Preferred Generic	4	11	1	2	1	3	111		01	111		1	30	60	90				1	1	30	60	90				30		31	2.00	4.00	4.00																			2.00	4.00	4.00																2.00				2.00		0.07			0.07			0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H9904	001	0	1	04	01	H9904_001_0	7		N	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	12.00																			6.00	12.00	12.00																6.00				6.00		0.20			0.20			0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9904	001	0	1	04	01	H9904_001_0	7		N	Generic	4	11	1	2	2	3	111		01	111		1	30	60	90				1	1	30	60	90				30		31	6.00	12.00	12.00																			6.00	12.00	12.00																6.00				6.00		0.20			0.20			0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H9904	001	0	1	04	01	H9904_001_0	7		N	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	84.00																			42.00	84.00	84.00																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	7		N	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	90				1	1	30	60	90				30		31	95.00	190.00	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												
H9904	001	0	1	04	01	H9904_001_0	7		N	Specialty Tier	4	11	1	1	5	1	111		01	111		1	30	60	90				1	1	30	60	90				30		31				1059.80	29	29	29																		29	29	29															29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9907	001	0	1	04	01	H9907_001_0	8		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								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												
H9907	001	0	1	04	01	H9907_001_0	8		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								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												
H9907	001	0	1	04	01	H9907_001_0	8		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					47.00	94.00	141.00					47.00	94.00	94.00																47.00				47.00			1.57	1.57	1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H9907	001	0	1	04	01	H9907_001_0	8		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	300.00					100.00	200.00	300.00					100.00	200.00	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												
H9907	001	0	1	04	01	H9907_001_0	8		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												30							30						30																	30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H9907	001	0	1	04	01	H9907_001_0	8		N	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												
H9907	001	0	1	04	01	H9907_001_0	8		N	Vaccines	4	11	1	2	6	3		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										1		
H9917	001	0	1	01	01	H9917_001_0	6		Y	Preferred Generic	4	01	1	2	1	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	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		Y	Generic	4	01	1	2	2	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	15.00	30.00	45.00																			15.00	30.00	45.00																	15.00			15.00		0.50			0.50			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9917	001	0	1	01	01	H9917_001_0	6		Y	Preferred Brand	4	10	1	2	3	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	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		Y	Non-Preferred Brand	4	10	1	2	4	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	95.00	190.00	285.00																			95.00	190.00	285.00																	95.00			95.00		3.17			3.17			3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9917	001	0	1	01	01	H9917_001_0	6		Y	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	5		Y	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	5		Y	Generic	4	01	1	2	2	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	15.00	30.00	45.00																			15.00	30.00	45.00																	15.00			15.00		0.50			0.50			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9917	002	0	1	01	01	H9917_002_0	5		Y	Preferred Brand	4	10	1	2	3	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	45.00	90.00	135.00																			45.00	90.00	135.00																	45.00			45.00		1.50			1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9917	002	0	1	01	01	H9917_002_0	5		Y	Non-Preferred Brand	4	10	1	2	4	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	95.00	190.00	285.00																			95.00	190.00	285.00																	95.00			95.00		3.17			3.17			3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9917	002	0	1	01	01	H9917_002_0	5		Y	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	003	0	1	01	01	H9917_003_0	7		Y	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, Select Care Drugs												
H9917	003	0	1	01	01	H9917_003_0	7		Y	Generic	4	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																			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												
H9917	003	0	1	01	01	H9917_003_0	7		Y	Preferred Brand	4	10	1	2	3	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	45.00	90.00	135.00																			45.00	90.00	135.00																	45.00			45.00		1.50			1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9917	003	0	1	01	01	H9917_003_0	7		Y	Non-Preferred Brand	4	10	1	2	4	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	95.00	190.00	285.00																			95.00	190.00	285.00																	95.00			95.00		3.17			3.17			3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9917	003	0	1	01	01	H9917_003_0	7		Y	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, Select Care Drugs												
H9917	003	0	1	01	01	H9917_003_0	7		Y	Select Care Drugs	4	11	1	2	6	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 Brand, Specialty Tier, Select Care Drugs												
H9943	001	0	1	02	01	H9943_001_0	5		N	Preferred Generic	4	11	1	2	1	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9943	001	0	1	02	01	H9943_001_0	5		N	Preferred Generic	4	11	1	2	1	3	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H9943	001	0	1	02	01	H9943_001_0	5		N	Generic	4	01	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9943	001	0	1	02	01	H9943_001_0	5		N	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	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												
H9943	001	0	1	02	01	H9943_001_0	5		N	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	300.00																			100.00	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												
H9943	001	0	1	02	01	H9943_001_0	5		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				852.21	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9943	001	0	1	02	01	H9943_001_0	5		N	Select Care Drugs	4	01	1	2	6	1	111		01	111		1	30	60	100				1	2	30	60	100				30		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												
H9943	001	0	1	02	01	H9943_001_0	5		N	Select Care Drugs	4	01	1	2	6	3	111		01	111		1	30	60	100				1	2	30	60	100				30		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		
H9943	002	0	1	02	01	H9943_002_0	5		N	Preferred Generic	4	11	1	2	1	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9943	002	0	1	02	01	H9943_002_0	5		N	Preferred Generic	4	11	1	2	1	3	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H9943	002	0	1	02	01	H9943_002_0	5		N	Generic	4	01	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9943	002	0	1	02	01	H9943_002_0	5		N	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	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												
H9943	002	0	1	02	01	H9943_002_0	5		N	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	300.00																			100.00	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												
H9943	002	0	1	02	01	H9943_002_0	5		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				852.21	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9943	002	0	1	02	01	H9943_002_0	5		N	Select Care Drugs	4	01	1	2	6	1	111		01	111		1	30	60	100				1	2	30	60	100				30		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												
H9943	002	0	1	02	01	H9943_002_0	5		N	Select Care Drugs	4	01	1	2	6	3	111		01	111		1	30	60	100				1	2	30	60	100				30		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		
H9943	003	0	1	01	01	H9943_003_0	6		N	Preferred Generic	4	11	1	2	1	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9943	003	0	1	01	01	H9943_003_0	6		N	Preferred Generic	4	11	1	2	1	3	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H9943	003	0	1	01	01	H9943_003_0	6		N	Generic	4	01	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9943	003	0	1	01	01	H9943_003_0	6		N	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	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												
H9943	003	0	1	01	01	H9943_003_0	6		N	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	300.00																			100.00	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												
H9943	003	0	1	01	01	H9943_003_0	6		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				860.99	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9943	003	0	1	01	01	H9943_003_0	6		N	Select Care Drugs	4	01	1	2	6	1	111		01	111		1	30	60	100				1	2	30	60	100				30		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												
H9943	003	0	1	01	01	H9943_003_0	6		N	Select Care Drugs	4	01	1	2	6	3	111		01	111		1	30	60	100				1	2	30	60	100				30		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		
H9943	004	0	1	01	01	H9943_004_0	4		N	Preferred Generic	4	11	1	2	1	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9943	004	0	1	01	01	H9943_004_0	4		N	Generic	4	01	1	2	2	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	20.00	40.00	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												
H9943	004	0	1	01	01	H9943_004_0	4		N	Preferred Brand	4	11	3	1	3	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31				82.21	25	25	25																		25	25	25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9943	004	0	1	01	01	H9943_004_0	4		N	Non-Preferred Drug	4	11	3	1	4	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31				58.35	25	25	25																		25	25	25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9943	004	0	1	01	01	H9943_004_0	4		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				548.43	25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9943	004	0	1	01	01	H9943_004_0	4		N	Select Care Drugs	4	01	1	2	6	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	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												
H9955	001	0	1	01	01	H9955_001_0	7		N	Preferred Generic	4	11	1	2	1	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9955	001	0	1	01	01	H9955_001_0	7		N	Generic	4	11	1	2	2	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31	4.00	8.00	12.00																			4.00	8.00	12.00																4.00				4.00		0.13			0.13			0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9955	001	0	1	01	01	H9955_001_0	7		N	Preferred Brand	4	11	1	2	3	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31	44.00	88.00	132.00																			44.00	88.00	132.00																44.00				44.00		1.42			1.42			1.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9955	001	0	1	01	01	H9955_001_0	7		N	Non-Preferred Drug	4	11	1	1	4	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31				91.93	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		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	31								31						31		31				841.41	25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9955	002	0	1	01	01	H9955_002_0	7		Y	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	7		Y	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	7		Y	Preferred Brand	4	11	1	2	3	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31	47.00	94.00	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	7		Y	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	7		Y	Specialty Tier	4	11	1	1	5	1	010		01	010		1	31								31						31		31				816.28	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	7		Y	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												
H9955	003	0	1	01	01	H9955_003_0	8		N	Preferred Generic	4	11	1	2	1	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9955	003	0	1	01	01	H9955_003_0	8		N	Generic	4	11	1	2	2	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9955	003	0	1	01	01	H9955_003_0	8		N	Preferred Brand	4	11	1	2	3	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31	29.00	58.00	87.00																			29.00	58.00	87.00																29.00				29.00		0.94			0.94			0.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9955	003	0	1	01	01	H9955_003_0	8		N	Non-Preferred Drug	4	11	1	1	4	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31				97.28	34	34	34																		34	34	34															34			34								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9955	003	0	1	01	01	H9955_003_0	8		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	31								31						31		31				844.66	25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9955	004	0	1	01	01	H9955_004_0	7		Y	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												
H9955	004	0	1	01	01	H9955_004_0	7		Y	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												
H9955	004	0	1	01	01	H9955_004_0	7		Y	Preferred Brand	4	11	1	2	3	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31	47.00	94.00	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	004	0	1	01	01	H9955_004_0	7		Y	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	004	0	1	01	01	H9955_004_0	7		Y	Specialty Tier	4	11	1	1	5	1	010		01	010		1	31								31						31		31				734.14	27																				27																	27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9955	004	0	1	01	01	H9955_004_0	7		Y	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												
H9976	001	0	1	04	01	H9976_001_0	4			Preferred Generic	3	11	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								19.00	38.00	57.00					0.00	0.00	0.00											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												
H9976	001	0	1	04	01	H9976_001_0	4			Generic	3	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					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												
H9976	001	0	1	04	01	H9976_001_0	4			Preferred Brand	3	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	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, Select Care Drugs												
H9976	001	0	1	04	01	H9976_001_0	4			Non-Preferred Drug	3	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											98.18	46	46	46				98.18	46	46	46										46	46	46				46	46	46			46			46								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	3	11	1	1	5	1		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												
H9976	001	0	1	04	01	H9976_001_0	4			Select Care Drugs	3	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			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	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												
H9976	002	0	1	04	01	H9976_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					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												
H9976	002	0	1	04	01	H9976_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												
H9976	002	0	1	04	01	H9976_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											77.68	45	45	45				74.23	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	4			Specialty Tier	4	11	1	1	5	1		010	01		010	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	4			Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			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	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	
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								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00				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												
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								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												
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	4		Y	Preferred Generic	4	11	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									15.00		45.00				0.00		0.00				0.00				0.00		0				0.50	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R0110	003	0	1	31	11	R0110_003_0	4		Y	Generic	4	11	1	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	5.00		15.00																									20.00		60.00				5.00		0.00				5.00				5.00		0.17				0.67	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R0110	003	0	1	31	11	R0110_003_0	4		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R0110	003	0	1	31	11	R0110_003_0	4		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	99.00		297.00																									100.00		300.00				99.00		287.00				99.00				99.00		3.30				3.33	3.30	3.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R0110	003	0	1	31	11	R0110_003_0	4		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R0759	001	0	1	31	11	R0759_001_0	2		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R0759	001	0	1	31	11	R0759_001_0	2		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
R0759	001	0	1	31	11	R0759_001_0	2		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R0759	001	0	1	31	11	R0759_001_0	2		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
R0759	001	0	1	31	11	R0759_001_0	2		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R0759	001	0	1	31	11	R0759_001_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R0759	001	0	1	31	11	R0759_001_0	2		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				345.00	30																										30						30					30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R0865	003	0	1	31	11	R0865_003_0	3		Y	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R0865	003	0	1	31	11	R0865_003_0	3		Y	Preferred Generic	4	11	3	2	1	3	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
R0865	003	0	1	31	11	R0865_003_0	3		Y	Generic	4	11	3	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	5.00		15.00																									20.00		60.00				5.00		0.00				5.00				5.00		0.17				0.67	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R0865	003	0	1	31	11	R0865_003_0	3		Y	Generic	4	11	3	2	2	3	110		01		110	1	30		90				2	2				30		90	30		31	5.00		15.00																									20.00		60.00				5.00		0.00				5.00				5.00		0.17				0.67	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
R0865	003	0	1	31	11	R0865_003_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R0865	003	0	1	31	11	R0865_003_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	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												
R0865	003	0	1	31	11	R0865_003_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					30																										30						30					30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R0923	002	0	1	31	11	R0923_002_0	3		Y	Preferred Generic	4	11	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	6.00		18.00																									10.00		30.00				6.00		0.00				6.00				6.00		0.20				0.33	0.20	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R0923	002	0	1	31	11	R0923_002_0	3		Y	Generic	4	11	1	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	20.00		60.00																									20.00		60.00				20.00		0.00				20.00				20.00		0.67				0.67	0.67	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R0923	002	0	1	31	11	R0923_002_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		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	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	99.00		297.00																									100.00		300.00				99.00		287.00				99.00				99.00		3.30				3.33	3.30	3.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R0923	002	0	1	31	11	R0923_002_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R1390	002	0	1	31	11	R1390_002_0	4		Y	Preferred Generic	4	11	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	8.00		24.00																									10.00		30.00				8.00		0.00				8.00				8.00		0.27				0.33	0.27	0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R1390	002	0	1	31	11	R1390_002_0	4		Y	Generic	4	11	1	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	18.00		54.00																									20.00		60.00				18.00		0.00				18.00				18.00		0.60				0.67	0.60	0.58	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R1390	002	0	1	31	11	R1390_002_0	4		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		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	4		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	99.00		297.00																									100.00		300.00				99.00		287.00				99.00				99.00		3.30				3.33	3.30	3.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R1390	002	0	1	31	11	R1390_002_0	4		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R1532	002	0	1	31	11	R1532_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																									15.00		45.00				10.00		0.00				10.00				10.00		0.33				0.50	0.33	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R1532	002	0	1	31	11	R1532_002_0	3			Generic	3	11	1	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	16.00		48.00																									20.00		60.00				16.00		0.00				16.00				16.00		0.53				0.67	0.53	0.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R1532	002	0	1	31	11	R1532_002_0	3			Preferred Brand	3	11	1	1	3	1	110		01		110	1	30		90				2	2				30		90	30		31				46.00	19		19																								19		19				19		19			19			19								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R1532	002	0	1	31	11	R1532_002_0	3			Non-Preferred Drug	3	11	1	1	4	1	110		01		110	1	30		90				2	2				30		90	30		31				59.00	25		25																								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	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												
R2604	001	0	1	31	11	R2604_001_0	2		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R2604	001	0	1	31	11	R2604_001_0	2		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
R2604	001	0	1	31	11	R2604_001_0	2		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	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		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	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		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R2604	001	0	1	31	11	R2604_001_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R2604	001	0	1	31	11	R2604_001_0	2		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				346.00	28																										28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R2604	003	0	1	31	11	R2604_003_0	2		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R2604	003	0	1	31	11	R2604_003_0	2		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
R2604	003	0	1	31	11	R2604_003_0	2		Y	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												
R2604	003	0	1	31	11	R2604_003_0	2		Y	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
R2604	003	0	1	31	11	R2604_003_0	2		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R2604	003	0	1	31	11	R2604_003_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R2604	003	0	1	31	11	R2604_003_0	2		Y	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												
R3332	001	0	1	31	11	R3332_001_0	12		Y	Preferred Generic	4	01	1	2	1	1	110		01	110		1	31		100				1	2	31		100				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												
R3332	001	0	1	31	11	R3332_001_0	12		Y	Preferred Generic	4	01	1	2	1	3	110		01	110		1	31		100				1	2	31		100				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		
R3332	001	0	1	31	11	R3332_001_0	12		Y	Generic	4	01	1	2	2	1	110		01	110		1	31		100				1	2	31		100				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												
R3332	001	0	1	31	11	R3332_001_0	12		Y	Preferred Brand	4	11	1	2	3	1	110		01	110		1	31		90				1	2	31		90				31		31	40.00		120.00																			40.00		120.00																40.00				40.00		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	12		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01	110		1	31		90				1	2	31		90				31		31	93.00		279.00																			93.00		279.00																93.00				93.00		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	12		Y	Specialty Tier	4	11	1	1	5	1	010		01	010		1	31								31						31		31				1328.94	29																				29																	29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
R3332	001	0	1	31	11	R3332_001_0	12		Y	Select Care Drugs	4	01	1	2	6	1	110		01	110		1	31		100				1	2	31		100				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												
R3332	001	0	1	31	11	R3332_001_0	12		Y	Select Care Drugs	4	01	1	2	6	3	110		01	110		1	31		100				1	2	31		100				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		
R3392	002	0	1	31	11	R3392_002_0	4		Y	Preferred Generic	4	11	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	7.00		21.00																									10.00		30.00				7.00		0.00				7.00				7.00		0.23				0.33	0.23	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R3392	002	0	1	31	11	R3392_002_0	4		Y	Generic	4	11	1	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	17.00		51.00																									20.00		60.00				17.00		0.00				17.00				17.00		0.57				0.67	0.57	0.55	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R3392	002	0	1	31	11	R3392_002_0	4		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		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		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	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												
R3392	002	0	1	31	11	R3392_002_0	4		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					27																										27						27					27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R3392	004	0	1	31	11	R3392_004_0	4		Y	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	4.00		12.00																									10.00		30.00				4.00		0.00				4.00				4.00		0.13				0.33	0.13	0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R3392	004	0	1	31	11	R3392_004_0	4		Y	Generic	4	11	3	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	12.00		36.00																									20.00		60.00				12.00		0.00				12.00				12.00		0.40				0.67	0.40	0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R3392	004	0	1	31	11	R3392_004_0	4		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R3392	004	0	1	31	11	R3392_004_0	4		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		290.00				100.00				100.00		3.33				3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R3392	004	0	1	31	11	R3392_004_0	4		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					30																										30						30					30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R3444	009	0	1	31	11	R3444_009_0	3		Y	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		Y	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		Y	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		Y	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		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R3444	009	0	1	31	11	R3444_009_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		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		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				389.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R3444	012	0	1	31	11	R3444_012_0	3		Y	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	3		Y	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	3		Y	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	3		Y	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	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R3444	012	0	1	31	11	R3444_012_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		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	3		Y	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												
R3444	023	0	1	31	11	R3444_023_0	3		Y	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	3		Y	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	3		Y	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	3		Y	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	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R3444	023	0	1	31	11	R3444_023_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		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	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				381.00	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	18.00		54.00																									19.00		57.00				18.00		0.00				18.00				18.00		0.60				0.63	0.60	0.58	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		0.00				20.00				20.00		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	1	3	1	110		01		110	1	30		90				2	2				30		90	30		31				45.00	18		18																								18		18				18		18			18			18								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	1	4	1	110		01		110	1	30		90				2	2				30		90	30		31				67.00	31		31																								31		31				31		31			31			31								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								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R4182	003	0	1	31	11	R4182_003_0	3		Y	Preferred Generic	4	11	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R4182	003	0	1	31	11	R4182_003_0	3		Y	Preferred Generic	4	11	1	2	1	3	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									10.00		30.00				0.00		0.00				0.00				0.00		0				0.33	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
R4182	003	0	1	31	11	R4182_003_0	3		Y	Generic	4	11	1	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	10.00		30.00																									20.00		60.00				10.00		0.00				10.00				10.00		0.33				0.67	0.33	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R4182	003	0	1	31	11	R4182_003_0	3		Y	Generic	4	11	1	2	2	3	110		01		110	1	30		90				2	2				30		90	30		31	10.00		30.00																									20.00		60.00				10.00		0.00				10.00				10.00		0.33				0.67	0.33	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
R4182	003	0	1	31	11	R4182_003_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		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		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	99.00		297.00																									100.00		300.00				99.00		287.00				99.00				99.00		3.30				3.33	3.30	3.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R4182	003	0	1	31	11	R4182_003_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					30																										30						30					30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R4182	004	0	1	31	11	R4182_004_0	3		Y	Preferred Generic	4	11	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	6.00		18.00																									10.00		30.00				6.00		0.00				6.00				6.00		0.20				0.33	0.20	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R4182	004	0	1	31	11	R4182_004_0	3		Y	Preferred Generic	4	11	1	2	1	3	110		01		110	1	30		90				1	2				30		90	30		31	6.00		18.00																									10.00		30.00				6.00		0.00				6.00				6.00		0.20				0.33	0.20	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
R4182	004	0	1	31	11	R4182_004_0	3		Y	Generic	4	11	1	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	13.00		39.00																									20.00		60.00				13.00		0.00				13.00				13.00		0.43				0.67	0.43	0.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R4182	004	0	1	31	11	R4182_004_0	3		Y	Generic	4	11	1	2	2	3	110		01		110	1	30		90				2	2				30		90	30		31	13.00		39.00																									20.00		60.00				13.00		0.00				13.00				13.00		0.43				0.67	0.43	0.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
R4182	004	0	1	31	11	R4182_004_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		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		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	99.00		297.00																									100.00		300.00				99.00		287.00				99.00				99.00		3.30				3.33	3.30	3.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R4182	004	0	1	31	11	R4182_004_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					30																										30						30					30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R4487	001	0	1	31	11	R4487_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								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	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												
R4487	001	0	1	31	11	R4487_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					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	6			Non-Preferred Drug	4	11	1	1	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34											73.32	47	47	47				71.76	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	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												
R4487	001	0	1	31	11	R4487_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								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				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	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		
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	8.00		24.00																									15.00		45.00				8.00		0.00				8.00				8.00		0.27				0.50	0.27	0.26	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	15.00		45.00																									20.00		60.00				15.00		0.00				15.00				15.00		0.50				0.67	0.50	0.48	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	1	3	1	110		01		110	1	30		90				2	2				30		90	30		31				42.00	19		19																								19		19				19		19			19			19								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	1	4	1	110		01		110	1	30		90				2	2				30		90	30		31				63.00	25		25																								25		25				25		25			25			25								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								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R5329	001	0	1	31	11	R5329_001_0	2		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R5329	001	0	1	31	11	R5329_001_0	2		Y	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		
R5329	001	0	1	31	11	R5329_001_0	2		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R5329	001	0	1	31	11	R5329_001_0	2		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
R5329	001	0	1	31	11	R5329_001_0	2		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R5329	001	0	1	31	11	R5329_001_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R5329	001	0	1	31	11	R5329_001_0	2		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				290.00	28																										28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R5342	001	0	1	31	11	R5342_001_0	2		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R5342	001	0	1	31	11	R5342_001_0	2		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
R5342	001	0	1	31	11	R5342_001_0	2		Y	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												
R5342	001	0	1	31	11	R5342_001_0	2		Y	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
R5342	001	0	1	31	11	R5342_001_0	2		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R5342	001	0	1	31	11	R5342_001_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R5342	001	0	1	31	11	R5342_001_0	2		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				307.00	29																										29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R5342	005	0	1	31	11	R5342_005_0	2		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R5342	005	0	1	31	11	R5342_005_0	2		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
R5342	005	0	1	31	11	R5342_005_0	2		Y	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												
R5342	005	0	1	31	11	R5342_005_0	2		Y	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
R5342	005	0	1	31	11	R5342_005_0	2		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R5342	005	0	1	31	11	R5342_005_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R5342	005	0	1	31	11	R5342_005_0	2		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				302.00	31																										31						31					31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R5342	006	0	1	31	11	R5342_006_0	2		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R5342	006	0	1	31	11	R5342_006_0	2		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
R5342	006	0	1	31	11	R5342_006_0	2		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R5342	006	0	1	31	11	R5342_006_0	2		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
R5342	006	0	1	31	11	R5342_006_0	2		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R5342	006	0	1	31	11	R5342_006_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R5342	006	0	1	31	11	R5342_006_0	2		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				538.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R5361	002	0	1	31	11	R5361_002_0	4			Preferred Generic	3	11	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	12.00		36.00																									13.00		39.00				12.00		0.00				12.00				12.00		0.40				0.43	0.40	0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R5361	002	0	1	31	11	R5361_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		0.00				20.00				20.00		0.67				0.67	0.67	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R5361	002	0	1	31	11	R5361_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		131.00				47.00				47.00		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	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		290.00				100.00				100.00		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	4			Specialty Tier	3	11	1	1	5	1	010		01		010	1	30											30			30		31					25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R5495	002	0	1	31	11	R5495_002_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																									19.00		57.00				18.00		0.00				18.00				18.00		0.60				0.63	0.60	0.58	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R5495	002	0	1	31	11	R5495_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		0.00				20.00				20.00		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	4			Preferred Brand	3	11	1	1	3	1	110		01		110	1	30		90				2	2				30		90	30		31				46.00	18		18																								18		18				18		18			18			18								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R5495	002	0	1	31	11	R5495_002_0	4			Non-Preferred Drug	3	11	1	1	4	1	110		01		110	1	30		90				2	2				30		90	30		31				48.00	21		21																								21		21				21		21			21			21								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R5495	002	0	1	31	11	R5495_002_0	4			Specialty Tier	3	11	1	1	5	1	010		01		010	1	30											30			30		31					25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R5826	005	0	1	31	11	R5826_005_0	3		Y	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	5.00		15.00																									10.00		30.00				5.00		0.00				5.00				5.00		0.17				0.33	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R5826	005	0	1	31	11	R5826_005_0	3		Y	Generic	4	11	3	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	15.00		45.00																									20.00		60.00				15.00		0.00				15.00				15.00		0.50				0.67	0.50	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R5826	005	0	1	31	11	R5826_005_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	45.00		135.00																									47.00		141.00				45.00		125.00				45.00				45.00		1.50				1.57	1.50	1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R5826	005	0	1	31	11	R5826_005_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	95.00		285.00																									100.00		300.00				95.00		275.00				95.00				95.00		3.17				3.33	3.17	3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R5826	005	0	1	31	11	R5826_005_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					31																										31						31					31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R5826	074	0	1	31	11	R5826_074_0	2		Y	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	6.00		18.00																									10.00		30.00				6.00		0.00				6.00				6.00		0.20				0.33	0.20	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R5826	074	0	1	31	11	R5826_074_0	2		Y	Generic	4	11	3	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	20.00		60.00																									20.00		60.00				20.00		0.00				20.00				20.00		0.67				0.67	0.67	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R5826	074	0	1	31	11	R5826_074_0	2		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R5826	074	0	1	31	11	R5826_074_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	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												
R5826	074	0	1	31	11	R5826_074_0	2		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					26																										26						26					26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R5941	014	0	1	31	11	R5941_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								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	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												
R5941	014	0	1	31	11	R5941_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												
R5941	014	0	1	31	11	R5941_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											72.82	42	42	42				71.09	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	6			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												
R5941	014	0	1	31	11	R5941_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												
R5941	014	0	1	31	11	R5941_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		
R6694	003	0	1	31	11	R6694_003_0	5			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	5			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	5			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	5			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	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					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00					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	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					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	5			Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1020.26	33						508.17	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R6694	005	0	1	31	11	R6694_005_0	4			Preferred Generic	3	01	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		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												
R6694	005	0	1	31	11	R6694_005_0	4			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	4			Preferred Brand	3	11	1	1	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31											44.60	18	18	18				58.37	18	18	18										18	18	18				18	18	18				18		18								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R6694	005	0	1	31	11	R6694_005_0	4			Non-Preferred Drug	3	11	1	1	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31											92.05	39	39	39				64.79	39	39	39										39	39	39				39	39	39				39		39								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R6694	005	0	1	31	11	R6694_005_0	4			Specialty Tier	3	11	1	1	5	1		010	10		010	1				30								30				10	31											763.15	25						405.64	25												25						25						25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R6694	006	0	1	31	11	R6694_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												
R6694	006	0	1	31	11	R6694_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		
R6694	006	0	1	31	11	R6694_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					10.00	20.00	20.00											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												
R6694	006	0	1	31	11	R6694_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					10.00	20.00	20.00											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										1		
R6694	006	0	1	31	11	R6694_006_0	2			Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					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	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												
R6694	006	0	1	31	11	R6694_006_0	2			Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											913.28	27						597.97	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		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	4.00		12.00																											12.00						0.00				4.00				4.00		0.13						0.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R6801	009	0	1	31	11	R6801_009_0	3		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	4.00		12.00																											12.00						0.00				4.00				4.00		0.13						0.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
R6801	009	0	1	31	11	R6801_009_0	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R6801	009	0	1	31	11	R6801_009_0	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
R6801	009	0	1	31	11	R6801_009_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R6801	009	0	1	31	11	R6801_009_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R6801	009	0	1	31	11	R6801_009_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				226.00	28																										28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R6801	012	0	1	31	11	R6801_012_0	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	4.00		12.00																											12.00						0.00				4.00				4.00		0.13						0.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R6801	012	0	1	31	11	R6801_012_0	3		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	4.00		12.00																											12.00						0.00				4.00				4.00		0.13						0.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
R6801	012	0	1	31	11	R6801_012_0	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R6801	012	0	1	31	11	R6801_012_0	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
R6801	012	0	1	31	11	R6801_012_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R6801	012	0	1	31	11	R6801_012_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R6801	012	0	1	31	11	R6801_012_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				254.00	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	12.00		36.00																									19.00		57.00				12.00		0.00				12.00				12.00		0.40				0.63	0.40	0.39	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	15.00		45.00																									20.00		60.00				15.00		0.00				15.00				15.00		0.50				0.67	0.50	0.48	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				43.00	21		21																								21		21				21		21			21			21								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				51.00	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								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R7315	002	0	1	31	11	R7315_002_0	3			Preferred Generic	3	11	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	5.00		15.00																									10.00		30.00				5.00		0.00				5.00				5.00		0.17				0.33	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R7315	002	0	1	31	11	R7315_002_0	3			Generic	3	11	1	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	12.00		36.00																									20.00		60.00				12.00		0.00				12.00				12.00		0.40				0.67	0.40	0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R7315	002	0	1	31	11	R7315_002_0	3			Preferred Brand	3	11	1	1	3	1	110		01		110	1	30		90				2	2				30		90	30		31				56.00	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	3			Non-Preferred Drug	3	11	1	1	4	1	110		01		110	1	30		90				2	2				30		90	30		31				53.00	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	3			Specialty Tier	3	11	1	1	5	1	010		01		010	1	30											30			30		31					26																										26						26					26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R7444	001	0	1	31	11	R7444_001_0	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R7444	001	0	1	31	11	R7444_001_0	3		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
R7444	001	0	1	31	11	R7444_001_0	3		Y	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												
R7444	001	0	1	31	11	R7444_001_0	3		Y	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
R7444	001	0	1	31	11	R7444_001_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R7444	001	0	1	31	11	R7444_001_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		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												
R7444	001	0	1	31	11	R7444_001_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				231.00	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											9.00		18.00				2.00		4.00				9.00				9.00			0.30	0.06		0.30	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											17.00		34.00				10.00		20.00				17.00				17.00			0.56	0.33		0.56	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											47.00		94.00				40.00		80.00				47.00				47.00			1.56	1.33		1.56	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											98.55	41		41				83.46	36		36										41		41				36		36			41			41								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			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	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	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	12.00		36.00																			12.00		24.00																12.00				12.00		.40			0.40			.38	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				83.14	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											9.00		18.00				2.00		4.00				9.00				9.00			0.30	0.06		0.30	0.07	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											15.00		30.00				8.00		16.00				15.00				15.00			0.50	0.26		0.50	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											47.00		94.00				40.00		80.00				47.00				47.00			1.56	1.33		1.56	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											91.12	43		43				97.07	38		38										43		43				38		38			43			43								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			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								9.00	18.00	27.00					1.00	2.00	2.00							2.00																9.00				9.00			0.30	0.03				0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
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								19.00	38.00	57.00					12.00	24.00	24.00							24.00																19.00				19.00			0.63	0.40				0.61	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											94.06	50	50	50				88.42	47	47	47						47															50			50								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											1364.79	25						1364.79	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											99.09	45	45	45				92.49	42	42	42						42															45			45								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											1309.96	33						1309.96	33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S2668	005	0		29	10	S2668_005_0	6			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																			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												
S2668	005	0		29	10	S2668_005_0	6			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																			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												
S2668	005	0		29	10	S2668_005_0	6			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	6			Non-Preferred Drug	2	11	1	1	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31				65.76	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	6			Specialty Tier	2	11	1	1	5	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31				578.99	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	6		Y	Preferred Generic	4	11	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								15.00	30.00	45.00					1.00	2.00	3.00					0.00	0.00	0.00																15.00				15.00			0.50	0.03	0.00			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S2668	006	0		29	10	S2668_006_0	6		Y	Generic	4	11	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								20.00	40.00	60.00					9.00	18.00	27.00					0.00	0.00	0.00																20.00				20.00			0.67	0.30	0.00			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S2668	006	0		29	10	S2668_006_0	6		Y	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					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												
S2668	006	0		29	10	S2668_006_0	6		Y	Non-Preferred Drug	4	11	1	1	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											43.03	50	50	50				40.11	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	6		Y	Specialty Tier	4	11	1	1	5	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											1530.44	33	33	33				1202.32	33	33	33				33	33	33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S2874	001	0		29	10	S2874_001_0	3		Y	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								5.00		15.00					1.00		3.00											5.00		15.00				1.00		0.00				5.00				5.00			0.17	0.03		0.17	0.03	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S2874	001	0		29	10	S2874_001_0	3		Y	Preferred Generic	4	11	1	2	1	3		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										1		
S2874	001	0		29	10	S2874_001_0	3		Y	Generic	4	11	3	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					4.00		12.00											10.00		30.00				4.00		0.00				10.00				10.00			0.33	0.13		0.33	0.13	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S2874	001	0		29	10	S2874_001_0	3		Y	Generic	4	11	3	2	2	3		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										1		3
S2874	001	0		29	10	S2874_001_0	3		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					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	3		Y	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				93.00	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	3		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S2874	004	0		29	10	S2874_004_0	1			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	1			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	1			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												
S2874	004	0		29	10	S2874_004_0	1			Non-Preferred Drug	2	11	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											75.00	47		47				72.00	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	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												
S2893	001	0		29	10	S2893_001_0	3			Preferred Generic	3	11	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								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	3			Generic	3	11	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								20.00	40.00	60.00					15.00	30.00	45.00					15.00	30.00	30.00																20.00				20.00			0.67	0.50	0.50			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S2893	001	0		29	10	S2893_001_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					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	3			Non-Preferred Drug	3	11	1	1	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											96.56	45	45	45				91.52	45	45	45				45	45	45															45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S2893	001	0		29	10	S2893_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												
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											83.65	44	44	44				64.48	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		N	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		N	Generic	3	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												
S3147	001	0		29	10	S3147_001_0	5		N	Preferred Brand	3	10	1	1	3	1	110		01	100		1	31		90				1	2			90				31		31				62.66	22		22																				22															22			22								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S3147	001	0		29	10	S3147_001_0	5		N	Non-Preferred Drug	3	10	1	1	4	1	110		01	100		1	31		90				1	2			90				31		31				98.93	38		38																				38															38			38								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S3147	001	0		29	10	S3147_001_0	5		N	Specialty Tier	3	11	1	1	5	1	010		01			1	31														31		31				293.49	25																																					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S3147	002	0		29	10	S3147_002_0	5		Y	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		Y	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		Y	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		Y	Non-Preferred Drug	4	10	1	1	4	1	110		01	100		1	31		90				1	2			90				31		31				82.49	37		37																				37															37			37								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S3147	002	0		29	10	S3147_002_0	5		Y	Specialty Tier	4	11	1	1	5	1	010		01			1	31														31		31				183.84	25																																					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S3147	003	0		29	10	S3147_003_0	5		Y	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		Y	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		Y	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		Y	Non-Preferred Drug	4	10	1	1	4	1	110		01	100		1	31		90				1	2			90				31		31				72.38	39		39																				39															39			39								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S3147	003	0		29	10	S3147_003_0	5		Y	Specialty Tier	4	11	1	1	5	1	010		01			1	31														31		31				229.38	33																																					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S3375	001	0		29	10	S3375_001_0	3			Preferred Generic	3	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								1.00	2.00	3.00					0.00	0.00	0.00					0.00	0.00	0.00																1.00				1.00			0.03	0.00	0.00			0.03	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S3375	001	0		29	10	S3375_001_0	3			Generic	3	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					1.00	2.00	3.00					1.00	2.00	3.00																2.00				2.00			0.07	0.03	0.03			0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S3375	001	0		29	10	S3375_001_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												
S3375	001	0		29	10	S3375_001_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											97.37	40	40	40				97.37	40	40	40				40	40	40															40			40								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S3375	001	0		29	10	S3375_001_0	3			Specialty Tier	3	11	1	1	5	1		010	01	010		1				30					30						30		34												25							25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S3375	002	0		29	10	S3375_002_0	4		Y	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		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		Y	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					4.00	8.00	12.00					4.00	8.00	12.00																20.00				20.00			0.67	0.13	0.13			0.59	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S3375	002	0		29	10	S3375_002_0	4		Y	Preferred Brand	4	11	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		Y	Non-Preferred Drug	4	11	1	1	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34											88.80	50	50	50				88.80	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		Y	Specialty Tier	4	11	1	1	5	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	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					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	2			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	012	0		29	10	S4802_012_0	2			Preferred Brand	2	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								38.00	76.00	114.00					33.00	66.00	99.00											38.00	76.00	114.00				33.00	66.00	99.00				38.00				38.00			1.27	1.1		1.27	1.1	1.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	012	0		29	10	S4802_012_0	2			Non-Preferred Drug	2	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											92.66	40	40	40				88.03	38	38	38										40	40	40				38	38	38			40			40								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	012	0		29	10	S4802_012_0	2			Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	013	0		29	10	S4802_013_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					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	013	0		29	10	S4802_013_0	2			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					5.00	10.00	15.00											8.00	16.00	24.00				5.00	10.00	15.00				8.00				8.00			0.27	0.17		0.27	0.17	0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	013	0		29	10	S4802_013_0	2			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					37.00	74.00	111.00											43.00	86.00	129.00				37.00	74.00	111.00				43.00				43.00			1.43	1.23		1.43	1.23	1.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	013	0		29	10	S4802_013_0	2			Non-Preferred Drug	2	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											92.93	42	42	42				90.71	41	41	41										42	42	42				41	41	41			42			42								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	013	0		29	10	S4802_013_0	2			Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	014	0		29	10	S4802_014_0	2			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	014	0		29	10	S4802_014_0	2			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					5.00	10.00	15.00											8.00	16.00	24.00				5.00	10.00	15.00				8.00				8.00			0.27	0.17		0.27	0.17	0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	014	0		29	10	S4802_014_0	2			Preferred Brand	2	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								40.00	80.00	120.00					34.00	68.00	102.00											40.00	80.00	120.00				34.00	68.00	102.00				40.00				40.00			1.33	1.13		1.33	1.13	1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	014	0		29	10	S4802_014_0	2			Non-Preferred Drug	2	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											91.98	39	39	39				89.62	38	38	38										39	39	39				38	38	38			39			39								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	014	0		29	10	S4802_014_0	2			Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	020	0		29	10	S4802_020_0	2			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	020	0		29	10	S4802_020_0	2			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					5.00	10.00	15.00											8.00	16.00	24.00				5.00	10.00	15.00				8.00				8.00			0.27	0.17		0.27	0.17	0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	020	0		29	10	S4802_020_0	2			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					37.00	74.00	111.00											42.00	84.00	126.00				37.00	74.00	111.00				42.00				42.00			1.4	1.23		1.4	1.23	1.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	020	0		29	10	S4802_020_0	2			Non-Preferred Drug	2	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											82.71	38	38	38				78.35	36	36	36										38	38	38				36	36	36			38			38								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	020	0		29	10	S4802_020_0	2			Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	021	0		29	10	S4802_021_0	2			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	2			Generic	2	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					5.00	10.00	15.00											7.00	14.00	21.00				5.00	10.00	15.00				7.00				7.00			0.23	0.17		0.23	0.17	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	021	0		29	10	S4802_021_0	2			Preferred Brand	2	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					35.00	70.00	105.00											41.00	82.00	123.00				35.00	70.00	105.00				41.00				41.00			1.37	1.17		1.37	1.17	1.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	021	0		29	10	S4802_021_0	2			Non-Preferred Drug	2	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											89.14	37	37	37				86.73	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	2			Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	069	0		29	10	S4802_069_0	3			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	069	0		29	10	S4802_069_0	3			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					7.00	14.00	21.00											11.00	22.00	33.00				7.00	14.00	21.00				11.00				11.00			0.37	0.23		0.37	0.23	0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	069	0		29	10	S4802_069_0	3			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					38.00	76.00	114.00											43.00	86.00	129.00				38.00	76.00	114.00				43.00				43.00			1.43	1.27		1.43	1.27	1.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	069	0		29	10	S4802_069_0	3			Non-Preferred Drug	2	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											89.59	38	38	38				84.87	36	36	36										38	38	38				36	36	36			38			38								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	069	0		29	10	S4802_069_0	3			Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	070	0		29	10	S4802_070_0	2			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	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					6.00	12.00	18.00											9.00	18.00	27.00				6.00	12.00	18.00				9.00				9.00			0.3	0.2		0.3	0.2	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	070	0		29	10	S4802_070_0	2			Preferred Brand	2	11	1	2	3	1		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	114.00				43.00				43.00			1.43	1.27		1.43	1.27	1.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	070	0		29	10	S4802_070_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											94.81	42	42	42				92.55	41	41	41										42	42	42				41	41	41			42			42								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	070	0		29	10	S4802_070_0	2			Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	071	0		29	10	S4802_071_0	2			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	071	0		29	10	S4802_071_0	2			Generic	2	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					5.00	10.00	15.00											7.00	14.00	21.00				5.00	10.00	15.00				7.00				7.00			0.23	0.17		0.23	0.17	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	071	0		29	10	S4802_071_0	2			Preferred Brand	2	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								37.00	74.00	111.00					33.00	66.00	99.00											37.00	74.00	111.00				33.00	66.00	99.00				37.00				37.00			1.23	1.1		1.23	1.1	1.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	071	0		29	10	S4802_071_0	2			Non-Preferred Drug	2	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											91.9	40	40	40				87.31	38	38	38										40	40	40				38	38	38			40			40								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	071	0		29	10	S4802_071_0	2			Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	072	0		29	10	S4802_072_0	2			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	072	0		29	10	S4802_072_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					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	072	0		29	10	S4802_072_0	2			Preferred Brand	2	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					35.00	70.00	105.00											41.00	82.00	123.00				35.00	70.00	105.00				41.00				41.00			1.37	1.17		1.37	1.17	1.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	072	0		29	10	S4802_072_0	2			Non-Preferred Drug	2	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											91.24	34	34	34				88.56	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	2			Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	073	0		29	10	S4802_073_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					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	073	0		29	10	S4802_073_0	2			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	073	0		29	10	S4802_073_0	2			Preferred Brand	2	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								40.00	80.00	120.00					32.00	64.00	96.00											40.00	80.00	120.00				32.00	64.00	96.00				40.00				40.00			1.33	1.07		1.33	1.07	1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	073	0		29	10	S4802_073_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											88.24	38	38	38				85.92	37	37	37										38	38	38				37	37	37			38			38								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	073	0		29	10	S4802_073_0	2			Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	074	0		29	10	S4802_074_0	2			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	074	0		29	10	S4802_074_0	2			Generic	2	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					4.00	8.00	12.00											7.00	14.00	21.00				4.00	8.00	12.00				7.00				7.00			0.23	0.13		0.23	0.13	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	074	0		29	10	S4802_074_0	2			Preferred Brand	2	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					36.00	72.00	108.00											41.00	82.00	123.00				36.00	72.00	108.00				41.00				41.00			1.37	1.2		1.37	1.2	1.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	074	0		29	10	S4802_074_0	2			Non-Preferred Drug	2	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											95.8	40	40	40				93.4	39	39	39										40	40	40				39	39	39			40			40								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	074	0		29	10	S4802_074_0	2			Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	075	0		29	10	S4802_075_0	2			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	075	0		29	10	S4802_075_0	2			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					4.00	8.00	12.00											10.00	20.00	30.00				4.00	8.00	12.00				10.00				10.00			0.33	0.13		0.33	0.13	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	075	0		29	10	S4802_075_0	2			Preferred Brand	2	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								40.00	80.00	120.00					34.00	68.00	102.00											40.00	80.00	120.00				34.00	68.00	102.00				40.00				40.00			1.33	1.13		1.33	1.13	1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	075	0		29	10	S4802_075_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											89.74	38	38	38				87.38	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	2			Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	076	0		29	10	S4802_076_0	2			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	076	0		29	10	S4802_076_0	2			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	076	0		29	10	S4802_076_0	2			Preferred Brand	2	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					34.00	68.00	102.00											41.00	82.00	123.00				34.00	68.00	102.00				41.00				41.00			1.37	1.13		1.37	1.13	1.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	076	0		29	10	S4802_076_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											89.58	40	40	40				87.34	39	39	39										40	40	40				39	39	39			40			40								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	076	0		29	10	S4802_076_0	2			Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	077	0		29	10	S4802_077_0	2			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	077	0		29	10	S4802_077_0	2			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	077	0		29	10	S4802_077_0	2			Preferred Brand	2	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								40.00	80.00	120.00					35.00	70.00	105.00											40.00	80.00	120.00				35.00	70.00	105.00				40.00				40.00			1.33	1.17		1.33	1.17	1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	077	0		29	10	S4802_077_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											92.25	37	37	37				89.76	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	2			Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	078	0		29	10	S4802_078_0	2			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	078	0		29	10	S4802_078_0	2			Generic	2	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					4.00	8.00	12.00											7.00	14.00	21.00				4.00	8.00	12.00				7.00				7.00			0.23	0.13		0.23	0.13	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	078	0		29	10	S4802_078_0	2			Preferred Brand	2	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								38.00	76.00	114.00					31.00	62.00	93.00											38.00	76.00	114.00				31.00	62.00	93.00				38.00				38.00			1.27	1.03		1.27	1.03	1.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	078	0		29	10	S4802_078_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											96.66	42	42	42				92.06	40	40	40										42	42	42				40	40	40			42			42								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	078	0		29	10	S4802_078_0	2			Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	079	0		29	10	S4802_079_0	2			Preferred Generic	2	11	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								6.00	12.00	18.00					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	079	0		29	10	S4802_079_0	2			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					6.00	12.00	18.00											10.00	20.00	30.00				6.00	12.00	18.00				10.00				10.00			0.33	0.2		0.33	0.2	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	079	0		29	10	S4802_079_0	2			Preferred Brand	2	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								40.00	80.00	120.00					35.00	70.00	105.00											40.00	80.00	120.00				35.00	70.00	105.00				40.00				40.00			1.33	1.17		1.33	1.17	1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	079	0		29	10	S4802_079_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											89.47	39	39	39				84.89	37	37	37										39	39	39				37	37	37			39			39								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	079	0		29	10	S4802_079_0	2			Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	080	0		29	10	S4802_080_0	2			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	080	0		29	10	S4802_080_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					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	080	0		29	10	S4802_080_0	2			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					37.00	74.00	111.00											42.00	84.00	126.00				37.00	74.00	111.00				42.00				42.00			1.4	1.23		1.4	1.23	1.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	080	0		29	10	S4802_080_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											90.28	43	43	43				86.08	41	41	41										43	43	43				41	41	41			43			43								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	080	0		29	10	S4802_080_0	2			Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	081	0		29	10	S4802_081_0	2			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	081	0		29	10	S4802_081_0	2			Generic	2	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								12.00	24.00	36.00					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	081	0		29	10	S4802_081_0	2			Preferred Brand	2	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								40.00	80.00	120.00					30.00	60.00	90.00											40.00	80.00	120.00				30.00	60.00	90.00				40.00				40.00			1.33	1.00		1.33	1.00	1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	081	0		29	10	S4802_081_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											95.37	40	40	40				92.99	39	39	39										40	40	40				39	39	39			40			40								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	081	0		29	10	S4802_081_0	2			Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	082	0		29	10	S4802_082_0	2			Preferred Generic	2	11	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								6.00	12.00	18.00					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	082	0		29	10	S4802_082_0	2			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	082	0		29	10	S4802_082_0	2			Preferred Brand	2	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								40.00	80.00	120.00					30.00	60.00	90.00											40.00	80.00	120.00				30.00	60.00	90.00				40.00				40.00			1.33	1.00		1.33	1.00	1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	082	0		29	10	S4802_082_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											93.83	41	41	41				91.54	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	2			Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	083	0		29	10	S4802_083_0	3			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	083	0		29	10	S4802_083_0	3			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					4.00	8.00	12.00											10.00	20.00	30.00				4.00	8.00	12.00				10.00				10.00			0.33	0.13		0.33	0.13	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	083	0		29	10	S4802_083_0	3			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					30.00	60.00	90.00											42.00	84.00	126.00				30.00	60.00	90.00				42.00				42.00			1.4	1.00		1.4	1.00	1.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	083	0		29	10	S4802_083_0	3			Non-Preferred Drug	2	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											89.73	40	40	40				87.49	39	39	39										40	40	40				39	39	39			40			40								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	083	0		29	10	S4802_083_0	3			Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	084	0		29	10	S4802_084_0	2			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	084	0		29	10	S4802_084_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					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	084	0		29	10	S4802_084_0	2			Preferred Brand	2	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					31.00	62.00	93.00											41.00	82.00	123.00				31.00	62.00	93.00				41.00				41.00			1.37	1.03		1.37	1.03	1.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	084	0		29	10	S4802_084_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											88.18	38	38	38				85.86	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	2			Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	085	0		29	10	S4802_085_0	2			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	2			Generic	2	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								12.00	24.00	36.00					6.00	12.00	18.00											12.00	24.00	36.00				6.00	12.00	18.00				12.00				12.00			0.4	0.2		0.4	0.2	0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	085	0		29	10	S4802_085_0	2			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					30.00	60.00	90.00											42.00	84.00	126.00				30.00	60.00	90.00				42.00				42.00			1.4	1.00		1.4	1.00	1.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	085	0		29	10	S4802_085_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											94.38	39	39	39				89.54	37	37	37										39	39	39				37	37	37			39			39								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	085	0		29	10	S4802_085_0	2			Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	086	0		29	10	S4802_086_0	2			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	086	0		29	10	S4802_086_0	2			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					4.00	8.00	12.00											11.00	22.00	33.00				4.00	8.00	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												
S4802	086	0		29	10	S4802_086_0	2			Preferred Brand	2	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								40.00	80.00	120.00					32.00	64.00	96.00											40.00	80.00	120.00				32.00	64.00	96.00				40.00				40.00			1.33	1.07		1.33	1.07	1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	086	0		29	10	S4802_086_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											93.09	39	39	39				90.71	38	38	38										39	39	39				38	38	38			39			39								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	086	0		29	10	S4802_086_0	2			Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	087	0		29	10	S4802_087_0	2			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	087	0		29	10	S4802_087_0	2			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	087	0		29	10	S4802_087_0	2			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					33.00	66.00	99.00											42.00	84.00	126.00				33.00	66.00	99.00				42.00				42.00			1.4	1.1		1.4	1.1	1.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	087	0		29	10	S4802_087_0	2			Non-Preferred Drug	2	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											90.2	44	44	44				86.1	42	42	42										44	44	44				42	42	42			44			44								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	087	0		29	10	S4802_087_0	2			Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	088	0		29	10	S4802_088_0	2			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	2			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	088	0		29	10	S4802_088_0	2			Preferred Brand	2	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								40.00	80.00	120.00					32.00	64.00	96.00											40.00	80.00	120.00				32.00	64.00	96.00				40.00				40.00			1.33	1.07		1.33	1.07	1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	088	0		29	10	S4802_088_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											92.58	38	38	38				90.15	37	37	37										38	38	38				37	37	37			38			38								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	088	0		29	10	S4802_088_0	2			Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	089	0		29	10	S4802_089_0	3			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	089	0		29	10	S4802_089_0	3			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					4.00	8.00	12.00											11.00	22.00	33.00				4.00	8.00	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												
S4802	089	0		29	10	S4802_089_0	3			Preferred Brand	2	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								38.00	76.00	114.00					31.00	62.00	93.00											38.00	76.00	114.00				31.00	62.00	93.00				38.00				38.00			1.27	1.03		1.27	1.03	1.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	089	0		29	10	S4802_089_0	3			Non-Preferred Drug	2	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											93.85	42	42	42				91.61	41	41	41										42	42	42				41	41	41			42			42								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	089	0		29	10	S4802_089_0	3			Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	090	0		29	10	S4802_090_0	2			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	090	0		29	10	S4802_090_0	2			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	090	0		29	10	S4802_090_0	2			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					34.00	68.00	102.00											43.00	86.00	129.00				34.00	68.00	102.00				43.00				43.00			1.43	1.13		1.43	1.13	1.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	090	0		29	10	S4802_090_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											90.08	46	46	46				86.17	44	44	44										46	46	46				44	44	44			46			46								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	090	0		29	10	S4802_090_0	2			Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	091	0		29	10	S4802_091_0	2			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	091	0		29	10	S4802_091_0	2			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	091	0		29	10	S4802_091_0	2			Preferred Brand	2	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					33.00	66.00	99.00											41.00	82.00	123.00				33.00	66.00	99.00				41.00				41.00			1.37	1.1		1.37	1.1	1.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	091	0		29	10	S4802_091_0	2			Non-Preferred Drug	2	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											95.72	42	42	42				91.17	40	40	40										42	42	42				40	40	40			42			42								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	091	0		29	10	S4802_091_0	2			Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	092	0		29	10	S4802_092_0	3			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	092	0		29	10	S4802_092_0	3			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	092	0		29	10	S4802_092_0	3			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					35.00	70.00	105.00											43.00	86.00	129.00				35.00	70.00	105.00				43.00				43.00			1.43	1.17		1.43	1.17	1.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	092	0		29	10	S4802_092_0	3			Non-Preferred Drug	2	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											92.66	46	46	46				88.63	44	44	44										46	46	46				44	44	44			46			46								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	092	0		29	10	S4802_092_0	3			Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	093	0		29	10	S4802_093_0	2			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	093	0		29	10	S4802_093_0	2			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	093	0		29	10	S4802_093_0	2			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					33.00	66.00	99.00											42.00	84.00	126.00				33.00	66.00	99.00				42.00				42.00			1.4	1.1		1.4	1.1	1.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	093	0		29	10	S4802_093_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											95.18	42	42	42				92.91	41	41	41										42	42	42				41	41	41			42			42								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	093	0		29	10	S4802_093_0	2			Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	094	0		29	10	S4802_094_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					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	094	0		29	10	S4802_094_0	2			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	094	0		29	10	S4802_094_0	2			Preferred Brand	2	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								40.00	80.00	120.00					33.00	66.00	99.00											40.00	80.00	120.00				33.00	66.00	99.00				40.00				40.00			1.33	1.1		1.33	1.1	1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	094	0		29	10	S4802_094_0	2			Non-Preferred Drug	2	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											97.89	40	40	40				95.45	39	39	39										40	40	40				39	39	39			40			40								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	094	0		29	10	S4802_094_0	2			Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	095	0		29	10	S4802_095_0	2			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	095	0		29	10	S4802_095_0	2			Generic	2	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					9.00	18.00	27.00											18.00	36.00	54.00				9.00	18.00	27.00				18.00				18.00			0.6	0.3		0.6	0.3	0.58	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	095	0		29	10	S4802_095_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					42.00	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	095	0		29	10	S4802_095_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											95.54	38	38	38				93.03	37	37	37										38	38	38				37	37	37			38			38								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	095	0		29	10	S4802_095_0	2			Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	096	0		29	10	S4802_096_0	2			Preferred Generic	2	11	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								6.00	12.00	18.00					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	096	0		29	10	S4802_096_0	2			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	096	0		29	10	S4802_096_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					42.00	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	096	0		29	10	S4802_096_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											93.61	45	45	45				91.53	44	44	44										45	45	45				44	44	44			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	096	0		29	10	S4802_096_0	2			Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	097	0		29	10	S4802_097_0	2			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	097	0		29	10	S4802_097_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					3.00	6.00	9.00											9.00	18.00	27.00				3.00	6.00	9.00				9.00				9.00			0.3	0.1		0.3	0.1	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	097	0		29	10	S4802_097_0	2			Preferred Brand	2	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								39.00	78.00	117.00					32.00	64.00	96.00											39.00	78.00	117.00				32.00	64.00	96.00				39.00				39.00			1.3	1.07		1.3	1.07	1.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	097	0		29	10	S4802_097_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											93.64	39	39	39				91.24	38	38	38										39	39	39				38	38	38			39			39								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	097	0		29	10	S4802_097_0	2			Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	132	0		29	10	S4802_132_0	2		Y	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, Select Diabetic Drugs												
S4802	132	0		29	10	S4802_132_0	2		Y	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	15.00				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 Diabetic Drugs												
S4802	132	0		29	10	S4802_132_0	2		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					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 Diabetic Drugs												
S4802	132	0		29	10	S4802_132_0	2		Y	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											73.42	50	50	50				69.01	47	47	47										50	50	50				47	47	47			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs												
S4802	132	0		29	10	S4802_132_0	2		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs												
S4802	132	0		29	10	S4802_132_0	2		Y	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					11.00	22.00	33.00											11.00	22.00	33.00				11.00	22.00	33.00				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												
S4802	133	0		29	10	S4802_133_0	2		Y	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, Select Diabetic Drugs												
S4802	133	0		29	10	S4802_133_0	2		Y	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	15.00				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 Diabetic Drugs												
S4802	133	0		29	10	S4802_133_0	2		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					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 Diabetic Drugs												
S4802	133	0		29	10	S4802_133_0	2		Y	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											66.82	50	50	50				62.81	47	47	47										50	50	50				47	47	47			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs												
S4802	133	0		29	10	S4802_133_0	2		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs												
S4802	133	0		29	10	S4802_133_0	2		Y	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					11.00	22.00	33.00											11.00	22.00	33.00				11.00	22.00	33.00				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												
S4802	134	0		29	10	S4802_134_0	2		Y	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, Select Diabetic Drugs												
S4802	134	0		29	10	S4802_134_0	2		Y	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	15.00				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 Diabetic Drugs												
S4802	134	0		29	10	S4802_134_0	2		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					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 Diabetic Drugs												
S4802	134	0		29	10	S4802_134_0	2		Y	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											81.92	50	50	50				77	47	47	47										50	50	50				47	47	47			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs												
S4802	134	0		29	10	S4802_134_0	2		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs												
S4802	134	0		29	10	S4802_134_0	2		Y	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					11.00	22.00	33.00											11.00	22.00	33.00				11.00	22.00	33.00				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												
S4802	135	0		29	10	S4802_135_0	2		Y	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, Select Diabetic Drugs												
S4802	135	0		29	10	S4802_135_0	2		Y	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	15.00				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 Diabetic Drugs												
S4802	135	0		29	10	S4802_135_0	2		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					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 Diabetic Drugs												
S4802	135	0		29	10	S4802_135_0	2		Y	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											66.52	50	50	50				62.53	47	47	47										50	50	50				47	47	47			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs												
S4802	135	0		29	10	S4802_135_0	2		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs												
S4802	135	0		29	10	S4802_135_0	2		Y	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					11.00	22.00	33.00											11.00	22.00	33.00				11.00	22.00	33.00				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												
S4802	136	0		29	10	S4802_136_0	2		Y	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, Select Diabetic Drugs												
S4802	136	0		29	10	S4802_136_0	2		Y	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	15.00				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 Diabetic Drugs												
S4802	136	0		29	10	S4802_136_0	2		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					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 Diabetic Drugs												
S4802	136	0		29	10	S4802_136_0	2		Y	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											69.83	50	50	50				65.64	47	47	47										50	50	50				47	47	47			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs												
S4802	136	0		29	10	S4802_136_0	2		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs												
S4802	136	0		29	10	S4802_136_0	2		Y	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					11.00	22.00	33.00											11.00	22.00	33.00				11.00	22.00	33.00				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												
S4802	137	0		29	10	S4802_137_0	2		Y	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, Select Diabetic Drugs												
S4802	137	0		29	10	S4802_137_0	2		Y	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	15.00				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 Diabetic Drugs												
S4802	137	0		29	10	S4802_137_0	2		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					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 Diabetic Drugs												
S4802	137	0		29	10	S4802_137_0	2		Y	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											76.11	50	50	50				71.55	47	47	47										50	50	50				47	47	47			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs												
S4802	137	0		29	10	S4802_137_0	2		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs												
S4802	137	0		29	10	S4802_137_0	2		Y	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					11.00	22.00	33.00											11.00	22.00	33.00				11.00	22.00	33.00				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												
S4802	138	0		29	10	S4802_138_0	2		Y	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, Select Diabetic Drugs												
S4802	138	0		29	10	S4802_138_0	2		Y	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	15.00				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 Diabetic Drugs												
S4802	138	0		29	10	S4802_138_0	2		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					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 Diabetic Drugs												
S4802	138	0		29	10	S4802_138_0	2		Y	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											87.79	50	50	50				82.52	47	47	47										50	50	50				47	47	47			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs												
S4802	138	0		29	10	S4802_138_0	2		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs												
S4802	138	0		29	10	S4802_138_0	2		Y	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					11.00	22.00	33.00											11.00	22.00	33.00				11.00	22.00	33.00				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												
S4802	139	0		29	10	S4802_139_0	2		Y	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, Select Diabetic Drugs												
S4802	139	0		29	10	S4802_139_0	2		Y	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	15.00				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 Diabetic Drugs												
S4802	139	0		29	10	S4802_139_0	2		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					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 Diabetic Drugs												
S4802	139	0		29	10	S4802_139_0	2		Y	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											76.44	50	50	50				71.85	47	47	47										50	50	50				47	47	47			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs												
S4802	139	0		29	10	S4802_139_0	2		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs												
S4802	139	0		29	10	S4802_139_0	2		Y	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					11.00	22.00	33.00											11.00	22.00	33.00				11.00	22.00	33.00				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												
S4802	140	0		29	10	S4802_140_0	2		Y	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, Select Diabetic Drugs												
S4802	140	0		29	10	S4802_140_0	2		Y	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	15.00				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 Diabetic Drugs												
S4802	140	0		29	10	S4802_140_0	2		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					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 Diabetic Drugs												
S4802	140	0		29	10	S4802_140_0	2		Y	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											72.77	50	50	50				68.4	47	47	47										50	50	50				47	47	47			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs												
S4802	140	0		29	10	S4802_140_0	2		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs												
S4802	140	0		29	10	S4802_140_0	2		Y	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					11.00	22.00	33.00											11.00	22.00	33.00				11.00	22.00	33.00				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												
S4802	141	0		29	10	S4802_141_0	2		Y	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, Select Diabetic Drugs												
S4802	141	0		29	10	S4802_141_0	2		Y	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	15.00				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 Diabetic Drugs												
S4802	141	0		29	10	S4802_141_0	2		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					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 Diabetic Drugs												
S4802	141	0		29	10	S4802_141_0	2		Y	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											74.98	50	50	50				70.48	47	47	47										50	50	50				47	47	47			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs												
S4802	141	0		29	10	S4802_141_0	2		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs												
S4802	141	0		29	10	S4802_141_0	2		Y	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					11.00	22.00	33.00											11.00	22.00	33.00				11.00	22.00	33.00				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												
S4802	142	0		29	10	S4802_142_0	2		Y	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, Select Diabetic Drugs												
S4802	142	0		29	10	S4802_142_0	2		Y	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	15.00				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 Diabetic Drugs												
S4802	142	0		29	10	S4802_142_0	2		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					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 Diabetic Drugs												
S4802	142	0		29	10	S4802_142_0	2		Y	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				71.88	47	47	47										50	50	50				47	47	47			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs												
S4802	142	0		29	10	S4802_142_0	2		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs												
S4802	142	0		29	10	S4802_142_0	2		Y	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					11.00	22.00	33.00											11.00	22.00	33.00				11.00	22.00	33.00				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												
S4802	143	0		29	10	S4802_143_0	2		Y	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, Select Diabetic Drugs												
S4802	143	0		29	10	S4802_143_0	2		Y	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	15.00				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 Diabetic Drugs												
S4802	143	0		29	10	S4802_143_0	2		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					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 Diabetic Drugs												
S4802	143	0		29	10	S4802_143_0	2		Y	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											67.85	50	50	50				63.78	47	47	47										50	50	50				47	47	47			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs												
S4802	143	0		29	10	S4802_143_0	2		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs												
S4802	143	0		29	10	S4802_143_0	2		Y	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					11.00	22.00	33.00											11.00	22.00	33.00				11.00	22.00	33.00				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												
S4802	144	0		29	10	S4802_144_0	2		Y	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, Select Diabetic Drugs												
S4802	144	0		29	10	S4802_144_0	2		Y	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	15.00				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 Diabetic Drugs												
S4802	144	0		29	10	S4802_144_0	2		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					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 Diabetic Drugs												
S4802	144	0		29	10	S4802_144_0	2		Y	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											84.02	50	50	50				78.97	47	47	47										50	50	50				47	47	47			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs												
S4802	144	0		29	10	S4802_144_0	2		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs												
S4802	144	0		29	10	S4802_144_0	2		Y	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					11.00	22.00	33.00											11.00	22.00	33.00				11.00	22.00	33.00				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												
S4802	145	0		29	10	S4802_145_0	2		Y	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, Select Diabetic Drugs												
S4802	145	0		29	10	S4802_145_0	2		Y	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	15.00				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 Diabetic Drugs												
S4802	145	0		29	10	S4802_145_0	2		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					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 Diabetic Drugs												
S4802	145	0		29	10	S4802_145_0	2		Y	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											77.87	50	50	50				73.2	47	47	47										50	50	50				47	47	47			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs												
S4802	145	0		29	10	S4802_145_0	2		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs												
S4802	145	0		29	10	S4802_145_0	2		Y	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					11.00	22.00	33.00											11.00	22.00	33.00				11.00	22.00	33.00				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												
S4802	146	0		29	10	S4802_146_0	2		Y	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, Select Diabetic Drugs												
S4802	146	0		29	10	S4802_146_0	2		Y	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	15.00				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 Diabetic Drugs												
S4802	146	0		29	10	S4802_146_0	2		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					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 Diabetic Drugs												
S4802	146	0		29	10	S4802_146_0	2		Y	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											85.75	50	50	50				80.6	47	47	47										50	50	50				47	47	47			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs												
S4802	146	0		29	10	S4802_146_0	2		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs												
S4802	146	0		29	10	S4802_146_0	2		Y	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					11.00	22.00	33.00											11.00	22.00	33.00				11.00	22.00	33.00				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												
S4802	147	0		29	10	S4802_147_0	2		Y	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, Select Diabetic Drugs												
S4802	147	0		29	10	S4802_147_0	2		Y	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	15.00				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 Diabetic Drugs												
S4802	147	0		29	10	S4802_147_0	2		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					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 Diabetic Drugs												
S4802	147	0		29	10	S4802_147_0	2		Y	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											77.15	50	50	50				72.52	47	47	47										50	50	50				47	47	47			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs												
S4802	147	0		29	10	S4802_147_0	2		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs												
S4802	147	0		29	10	S4802_147_0	2		Y	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					11.00	22.00	33.00											11.00	22.00	33.00				11.00	22.00	33.00				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												
S4802	148	0		29	10	S4802_148_0	2		Y	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, Select Diabetic Drugs												
S4802	148	0		29	10	S4802_148_0	2		Y	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	15.00				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 Diabetic Drugs												
S4802	148	0		29	10	S4802_148_0	2		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					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 Diabetic Drugs												
S4802	148	0		29	10	S4802_148_0	2		Y	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											69.77	50	50	50				65.58	47	47	47										50	50	50				47	47	47			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs												
S4802	148	0		29	10	S4802_148_0	2		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs												
S4802	148	0		29	10	S4802_148_0	2		Y	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					11.00	22.00	33.00											11.00	22.00	33.00				11.00	22.00	33.00				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												
S4802	149	0		29	10	S4802_149_0	2		Y	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, Select Diabetic Drugs												
S4802	149	0		29	10	S4802_149_0	2		Y	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	15.00				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 Diabetic Drugs												
S4802	149	0		29	10	S4802_149_0	2		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					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 Diabetic Drugs												
S4802	149	0		29	10	S4802_149_0	2		Y	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											75.07	50	50	50				70.57	47	47	47										50	50	50				47	47	47			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs												
S4802	149	0		29	10	S4802_149_0	2		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs												
S4802	149	0		29	10	S4802_149_0	2		Y	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					11.00	22.00	33.00											11.00	22.00	33.00				11.00	22.00	33.00				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												
S4802	150	0		29	10	S4802_150_0	2		Y	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, Select Diabetic Drugs												
S4802	150	0		29	10	S4802_150_0	2		Y	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	15.00				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 Diabetic Drugs												
S4802	150	0		29	10	S4802_150_0	2		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					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 Diabetic Drugs												
S4802	150	0		29	10	S4802_150_0	2		Y	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											70.39	50	50	50				66.17	47	47	47										50	50	50				47	47	47			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs												
S4802	150	0		29	10	S4802_150_0	2		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs												
S4802	150	0		29	10	S4802_150_0	2		Y	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					11.00	22.00	33.00											11.00	22.00	33.00				11.00	22.00	33.00				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												
S4802	151	0		29	10	S4802_151_0	2		Y	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, Select Diabetic Drugs												
S4802	151	0		29	10	S4802_151_0	2		Y	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	15.00				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 Diabetic Drugs												
S4802	151	0		29	10	S4802_151_0	2		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					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 Diabetic Drugs												
S4802	151	0		29	10	S4802_151_0	2		Y	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											70.65	50	50	50				66.41	47	47	47										50	50	50				47	47	47			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs												
S4802	151	0		29	10	S4802_151_0	2		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs												
S4802	151	0		29	10	S4802_151_0	2		Y	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					11.00	22.00	33.00											11.00	22.00	33.00				11.00	22.00	33.00				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												
S4802	152	0		29	10	S4802_152_0	2		Y	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, Select Diabetic Drugs												
S4802	152	0		29	10	S4802_152_0	2		Y	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	15.00				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 Diabetic Drugs												
S4802	152	0		29	10	S4802_152_0	2		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					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 Diabetic Drugs												
S4802	152	0		29	10	S4802_152_0	2		Y	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											69.09	50	50	50				64.94	47	47	47										50	50	50				47	47	47			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs												
S4802	152	0		29	10	S4802_152_0	2		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs												
S4802	152	0		29	10	S4802_152_0	2		Y	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					11.00	22.00	33.00											11.00	22.00	33.00				11.00	22.00	33.00				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												
S4802	153	0		29	10	S4802_153_0	2		Y	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, Select Diabetic Drugs												
S4802	153	0		29	10	S4802_153_0	2		Y	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	15.00				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 Diabetic Drugs												
S4802	153	0		29	10	S4802_153_0	2		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					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 Diabetic Drugs												
S4802	153	0		29	10	S4802_153_0	2		Y	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											62.72	50	50	50				58.96	47	47	47										50	50	50				47	47	47			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs												
S4802	153	0		29	10	S4802_153_0	2		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs												
S4802	153	0		29	10	S4802_153_0	2		Y	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					11.00	22.00	33.00											11.00	22.00	33.00				11.00	22.00	33.00				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												
S4802	154	0		29	10	S4802_154_0	2		Y	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, Select Diabetic Drugs												
S4802	154	0		29	10	S4802_154_0	2		Y	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	15.00				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 Diabetic Drugs												
S4802	154	0		29	10	S4802_154_0	2		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					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 Diabetic Drugs												
S4802	154	0		29	10	S4802_154_0	2		Y	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											69.24	50	50	50				65.09	47	47	47										50	50	50				47	47	47			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs												
S4802	154	0		29	10	S4802_154_0	2		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs												
S4802	154	0		29	10	S4802_154_0	2		Y	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					11.00	22.00	33.00											11.00	22.00	33.00				11.00	22.00	33.00				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												
S4802	155	0		29	10	S4802_155_0	2		Y	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, Select Diabetic Drugs												
S4802	155	0		29	10	S4802_155_0	2		Y	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	15.00				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 Diabetic Drugs												
S4802	155	0		29	10	S4802_155_0	2		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					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 Diabetic Drugs												
S4802	155	0		29	10	S4802_155_0	2		Y	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											67.09	50	50	50				63.07	47	47	47										50	50	50				47	47	47			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs												
S4802	155	0		29	10	S4802_155_0	2		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs												
S4802	155	0		29	10	S4802_155_0	2		Y	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					11.00	22.00	33.00											11.00	22.00	33.00				11.00	22.00	33.00				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												
S4802	156	0		29	10	S4802_156_0	2		Y	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, Select Diabetic Drugs												
S4802	156	0		29	10	S4802_156_0	2		Y	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	15.00				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 Diabetic Drugs												
S4802	156	0		29	10	S4802_156_0	2		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					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 Diabetic Drugs												
S4802	156	0		29	10	S4802_156_0	2		Y	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											74.69	50	50	50				70.21	47	47	47										50	50	50				47	47	47			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs												
S4802	156	0		29	10	S4802_156_0	2		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs												
S4802	156	0		29	10	S4802_156_0	2		Y	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					11.00	22.00	33.00											11.00	22.00	33.00				11.00	22.00	33.00				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												
S4802	157	0		29	10	S4802_157_0	2		Y	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, Select Diabetic Drugs												
S4802	157	0		29	10	S4802_157_0	2		Y	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	15.00				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 Diabetic Drugs												
S4802	157	0		29	10	S4802_157_0	2		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					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 Diabetic Drugs												
S4802	157	0		29	10	S4802_157_0	2		Y	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											70.27	50	50	50				66.05	47	47	47										50	50	50				47	47	47			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs												
S4802	157	0		29	10	S4802_157_0	2		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs												
S4802	157	0		29	10	S4802_157_0	2		Y	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					11.00	22.00	33.00											11.00	22.00	33.00				11.00	22.00	33.00				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												
S4802	158	0		29	10	S4802_158_0	2		Y	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, Select Diabetic Drugs												
S4802	158	0		29	10	S4802_158_0	2		Y	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	15.00				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 Diabetic Drugs												
S4802	158	0		29	10	S4802_158_0	2		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					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 Diabetic Drugs												
S4802	158	0		29	10	S4802_158_0	2		Y	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											73.51	50	50	50				69.1	47	47	47										50	50	50				47	47	47			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs												
S4802	158	0		29	10	S4802_158_0	2		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs												
S4802	158	0		29	10	S4802_158_0	2		Y	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					11.00	22.00	33.00											11.00	22.00	33.00				11.00	22.00	33.00				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												
S4802	159	0		29	10	S4802_159_0	2		Y	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, Select Diabetic Drugs												
S4802	159	0		29	10	S4802_159_0	2		Y	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	15.00				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 Diabetic Drugs												
S4802	159	0		29	10	S4802_159_0	2		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					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 Diabetic Drugs												
S4802	159	0		29	10	S4802_159_0	2		Y	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											59.92	50	50	50				56.33	47	47	47										50	50	50				47	47	47			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs												
S4802	159	0		29	10	S4802_159_0	2		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs												
S4802	159	0		29	10	S4802_159_0	2		Y	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					11.00	22.00	33.00											11.00	22.00	33.00				11.00	22.00	33.00				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												
S4802	160	0		29	10	S4802_160_0	2		Y	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, Select Diabetic Drugs												
S4802	160	0		29	10	S4802_160_0	2		Y	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	15.00				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 Diabetic Drugs												
S4802	160	0		29	10	S4802_160_0	2		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					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 Diabetic Drugs												
S4802	160	0		29	10	S4802_160_0	2		Y	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											78.04	50	50	50				73.36	47	47	47										50	50	50				47	47	47			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs												
S4802	160	0		29	10	S4802_160_0	2		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs												
S4802	160	0		29	10	S4802_160_0	2		Y	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					11.00	22.00	33.00											11.00	22.00	33.00				11.00	22.00	33.00				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												
S4802	161	0		29	10	S4802_161_0	2		Y	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, Select Diabetic Drugs												
S4802	161	0		29	10	S4802_161_0	2		Y	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	15.00				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 Diabetic Drugs												
S4802	161	0		29	10	S4802_161_0	2		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					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 Diabetic Drugs												
S4802	161	0		29	10	S4802_161_0	2		Y	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											75.68	50	50	50				71.14	47	47	47										50	50	50				47	47	47			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs												
S4802	161	0		29	10	S4802_161_0	2		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs												
S4802	161	0		29	10	S4802_161_0	2		Y	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					11.00	22.00	33.00											11.00	22.00	33.00				11.00	22.00	33.00				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												
S4802	162	0		29	10	S4802_162_0	2		Y	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, Select Diabetic Drugs												
S4802	162	0		29	10	S4802_162_0	2		Y	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	15.00				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 Diabetic Drugs												
S4802	162	0		29	10	S4802_162_0	2		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					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 Diabetic Drugs												
S4802	162	0		29	10	S4802_162_0	2		Y	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											76.23	50	50	50				71.65	47	47	47										50	50	50				47	47	47			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs												
S4802	162	0		29	10	S4802_162_0	2		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs												
S4802	162	0		29	10	S4802_162_0	2		Y	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					11.00	22.00	33.00											11.00	22.00	33.00				11.00	22.00	33.00				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												
S4802	163	0		29	10	S4802_163_0	2		Y	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, Select Diabetic Drugs												
S4802	163	0		29	10	S4802_163_0	2		Y	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	15.00				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 Diabetic Drugs												
S4802	163	0		29	10	S4802_163_0	2		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					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 Diabetic Drugs												
S4802	163	0		29	10	S4802_163_0	2		Y	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											77.65	50	50	50				72.99	47	47	47										50	50	50				47	47	47			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs												
S4802	163	0		29	10	S4802_163_0	2		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs												
S4802	163	0		29	10	S4802_163_0	2		Y	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					11.00	22.00	33.00											11.00	22.00	33.00				11.00	22.00	33.00				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												
S4802	164	0		29	10	S4802_164_0	2		Y	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, Select Diabetic Drugs												
S4802	164	0		29	10	S4802_164_0	2		Y	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	15.00				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 Diabetic Drugs												
S4802	164	0		29	10	S4802_164_0	2		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					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 Diabetic Drugs												
S4802	164	0		29	10	S4802_164_0	2		Y	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											84.32	50	50	50				79.26	47	47	47										50	50	50				47	47	47			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs												
S4802	164	0		29	10	S4802_164_0	2		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs												
S4802	164	0		29	10	S4802_164_0	2		Y	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					11.00	22.00	33.00											11.00	22.00	33.00				11.00	22.00	33.00				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												
S4802	165	0		29	10	S4802_165_0	2		Y	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, Select Diabetic Drugs												
S4802	165	0		29	10	S4802_165_0	2		Y	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	15.00				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 Diabetic Drugs												
S4802	165	0		29	10	S4802_165_0	2		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					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 Diabetic Drugs												
S4802	165	0		29	10	S4802_165_0	2		Y	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											84.34	50	50	50				79.28	47	47	47										50	50	50				47	47	47			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs												
S4802	165	0		29	10	S4802_165_0	2		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs												
S4802	165	0		29	10	S4802_165_0	2		Y	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					11.00	22.00	33.00											11.00	22.00	33.00				11.00	22.00	33.00				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												
S4802	204	0		29	10	S4802_204_0	2		Y	Preferred Generic	4	11	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00				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												
S4802	204	0		29	10	S4802_204_0	2		Y	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					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, Select Diabetic Drugs												
S4802	204	0		29	10	S4802_204_0	2		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	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 Diabetic Drugs												
S4802	204	0		29	10	S4802_204_0	2		Y	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											52.64	50	50	50				52.64	50	50	50										50	50	50				50	50	50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs												
S4802	204	0		29	10	S4802_204_0	2		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs												
S4802	204	0		29	10	S4802_204_0	2		Y	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					11.00	22.00	33.00											11.00	22.00	33.00				11.00	22.00	27.50				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												
S4802	205	0		29	10	S4802_205_0	2		Y	Preferred Generic	4	11	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00				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												
S4802	205	0		29	10	S4802_205_0	2		Y	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					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, Select Diabetic Drugs												
S4802	205	0		29	10	S4802_205_0	2		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	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 Diabetic Drugs												
S4802	205	0		29	10	S4802_205_0	2		Y	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											63.34	50	50	50				63.34	50	50	50										50	50	50				50	50	50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs												
S4802	205	0		29	10	S4802_205_0	2		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs												
S4802	205	0		29	10	S4802_205_0	2		Y	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					11.00	22.00	33.00											11.00	22.00	33.00				11.00	22.00	27.50				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												
S4802	206	0		29	10	S4802_206_0	2		Y	Preferred Generic	4	11	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00				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												
S4802	206	0		29	10	S4802_206_0	2		Y	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					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, Select Diabetic Drugs												
S4802	206	0		29	10	S4802_206_0	2		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	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 Diabetic Drugs												
S4802	206	0		29	10	S4802_206_0	2		Y	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											77.94	50	50	50				77.94	50	50	50										50	50	50				50	50	50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs												
S4802	206	0		29	10	S4802_206_0	2		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs												
S4802	206	0		29	10	S4802_206_0	2		Y	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					11.00	22.00	33.00											11.00	22.00	33.00				11.00	22.00	27.50				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												
S4802	207	0		29	10	S4802_207_0	2		Y	Preferred Generic	4	11	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00				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												
S4802	207	0		29	10	S4802_207_0	2		Y	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					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, Select Diabetic Drugs												
S4802	207	0		29	10	S4802_207_0	2		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	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 Diabetic Drugs												
S4802	207	0		29	10	S4802_207_0	2		Y	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											72.95	50	50	50				72.95	50	50	50										50	50	50				50	50	50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs												
S4802	207	0		29	10	S4802_207_0	2		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs												
S4802	207	0		29	10	S4802_207_0	2		Y	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					11.00	22.00	33.00											11.00	22.00	33.00				11.00	22.00	27.50				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												
S4802	208	0		29	10	S4802_208_0	2		Y	Preferred Generic	4	11	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00				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												
S4802	208	0		29	10	S4802_208_0	2		Y	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					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, Select Diabetic Drugs												
S4802	208	0		29	10	S4802_208_0	2		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	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 Diabetic Drugs												
S4802	208	0		29	10	S4802_208_0	2		Y	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											63.59	50	50	50				63.59	50	50	50										50	50	50				50	50	50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs												
S4802	208	0		29	10	S4802_208_0	2		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs												
S4802	208	0		29	10	S4802_208_0	2		Y	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					11.00	22.00	33.00											11.00	22.00	33.00				11.00	22.00	27.50				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												
S4802	209	0		29	10	S4802_209_0	2		Y	Preferred Generic	4	11	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00				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												
S4802	209	0		29	10	S4802_209_0	2		Y	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					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, Select Diabetic Drugs												
S4802	209	0		29	10	S4802_209_0	2		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	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 Diabetic Drugs												
S4802	209	0		29	10	S4802_209_0	2		Y	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											62.23	50	50	50				62.23	50	50	50										50	50	50				50	50	50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs												
S4802	209	0		29	10	S4802_209_0	2		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs												
S4802	209	0		29	10	S4802_209_0	2		Y	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					11.00	22.00	33.00											11.00	22.00	33.00				11.00	22.00	27.50				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												
S4802	210	0		29	10	S4802_210_0	2		Y	Preferred Generic	4	11	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00				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												
S4802	210	0		29	10	S4802_210_0	2		Y	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					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, Select Diabetic Drugs												
S4802	210	0		29	10	S4802_210_0	2		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	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 Diabetic Drugs												
S4802	210	0		29	10	S4802_210_0	2		Y	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											57.73	50	50	50				57.73	50	50	50										50	50	50				50	50	50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs												
S4802	210	0		29	10	S4802_210_0	2		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs												
S4802	210	0		29	10	S4802_210_0	2		Y	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					11.00	22.00	33.00											11.00	22.00	33.00				11.00	22.00	27.50				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												
S4802	211	0		29	10	S4802_211_0	2		Y	Preferred Generic	4	11	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00				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												
S4802	211	0		29	10	S4802_211_0	2		Y	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					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, Select Diabetic Drugs												
S4802	211	0		29	10	S4802_211_0	2		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	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 Diabetic Drugs												
S4802	211	0		29	10	S4802_211_0	2		Y	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											59.1	50	50	50				59.1	50	50	50										50	50	50				50	50	50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs												
S4802	211	0		29	10	S4802_211_0	2		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs												
S4802	211	0		29	10	S4802_211_0	2		Y	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					11.00	22.00	33.00											11.00	22.00	33.00				11.00	22.00	27.50				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												
S4802	212	0		29	10	S4802_212_0	2		Y	Preferred Generic	4	11	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00				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												
S4802	212	0		29	10	S4802_212_0	2		Y	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					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, Select Diabetic Drugs												
S4802	212	0		29	10	S4802_212_0	2		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	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 Diabetic Drugs												
S4802	212	0		29	10	S4802_212_0	2		Y	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											60.96	50	50	50				60.96	50	50	50										50	50	50				50	50	50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs												
S4802	212	0		29	10	S4802_212_0	2		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs												
S4802	212	0		29	10	S4802_212_0	2		Y	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					11.00	22.00	33.00											11.00	22.00	33.00				11.00	22.00	27.50				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												
S4802	213	0		29	10	S4802_213_0	2		Y	Preferred Generic	4	11	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00				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												
S4802	213	0		29	10	S4802_213_0	2		Y	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					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, Select Diabetic Drugs												
S4802	213	0		29	10	S4802_213_0	2		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	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 Diabetic Drugs												
S4802	213	0		29	10	S4802_213_0	2		Y	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											64.88	50	50	50				64.88	50	50	50										50	50	50				50	50	50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs												
S4802	213	0		29	10	S4802_213_0	2		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs												
S4802	213	0		29	10	S4802_213_0	2		Y	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					11.00	22.00	33.00											11.00	22.00	33.00				11.00	22.00	27.50				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												
S4802	214	0		29	10	S4802_214_0	2		Y	Preferred Generic	4	11	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00				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												
S4802	214	0		29	10	S4802_214_0	2		Y	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					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, Select Diabetic Drugs												
S4802	214	0		29	10	S4802_214_0	2		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	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 Diabetic Drugs												
S4802	214	0		29	10	S4802_214_0	2		Y	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											71.79	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, Select Diabetic Drugs												
S4802	214	0		29	10	S4802_214_0	2		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs												
S4802	214	0		29	10	S4802_214_0	2		Y	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					11.00	22.00	33.00											11.00	22.00	33.00				11.00	22.00	27.50				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												
S4802	215	0		29	10	S4802_215_0	2		Y	Preferred Generic	4	11	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00				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												
S4802	215	0		29	10	S4802_215_0	2		Y	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					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, Select Diabetic Drugs												
S4802	215	0		29	10	S4802_215_0	2		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	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 Diabetic Drugs												
S4802	215	0		29	10	S4802_215_0	2		Y	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											61.99	50	50	50				61.99	50	50	50										50	50	50				50	50	50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs												
S4802	215	0		29	10	S4802_215_0	2		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs												
S4802	215	0		29	10	S4802_215_0	2		Y	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					11.00	22.00	33.00											11.00	22.00	33.00				11.00	22.00	27.50				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												
S4802	216	0		29	10	S4802_216_0	2		Y	Preferred Generic	4	11	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00				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												
S4802	216	0		29	10	S4802_216_0	2		Y	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					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, Select Diabetic Drugs												
S4802	216	0		29	10	S4802_216_0	2		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	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 Diabetic Drugs												
S4802	216	0		29	10	S4802_216_0	2		Y	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											58.38	50	50	50				58.38	50	50	50										50	50	50				50	50	50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs												
S4802	216	0		29	10	S4802_216_0	2		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs												
S4802	216	0		29	10	S4802_216_0	2		Y	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					11.00	22.00	33.00											11.00	22.00	33.00				11.00	22.00	27.50				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												
S4802	217	0		29	10	S4802_217_0	2		Y	Preferred Generic	4	11	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00				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												
S4802	217	0		29	10	S4802_217_0	2		Y	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					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, Select Diabetic Drugs												
S4802	217	0		29	10	S4802_217_0	2		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	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 Diabetic Drugs												
S4802	217	0		29	10	S4802_217_0	2		Y	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				54.59	50	50	50										50	50	50				50	50	50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs												
S4802	217	0		29	10	S4802_217_0	2		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs												
S4802	217	0		29	10	S4802_217_0	2		Y	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					11.00	22.00	33.00											11.00	22.00	33.00				11.00	22.00	27.50				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												
S4802	218	0		29	10	S4802_218_0	2		Y	Preferred Generic	4	11	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00				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												
S4802	218	0		29	10	S4802_218_0	2		Y	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					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, Select Diabetic Drugs												
S4802	218	0		29	10	S4802_218_0	2		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	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 Diabetic Drugs												
S4802	218	0		29	10	S4802_218_0	2		Y	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											58.23	50	50	50				58.23	50	50	50										50	50	50				50	50	50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs												
S4802	218	0		29	10	S4802_218_0	2		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs												
S4802	218	0		29	10	S4802_218_0	2		Y	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					11.00	22.00	33.00											11.00	22.00	33.00				11.00	22.00	27.50				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												
S4802	219	0		29	10	S4802_219_0	2		Y	Preferred Generic	4	11	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00				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												
S4802	219	0		29	10	S4802_219_0	2		Y	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					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, Select Diabetic Drugs												
S4802	219	0		29	10	S4802_219_0	2		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	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 Diabetic Drugs												
S4802	219	0		29	10	S4802_219_0	2		Y	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											63.88	50	50	50				63.88	50	50	50										50	50	50				50	50	50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs												
S4802	219	0		29	10	S4802_219_0	2		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs												
S4802	219	0		29	10	S4802_219_0	2		Y	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					11.00	22.00	33.00											11.00	22.00	33.00				11.00	22.00	27.50				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												
S4802	220	0		29	10	S4802_220_0	2		Y	Preferred Generic	4	11	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00				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												
S4802	220	0		29	10	S4802_220_0	2		Y	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					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, Select Diabetic Drugs												
S4802	220	0		29	10	S4802_220_0	2		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	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 Diabetic Drugs												
S4802	220	0		29	10	S4802_220_0	2		Y	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											53.3	50	50	50				53.3	50	50	50										50	50	50				50	50	50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs												
S4802	220	0		29	10	S4802_220_0	2		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs												
S4802	220	0		29	10	S4802_220_0	2		Y	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					11.00	22.00	33.00											11.00	22.00	33.00				11.00	22.00	27.50				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												
S4802	221	0		29	10	S4802_221_0	2		Y	Preferred Generic	4	11	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00				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												
S4802	221	0		29	10	S4802_221_0	2		Y	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					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, Select Diabetic Drugs												
S4802	221	0		29	10	S4802_221_0	2		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	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 Diabetic Drugs												
S4802	221	0		29	10	S4802_221_0	2		Y	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											60.54	50	50	50				60.54	50	50	50										50	50	50				50	50	50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs												
S4802	221	0		29	10	S4802_221_0	2		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs												
S4802	221	0		29	10	S4802_221_0	2		Y	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					11.00	22.00	33.00											11.00	22.00	33.00				11.00	22.00	27.50				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												
S4802	222	0		29	10	S4802_222_0	2		Y	Preferred Generic	4	11	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00				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												
S4802	222	0		29	10	S4802_222_0	2		Y	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					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, Select Diabetic Drugs												
S4802	222	0		29	10	S4802_222_0	2		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	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 Diabetic Drugs												
S4802	222	0		29	10	S4802_222_0	2		Y	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											55.85	50	50	50				55.85	50	50	50										50	50	50				50	50	50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs												
S4802	222	0		29	10	S4802_222_0	2		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs												
S4802	222	0		29	10	S4802_222_0	2		Y	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					11.00	22.00	33.00											11.00	22.00	33.00				11.00	22.00	27.50				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												
S4802	223	0		29	10	S4802_223_0	2		Y	Preferred Generic	4	11	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00				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												
S4802	223	0		29	10	S4802_223_0	2		Y	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					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, Select Diabetic Drugs												
S4802	223	0		29	10	S4802_223_0	2		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	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 Diabetic Drugs												
S4802	223	0		29	10	S4802_223_0	2		Y	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											57.86	50	50	50				57.86	50	50	50										50	50	50				50	50	50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs												
S4802	223	0		29	10	S4802_223_0	2		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs												
S4802	223	0		29	10	S4802_223_0	2		Y	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					11.00	22.00	33.00											11.00	22.00	33.00				11.00	22.00	27.50				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												
S4802	224	0		29	10	S4802_224_0	2		Y	Preferred Generic	4	11	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00				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												
S4802	224	0		29	10	S4802_224_0	2		Y	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					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, Select Diabetic Drugs												
S4802	224	0		29	10	S4802_224_0	2		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	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 Diabetic Drugs												
S4802	224	0		29	10	S4802_224_0	2		Y	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											64.94	50	50	50				64.94	50	50	50										50	50	50				50	50	50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs												
S4802	224	0		29	10	S4802_224_0	2		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs												
S4802	224	0		29	10	S4802_224_0	2		Y	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					11.00	22.00	33.00											11.00	22.00	33.00				11.00	22.00	27.50				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												
S4802	225	0		29	10	S4802_225_0	2		Y	Preferred Generic	4	11	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00				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												
S4802	225	0		29	10	S4802_225_0	2		Y	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					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, Select Diabetic Drugs												
S4802	225	0		29	10	S4802_225_0	2		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	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 Diabetic Drugs												
S4802	225	0		29	10	S4802_225_0	2		Y	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											63.63	50	50	50				63.63	50	50	50										50	50	50				50	50	50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs												
S4802	225	0		29	10	S4802_225_0	2		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs												
S4802	225	0		29	10	S4802_225_0	2		Y	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					11.00	22.00	33.00											11.00	22.00	33.00				11.00	22.00	27.50				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												
S4802	226	0		29	10	S4802_226_0	2		Y	Preferred Generic	4	11	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00				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												
S4802	226	0		29	10	S4802_226_0	2		Y	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					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, Select Diabetic Drugs												
S4802	226	0		29	10	S4802_226_0	2		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	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 Diabetic Drugs												
S4802	226	0		29	10	S4802_226_0	2		Y	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											55.6	50	50	50				55.6	50	50	50										50	50	50				50	50	50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs												
S4802	226	0		29	10	S4802_226_0	2		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs												
S4802	226	0		29	10	S4802_226_0	2		Y	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					11.00	22.00	33.00											11.00	22.00	33.00				11.00	22.00	27.50				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												
S4802	227	0		29	10	S4802_227_0	2		Y	Preferred Generic	4	11	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00				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												
S4802	227	0		29	10	S4802_227_0	2		Y	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					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, Select Diabetic Drugs												
S4802	227	0		29	10	S4802_227_0	2		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	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 Diabetic Drugs												
S4802	227	0		29	10	S4802_227_0	2		Y	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											58.62	50	50	50				58.62	50	50	50										50	50	50				50	50	50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs												
S4802	227	0		29	10	S4802_227_0	2		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs												
S4802	227	0		29	10	S4802_227_0	2		Y	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					11.00	22.00	33.00											11.00	22.00	33.00				11.00	22.00	27.50				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												
S4802	228	0		29	10	S4802_228_0	2		Y	Preferred Generic	4	11	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00				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												
S4802	228	0		29	10	S4802_228_0	2		Y	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					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, Select Diabetic Drugs												
S4802	228	0		29	10	S4802_228_0	2		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	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 Diabetic Drugs												
S4802	228	0		29	10	S4802_228_0	2		Y	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											56.55	50	50	50				56.55	50	50	50										50	50	50				50	50	50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs												
S4802	228	0		29	10	S4802_228_0	2		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs												
S4802	228	0		29	10	S4802_228_0	2		Y	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					11.00	22.00	33.00											11.00	22.00	33.00				11.00	22.00	27.50				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												
S4802	229	0		29	10	S4802_229_0	2		Y	Preferred Generic	4	11	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00				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												
S4802	229	0		29	10	S4802_229_0	2		Y	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					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, Select Diabetic Drugs												
S4802	229	0		29	10	S4802_229_0	2		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	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 Diabetic Drugs												
S4802	229	0		29	10	S4802_229_0	2		Y	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											61.64	50	50	50				61.64	50	50	50										50	50	50				50	50	50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs												
S4802	229	0		29	10	S4802_229_0	2		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs												
S4802	229	0		29	10	S4802_229_0	2		Y	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					11.00	22.00	33.00											11.00	22.00	33.00				11.00	22.00	27.50				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												
S4802	230	0		29	10	S4802_230_0	2		Y	Preferred Generic	4	11	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00				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												
S4802	230	0		29	10	S4802_230_0	2		Y	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					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, Select Diabetic Drugs												
S4802	230	0		29	10	S4802_230_0	2		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	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 Diabetic Drugs												
S4802	230	0		29	10	S4802_230_0	2		Y	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											64.35	50	50	50				64.35	50	50	50										50	50	50				50	50	50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs												
S4802	230	0		29	10	S4802_230_0	2		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs												
S4802	230	0		29	10	S4802_230_0	2		Y	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					11.00	22.00	33.00											11.00	22.00	33.00				11.00	22.00	27.50				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												
S4802	231	0		29	10	S4802_231_0	2		Y	Preferred Generic	4	11	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00				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												
S4802	231	0		29	10	S4802_231_0	2		Y	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					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, Select Diabetic Drugs												
S4802	231	0		29	10	S4802_231_0	2		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	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 Diabetic Drugs												
S4802	231	0		29	10	S4802_231_0	2		Y	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											55.2	50	50	50				55.2	50	50	50										50	50	50				50	50	50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs												
S4802	231	0		29	10	S4802_231_0	2		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs												
S4802	231	0		29	10	S4802_231_0	2		Y	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					11.00	22.00	33.00											11.00	22.00	33.00				11.00	22.00	27.50				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												
S4802	232	0		29	10	S4802_232_0	2		Y	Preferred Generic	4	11	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00				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												
S4802	232	0		29	10	S4802_232_0	2		Y	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					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, Select Diabetic Drugs												
S4802	232	0		29	10	S4802_232_0	2		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	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 Diabetic Drugs												
S4802	232	0		29	10	S4802_232_0	2		Y	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											67.07	50	50	50				67.07	50	50	50										50	50	50				50	50	50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs												
S4802	232	0		29	10	S4802_232_0	2		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs												
S4802	232	0		29	10	S4802_232_0	2		Y	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					11.00	22.00	33.00											11.00	22.00	33.00				11.00	22.00	27.50				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												
S4802	233	0		29	10	S4802_233_0	2		Y	Preferred Generic	4	11	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00				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												
S4802	233	0		29	10	S4802_233_0	2		Y	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					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, Select Diabetic Drugs												
S4802	233	0		29	10	S4802_233_0	2		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	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 Diabetic Drugs												
S4802	233	0		29	10	S4802_233_0	2		Y	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											53.91	50	50	50				53.91	50	50	50										50	50	50				50	50	50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs												
S4802	233	0		29	10	S4802_233_0	2		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs												
S4802	233	0		29	10	S4802_233_0	2		Y	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					11.00	22.00	33.00											11.00	22.00	33.00				11.00	22.00	27.50				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												
S4802	234	0		29	10	S4802_234_0	2		Y	Preferred Generic	4	11	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00				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												
S4802	234	0		29	10	S4802_234_0	2		Y	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					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, Select Diabetic Drugs												
S4802	234	0		29	10	S4802_234_0	2		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	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 Diabetic Drugs												
S4802	234	0		29	10	S4802_234_0	2		Y	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											50.48	50	50	50				50.48	50	50	50										50	50	50				50	50	50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs												
S4802	234	0		29	10	S4802_234_0	2		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs												
S4802	234	0		29	10	S4802_234_0	2		Y	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					11.00	22.00	33.00											11.00	22.00	33.00				11.00	22.00	27.50				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												
S4802	235	0		29	10	S4802_235_0	2		Y	Preferred Generic	4	11	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00				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												
S4802	235	0		29	10	S4802_235_0	2		Y	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					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, Select Diabetic Drugs												
S4802	235	0		29	10	S4802_235_0	2		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	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 Diabetic Drugs												
S4802	235	0		29	10	S4802_235_0	2		Y	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											73.28	50	50	50				73.28	50	50	50										50	50	50				50	50	50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs												
S4802	235	0		29	10	S4802_235_0	2		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs												
S4802	235	0		29	10	S4802_235_0	2		Y	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					11.00	22.00	33.00											11.00	22.00	33.00				11.00	22.00	27.50				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												
S4802	236	0		29	10	S4802_236_0	2		Y	Preferred Generic	4	11	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00				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												
S4802	236	0		29	10	S4802_236_0	2		Y	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					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, Select Diabetic Drugs												
S4802	236	0		29	10	S4802_236_0	2		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	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 Diabetic Drugs												
S4802	236	0		29	10	S4802_236_0	2		Y	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											67.34	50	50	50				67.34	50	50	50										50	50	50				50	50	50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs												
S4802	236	0		29	10	S4802_236_0	2		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs												
S4802	236	0		29	10	S4802_236_0	2		Y	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					11.00	22.00	33.00											11.00	22.00	33.00				11.00	22.00	27.50				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												
S4802	237	0		29	10	S4802_237_0	2		Y	Preferred Generic	4	11	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00				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												
S4802	237	0		29	10	S4802_237_0	2		Y	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					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, Select Diabetic Drugs												
S4802	237	0		29	10	S4802_237_0	2		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	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 Diabetic Drugs												
S4802	237	0		29	10	S4802_237_0	2		Y	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											66.49	50	50	50				66.49	50	50	50										50	50	50				50	50	50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs												
S4802	237	0		29	10	S4802_237_0	2		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs												
S4802	237	0		29	10	S4802_237_0	2		Y	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					11.00	22.00	33.00											11.00	22.00	33.00				11.00	22.00	27.50				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												
S5540	002	0		29	10	S5540_002_0	5			Preferred Generic	3	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					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												
S5540	002	0		29	10	S5540_002_0	5			Generic	3	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					8.00	16.00	24.00											20.00	40.00	60.00				8.00	16.00	24.00				20.00				20.00			0.67	0.27		0.67	0.27	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5540	002	0		29	10	S5540_002_0	5			Preferred Brand	3	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											47.00	94.00	141.00				37.00	74.00	111.00				47.00				47.00			1.57	1.23		1.57	1.23	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5540	002	0		29	10	S5540_002_0	5			Non-Preferred Drug	3	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											99.47	48	48	48				90.34	46	46	46										48	48	48				46	46	46			48			48								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5540	002	0		29	10	S5540_002_0	5			Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5540	004	0		29	10	S5540_004_0	5			Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					3.00	6.00	9.00											15.00	30.00	45.00				3.00	6.00	9.00				15.00				15.00			0.50	0.10		0.50	0.10	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5540	004	0		29	10	S5540_004_0	5			Preferred Generic	4	01	1	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					3.00	6.00	9.00											15.00	30.00	45.00				3.00	6.00	9.00				15.00				15.00			0.50	0.10		0.50	0.10	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
S5540	004	0		29	10	S5540_004_0	5			Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					6.00	12.00	18.00											20.00	40.00	60.00				6.00	12.00	18.00				20.00				20.00			0.67	0.20		0.67	0.20	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5540	004	0		29	10	S5540_004_0	5			Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								45.00	90.00	135.00					30.00	60.00	90.00											45.00	90.00	135.00				30.00	60.00	90.00				45.00				45.00			1.50	1.00		1.50	1.00	1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5540	004	0		29	10	S5540_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											98.15	34	34	34				87.94	32	32	32										34	34	34				32	32	32			34			34								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5540	004	0		29	10	S5540_004_0	5			Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5552	004	0		29	10	S5552_004_0	1			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	1			Generic	2	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								3.00		9.00					1.00		3.00											3.00		9.00				1.00		0.00				3.00				3.00			0.10	0.03		0.10	0.03	0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5552	004	0		29	10	S5552_004_0	1			Preferred Brand	2	11	1	1	3	1		110	01		110	1				30		90	2	2				30		90	30		31											46.00	20		20				44.00	19		19										20		20				19		19			20			20								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5552	004	0		29	10	S5552_004_0	1			Non-Preferred Drug	2	11	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											98.00	39		39				98.00	39		39										39		39				39		39			39			39								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5552	004	0		29	10	S5552_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												
S5552	005	0		29	10	S5552_005_0	3		Y	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								5.00		15.00					1.00		3.00											5.00		15.00				1.00		0.00				5.00				5.00			0.17	0.03		0.17	0.03	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5552	005	0		29	10	S5552_005_0	3		Y	Preferred Generic	4	11	1	2	1	3		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										1		
S5552	005	0		29	10	S5552_005_0	3		Y	Generic	4	11	3	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					4.00		12.00											10.00		30.00				4.00		0.00				10.00				10.00			0.33	0.13		0.33	0.13	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5552	005	0		29	10	S5552_005_0	3		Y	Generic	4	11	3	2	2	3		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										1		3
S5552	005	0		29	10	S5552_005_0	3		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					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	3		Y	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											96.00	47		47				79.00	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	3		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												28							28												28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5552	006	0		29	10	S5552_006_0	1			Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		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	1			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	1			Preferred Brand	4	11	1	1	3	1		110	01		110	1				30		90	2	2				30		90	30		31											32.00	17		17				24.00	13		13										17		17				13		13			17			17								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5552	006	0		29	10	S5552_006_0	1			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				97.00	50		50										50		50				50		50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5552	006	0		29	10	S5552_006_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												
S5584	001	0		29	10	S5584_001_0	3			Preferred Generic	3	01	1	2	1	1		110	01		110	1				31		90	1	2				31		90	31		31								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												
S5584	001	0		29	10	S5584_001_0	3			Generic	3	01	1	2	2	1		110	01		110	1				31		90	1	2				31		90	31		31								8.00		24.00					3.00		0.00											8.00		24.00				3.00		0.00				8.00				8.00			0.26	0.10		0.26	0.10	0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5584	001	0		29	10	S5584_001_0	3			Preferred Brand	3	11	1	2	3	1		110	01		110	1				31		90	1	2				31		90	31		31								35.00		105.00					30.00		90.00											35.00		105.00				30.00		90.00				35.00				35.00			1.13	0.97		1.13	0.97	1.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5584	001	0		29	10	S5584_001_0	3			Non-Preferred Drug	3	11	1	1	4	1		110	01		110	1				31		90	1	2				31		90	31		31											82.00	37		37				78.00	37		37										37		37				37		37			37			37								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5584	001	0		29	10	S5584_001_0	3			Specialty Tier	3	11	1	1	5	1		010	01		010	1				31								31			31		31											1.00	25						1.00	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5584	002	0		29	10	S5584_002_0	3			Preferred Generic	4	01	1	2	1	1		110	01		110	1				31		90	1	2				31		90	31		31								6.00		18.00					1.00		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	3			Generic	4	01	1	2	2	1		110	01		110	1				31		90	1	2				31		90	31		31								10.00		30.00					5.00		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	3			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	3			Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				31		90	1	2				31		90	31		31											71.00	45		45				67.00	45		45										45		45				45		45			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5584	002	0		29	10	S5584_002_0	3			Specialty Tier	4	11	1	1	5	1		010	01		010	1				31								31			31		31											1.00	33						1.00	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5593	002	0		29	10	S5593_002_0	7			Preferred Generic	2	01	1	2	1	1		110	01		100	1				31		90	1	2						90	31		31								6.00		18.00					0.00		0.00													18.00						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	7			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													42.00						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	7			Preferred Brand	2	11	1	1	3	1		110	01		100	1				31		90	1	2						90	31		31											59.62	25		25				59.62	20		20												25						20			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5593	002	0		29	10	S5593_002_0	7			Non-Preferred Drug	2	11	1	1	4	1		110	01		100	1				31		90	1	2						90	31		31											72.95	50		50				72.95	40		40												50						40			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5593	002	0		29	10	S5593_002_0	7			Specialty Tier	2	11	1	1	5	1		010	01		010	1				31								31			31		31											802.64	25						802.64	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5593	003	0		29	10	S5593_003_0	7			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													12.00						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	7			Preferred Generic	4	01	1	1	1	3		110	01		100	1				31		90	1	2						90	31		31											1.05	15		15				1.05	10		10												15						10			15			15								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
S5593	003	0		29	10	S5593_003_0	7			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													30.00						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	7			Generic	4	01	1	1	2	3		110	01		100	1				31		90	1	2						90	31		31											3.45	15		15				3.45	10		10												15						10			15			15								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
S5593	003	0		29	10	S5593_003_0	7			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													135.00						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	7			Non-Preferred Drug	4	11	1	1	4	1		110	01		100	1				31		90	1	2						90	31		31											64.45	50		50				64.45	35		35												50						35			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5593	003	0		29	10	S5593_003_0	7			Specialty Tier	4	11	1	1	5	1		010	01		010	1				31								31			31		31											1061.95	33						1061.95	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5596	001	0		29	10	S5596_001_0	4		Y	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		Y	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					4.00	8.00	12.00					4.00	8.00	12.00																20.00				20.00			0.67	0.13	0.13			0.59	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5596	001	0		29	10	S5596_001_0	4		Y	Preferred Brand	4	11	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		Y	Non-Preferred Drug	4	11	1	1	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34											81.90	50	50	50				81.90	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		Y	Specialty Tier	4	11	1	1	5	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	3			Preferred Generic	3	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								3.00	6.00	9.00					1.00	2.00	3.00					1.00	2.00	3.00																3.00				3.00			0.10	0.03	0.03			0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5596	005	0		29	10	S5596_005_0	3			Generic	3	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					3.00	6.00	9.00					3.00	6.00	9.00																5.00				5.00			0.17	0.10	0.10			0.15	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5596	005	0		29	10	S5596_005_0	3			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	3			Non-Preferred Drug	3	11	1	1	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34											90.20	47	47	47				88.28	46	46	46				46	46	46															47			47								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5596	005	0		29	10	S5596_005_0	3			Specialty Tier	3	11	1	1	5	1		010	01	010		1				30					30						30		34												25							25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5596	006	0		29	10	S5596_006_0	3		Y	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	3		Y	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					4.00	8.00	12.00					4.00	8.00	12.00																20.00				20.00			0.67	0.13	0.13			0.59	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5596	006	0		29	10	S5596_006_0	3		Y	Preferred Brand	4	11	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	3		Y	Non-Preferred Drug	4	11	1	1	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34											74.05	50	50	50				74.05	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	3		Y	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5596	013	0		29	10	S5596_013_0	3			Preferred Generic	3	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								3.00	6.00	9.00					1.00	2.00	3.00					1.00	2.00	3.00																3.00				3.00			0.10	0.03	0.03			0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5596	013	0		29	10	S5596_013_0	3			Generic	3	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					3.00	6.00	9.00					3.00	6.00	9.00																5.00				5.00			0.17	0.10	0.10			0.15	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5596	013	0		29	10	S5596_013_0	3			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	3			Non-Preferred Drug	3	11	1	1	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34											90.42	47	47	47				88.49	46	46	46				46	46	46															47			47								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5596	013	0		29	10	S5596_013_0	3			Specialty Tier	3	11	1	1	5	1		010	01	010		1				30					30						30		34												25							25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5596	014	0		29	10	S5596_014_0	3		Y	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	3		Y	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					4.00	8.00	12.00					4.00	8.00	12.00																20.00				20.00			0.67	0.13	0.13			0.59	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5596	014	0		29	10	S5596_014_0	3		Y	Preferred Brand	4	11	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	3		Y	Non-Preferred Drug	4	11	1	1	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34											75.01	50	50	50				75.01	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	3		Y	Specialty Tier	4	11	1	1	5	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								3.00	6.00	9.00					1.00	2.00	3.00					1.00	2.00	3.00																3.00				3.00			0.10	0.03	0.03			0.09	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								5.00	10.00	15.00					3.00	6.00	9.00					3.00	6.00	9.00																5.00				5.00			0.17	0.10	0.10			0.15	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								44.00	88.00	132.00					43.00	86.00	129.00					43.00	86.00	129.00																44.00				44.00			1.47	1.43	1.43			1.29	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											79.52	40	40	40				79.52	40	40	40				40	40	40															40			40								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												25							25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5596	018	0		29	10	S5596_018_0	3		Y	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	3		Y	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					4.00	8.00	12.00					4.00	8.00	12.00																20.00				20.00			0.67	0.13	0.13			0.59	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5596	018	0		29	10	S5596_018_0	3		Y	Preferred Brand	4	11	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	3		Y	Non-Preferred Drug	4	11	1	1	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34											67.72	50	50	50				67.72	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	3		Y	Specialty Tier	4	11	1	1	5	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								2.00	4.00	6.00					1.00	2.00	3.00					1.00	2.00	3.00																2.00				2.00			0.07	0.03	0.03			0.06	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								3.00	6.00	9.00					2.00	4.00	6.00					2.00	4.00	6.00																3.00				3.00			0.10	0.07	0.07			0.09	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								40.00	80.00	120.00					40.00	80.00	120.00					40.00	80.00	120.00																40.00				40.00			1.33	1.33	1.33			1.18	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
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											74.18	40	40	40				74.18	40	40	40				40	40	40															40			40								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												25							25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5596	044	0		29	10	S5596_044_0	4		Y	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		Y	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					4.00	8.00	12.00					4.00	8.00	12.00																20.00				20.00			0.67	0.13	0.13			0.59	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5596	044	0		29	10	S5596_044_0	4		Y	Preferred Brand	4	11	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		Y	Non-Preferred Drug	4	11	1	1	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34											69.28	50	50	50				69.28	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		Y	Specialty Tier	4	11	1	1	5	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	3			Preferred Generic	3	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								3.00	6.00	9.00					1.00	2.00	3.00					1.00	2.00	3.00																3.00				3.00			0.10	0.03	0.03			0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5596	046	0		29	10	S5596_046_0	3			Generic	3	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					3.00	6.00	9.00					3.00	6.00	9.00																5.00				5.00			0.17	0.10	0.10			0.15	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5596	046	0		29	10	S5596_046_0	3			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	3			Non-Preferred Drug	3	11	1	1	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34											86.29	42	42	42				84.24	41	41	41				41	41	41															42			42								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5596	046	0		29	10	S5596_046_0	3			Specialty Tier	3	11	1	1	5	1		010	01	010		1				30					30						30		34												25							25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5596	056	0		29	10	S5596_056_0	3			Preferred Generic	3	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								2.00	4.00	6.00					1.00	2.00	3.00					1.00	2.00	3.00																2.00				2.00			0.07	0.03	0.03			0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5596	056	0		29	10	S5596_056_0	3			Generic	3	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								3.00	6.00	9.00					2.00	4.00	6.00					2.00	4.00	6.00																3.00				3.00			0.10	0.07	0.07			0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5596	056	0		29	10	S5596_056_0	3			Preferred Brand	3	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								43.00	86.00	129.00					43.00	86.00	129.00					43.00	86.00	129.00																43.00				43.00			1.43	1.43	1.43			1.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5596	056	0		29	10	S5596_056_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											80.52	40	40	40				80.52	40	40	40				40	40	40															40			40								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5596	056	0		29	10	S5596_056_0	3			Specialty Tier	3	11	1	1	5	1		010	01	010		1				30					30						30		34												25							25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5596	057	0		29	10	S5596_057_0	3		Y	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	3		Y	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					4.00	8.00	12.00					4.00	8.00	12.00																20.00				20.00			0.67	0.13	0.13			0.59	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5596	057	0		29	10	S5596_057_0	3		Y	Preferred Brand	4	11	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	3		Y	Non-Preferred Drug	4	11	1	1	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34											74.62	50	50	50				74.62	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	3		Y	Specialty Tier	4	11	1	1	5	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								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												
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								7.00	14.00	21.00					4.00	8.00	12.00					4.00	8.00	12.00																7.00				7.00			0.23	0.13	0.13			0.21	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								47.00	94.00	141.00					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	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											91.48	41	41	41				89.25	40	40	40				40	40	40															41			41								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	3		Y	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	3		Y	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					4.00	8.00	12.00					4.00	8.00	12.00																20.00				20.00			0.67	0.13	0.13			0.59	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5596	060	0		29	10	S5596_060_0	3		Y	Preferred Brand	4	11	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	3		Y	Non-Preferred Drug	4	11	1	1	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34											75.42	50	50	50				75.42	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	3		Y	Specialty Tier	4	11	1	1	5	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								3.00	6.00	9.00					1.00	2.00	3.00					1.00	2.00	3.00																3.00				3.00			0.10	0.03	0.03			0.09	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								5.00	10.00	15.00					3.00	6.00	9.00					3.00	6.00	9.00																5.00				5.00			0.17	0.10	0.10			0.15	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								45.00	90.00	135.00					44.00	88.00	132.00					44.00	88.00	132.00																45.00				45.00			1.50	1.47	1.47			1.32	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											87.57	40	40	40				87.57	40	40	40				40	40	40															40			40								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	3		Y	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	3		Y	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					4.00	8.00	12.00					4.00	8.00	12.00																20.00				20.00			0.67	0.13	0.13			0.59	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5596	063	0		29	10	S5596_063_0	3		Y	Preferred Brand	4	11	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	3		Y	Non-Preferred Drug	4	11	1	1	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34											71.60	50	50	50				71.60	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	3		Y	Specialty Tier	4	11	1	1	5	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	4			Preferred Generic	3	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								2.00	4.00	6.00					1.00	2.00	3.00					1.00	2.00	3.00																2.00				2.00			0.07	0.03	0.03			0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5596	085	0		29	10	S5596_085_0	4			Generic	3	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					3.00	6.00	9.00					3.00	6.00	9.00																4.00				4.00			0.13	0.10	0.10			0.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5596	085	0		29	10	S5596_085_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	085	0		29	10	S5596_085_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											98.06	45	45	45				98.06	45	45	45				45	45	45															45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5596	085	0		29	10	S5596_085_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	086	0		29	10	S5596_086_0	3		Y	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		Y	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					4.00	8.00	12.00					4.00	8.00	12.00																20.00				20.00			0.67	0.13	0.13			0.59	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5596	086	0		29	10	S5596_086_0	3		Y	Preferred Brand	4	11	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		Y	Non-Preferred Drug	4	11	1	1	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34											78.50	50	50	50				78.50	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		Y	Specialty Tier	4	11	1	1	5	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								2.00	4.00	6.00					1.00	2.00	3.00					1.00	2.00	3.00																2.00				2.00			0.07	0.03	0.03			0.06	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								3.00	6.00	9.00					2.00	4.00	6.00					2.00	4.00	6.00																3.00				3.00			0.10	0.07	0.07			0.09	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								41.00	82.00	123.00					40.00	80.00	120.00					40.00	80.00	120.00																41.00				41.00			1.37	1.33	1.33			1.21	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											89.69	40	40	40				89.69	40	40	40				40	40	40															40			40								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												25							25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5596	088	0		29	10	S5596_088_0	3		Y	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		Y	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					4.00	8.00	12.00					4.00	8.00	12.00																20.00				20.00			0.67	0.13	0.13			0.59	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5596	088	0		29	10	S5596_088_0	3		Y	Preferred Brand	4	11	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		Y	Non-Preferred Drug	4	11	1	1	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34											82.89	50	50	50				82.89	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		Y	Specialty Tier	4	11	1	1	5	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	1			Preferred Generic	2	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					2.00	4.00	6.00											8.00	16.00	24.00				2.00	4.00	6.00					8.00			8.00			0.27	0.07		0.27	0.07	0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	002	0		29	10	S5601_002_0	1			Generic	2	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					7.00	14.00	21.00											15.00	30.00	45.00				7.00	14.00	21.00					15.00			15.00			0.50	0.23		0.50	0.23	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	002	0		29	10	S5601_002_0	1			Preferred Brand	2	11	1	1	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											52.21	17	17	17				66.08	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	1			Non-Preferred Drug	2	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											79.66	36	36	36				68.04	36	36	36										36	36	36				36	36	36				36		36								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	002	0		29	10	S5601_002_0	1			Specialty Tier	2	11	1	1	5	1		010	10		010	1				30								30				10	31											1016.91	25						644.03	25												25						25						25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	003	0		29	10	S5601_003_0	2		Y	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	2		Y	Preferred Generic	4	01	3	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00					5.00			5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
S5601	003	0		29	10	S5601_003_0	2		Y	Generic	4	01	3	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								14.00	28.00	42.00					0.00	0.00	0.00											14.00	28.00	42.00				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												
S5601	003	0		29	10	S5601_003_0	2		Y	Generic	4	01	3	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								14.00	28.00	42.00					0.00	0.00	0.00											14.00	28.00	42.00				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		3
S5601	003	0		29	10	S5601_003_0	2		Y	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					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	2		Y	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											67.40	50	50	50				55.53	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	2		Y	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1201.26	33						853.68	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	004	0		29	10	S5601_004_0	1		N	Preferred Generic	2	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					2.00	4.00	6.00											8.00	16.00	24.00				2.00	4.00	6.00					8.00			8.00			0.27	0.07		0.27	0.07	0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	004	0		29	10	S5601_004_0	1		N	Generic	2	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					7.00	14.00	21.00											15.00	30.00	45.00				7.00	14.00	21.00					15.00			15.00			0.50	0.23		0.50	0.23	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	004	0		29	10	S5601_004_0	1		N	Preferred Brand	2	11	1	1	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											47.08	17	17	17				62.57	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		N	Non-Preferred Drug	2	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											75.47	35	35	35				66.69	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		N	Specialty Tier	2	11	1	1	5	1		010	10		010	1				30								30				10	31											898.95	25						642.94	25												25						25						25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	005	0		29	10	S5601_005_0	1		Y	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		Y	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		Y	Generic	4	01	3	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								14.00	28.00	42.00					0.00	0.00	0.00											14.00	28.00	42.00				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												
S5601	005	0		29	10	S5601_005_0	1		Y	Generic	4	01	3	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								14.00	28.00	42.00					0.00	0.00	0.00											14.00	28.00	42.00				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		3
S5601	005	0		29	10	S5601_005_0	1		Y	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					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		Y	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											95.36	50	50	50				77.34	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		Y	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1568.87	33						959.53	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	006	0		29	10	S5601_006_0	1		N	Preferred Generic	2	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					2.00	4.00	6.00											6.00	12.00	18.00				2.00	4.00	6.00					6.00			6.00			0.20	0.07		0.20	0.07	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	006	0		29	10	S5601_006_0	1		N	Generic	2	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					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												
S5601	006	0		29	10	S5601_006_0	1		N	Preferred Brand	2	11	1	1	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											49.41	17	17	17				61.24	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		N	Non-Preferred Drug	2	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											83.30	35	35	35				66.88	35	35	35										35	35	35				35	35	35				35		35								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	006	0		29	10	S5601_006_0	1		N	Specialty Tier	2	11	1	1	5	1		010	10		010	1				30								30				10	31											831.50	25						624.65	25												25						25						25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	007	0		29	10	S5601_007_0	1		Y	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		Y	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		Y	Generic	4	01	3	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								14.00	28.00	42.00					0.00	0.00	0.00											14.00	28.00	42.00				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												
S5601	007	0		29	10	S5601_007_0	1		Y	Generic	4	01	3	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								14.00	28.00	42.00					0.00	0.00	0.00											14.00	28.00	42.00				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		3
S5601	007	0		29	10	S5601_007_0	1		Y	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					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		Y	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											99.04	50	50	50				78.51	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		Y	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1298.47	33						815.49	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	008	0		29	10	S5601_008_0	1		N	Preferred Generic	2	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					2.00	4.00	6.00											8.00	16.00	24.00				2.00	4.00	6.00					8.00			8.00			0.27	0.07		0.27	0.07	0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	008	0		29	10	S5601_008_0	1		N	Generic	2	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					7.00	14.00	21.00											15.00	30.00	45.00				7.00	14.00	21.00					15.00			15.00			0.50	0.23		0.50	0.23	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	008	0		29	10	S5601_008_0	1		N	Preferred Brand	2	11	1	1	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											53.85	17	17	17				65.59	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		N	Non-Preferred Drug	2	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											81.68	36	36	36				65.36	36	36	36										36	36	36				36	36	36				36		36								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	008	0		29	10	S5601_008_0	1		N	Specialty Tier	2	11	1	1	5	1		010	10		010	1				30								30				10	31											880.18	25						605.81	25												25						25						25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	009	0		29	10	S5601_009_0	1		Y	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		Y	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		Y	Generic	4	01	3	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								14.00	28.00	42.00					0.00	0.00	0.00											14.00	28.00	42.00				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												
S5601	009	0		29	10	S5601_009_0	1		Y	Generic	4	01	3	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								14.00	28.00	42.00					0.00	0.00	0.00											14.00	28.00	42.00				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		3
S5601	009	0		29	10	S5601_009_0	1		Y	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					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		Y	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											91.33	50	50	50				68.25	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		Y	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1500.97	33						1172.15	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	010	0		29	10	S5601_010_0	1		N	Preferred Generic	2	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					2.00	4.00	6.00											8.00	16.00	24.00				2.00	4.00	6.00					8.00			8.00			0.27	0.07		0.27	0.07	0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	010	0		29	10	S5601_010_0	1		N	Generic	2	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					7.00	14.00	21.00											15.00	30.00	45.00				7.00	14.00	21.00					15.00			15.00			0.50	0.23		0.50	0.23	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	010	0		29	10	S5601_010_0	1		N	Preferred Brand	2	11	1	1	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											54.03	17	17	17				66.45	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		N	Non-Preferred Drug	2	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											80.76	38	38	38				66.39	38	38	38										38	38	38				38	38	38				38		38								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	010	0		29	10	S5601_010_0	1		N	Specialty Tier	2	11	1	1	5	1		010	10		010	1				30								30				10	31											912.92	25						734.08	25												25						25						25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	011	0		29	10	S5601_011_0	2		Y	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	2		Y	Preferred Generic	4	01	3	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00					5.00			5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
S5601	011	0		29	10	S5601_011_0	2		Y	Generic	4	01	3	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								14.00	28.00	42.00					0.00	0.00	0.00											14.00	28.00	42.00				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												
S5601	011	0		29	10	S5601_011_0	2		Y	Generic	4	01	3	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								14.00	28.00	42.00					0.00	0.00	0.00											14.00	28.00	42.00				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		3
S5601	011	0		29	10	S5601_011_0	2		Y	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					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	2		Y	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											78.16	50	50	50				58.34	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	2		Y	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1340.33	33						1132.24	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	012	0		29	10	S5601_012_0	1		N	Preferred Generic	2	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					2.00	4.00	6.00											6.00	12.00	18.00				2.00	4.00	6.00					6.00			6.00			0.20	0.07		0.20	0.07	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	012	0		29	10	S5601_012_0	1		N	Generic	2	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					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												
S5601	012	0		29	10	S5601_012_0	1		N	Preferred Brand	2	11	1	1	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											51.90	17	17	17				67.24	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		N	Non-Preferred Drug	2	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											74.79	39	39	39				62.65	39	39	39										39	39	39				39	39	39				39		39								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	012	0		29	10	S5601_012_0	1		N	Specialty Tier	2	11	1	1	5	1		010	10		010	1				30								30				10	31											1057.79	25						703.01	25												25						25						25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	013	0		29	10	S5601_013_0	1		Y	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		Y	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		Y	Generic	4	01	3	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								14.00	28.00	42.00					0.00	0.00	0.00											14.00	28.00	42.00				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												
S5601	013	0		29	10	S5601_013_0	1		Y	Generic	4	01	3	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								14.00	28.00	42.00					0.00	0.00	0.00											14.00	28.00	42.00				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		3
S5601	013	0		29	10	S5601_013_0	1		Y	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					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		Y	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											79.64	50	50	50				58.63	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		Y	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1900.63	33						1231.45	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	014	0		29	10	S5601_014_0	1		N	Preferred Generic	2	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					2.00	4.00	6.00											8.00	16.00	24.00				2.00	4.00	6.00					8.00			8.00			0.27	0.07		0.27	0.07	0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	014	0		29	10	S5601_014_0	1		N	Generic	2	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					7.00	14.00	21.00											15.00	30.00	45.00				7.00	14.00	21.00					15.00			15.00			0.50	0.23		0.50	0.23	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	014	0		29	10	S5601_014_0	1		N	Preferred Brand	2	11	1	1	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											52.91	17	17	17				68.84	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	1		N	Non-Preferred Drug	2	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											81.15	40	40	40				68.02	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	1		N	Specialty Tier	2	11	1	1	5	1		010	10		010	1				30								30				10	31											1180.80	25						751.96	25												25						25						25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	015	0		29	10	S5601_015_0	1		Y	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		Y	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		Y	Generic	4	01	3	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								14.00	28.00	42.00					0.00	0.00	0.00											14.00	28.00	42.00				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												
S5601	015	0		29	10	S5601_015_0	1		Y	Generic	4	01	3	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								14.00	28.00	42.00					0.00	0.00	0.00											14.00	28.00	42.00				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		3
S5601	015	0		29	10	S5601_015_0	1		Y	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					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		Y	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											66.49	50	50	50				52.48	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		Y	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1483.05	33						820.67	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	016	0		29	10	S5601_016_0	1		N	Preferred Generic	2	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					2.00	4.00	6.00											8.00	16.00	24.00				2.00	4.00	6.00					8.00			8.00			0.27	0.07		0.27	0.07	0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	016	0		29	10	S5601_016_0	1		N	Generic	2	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					7.00	14.00	21.00											15.00	30.00	45.00				7.00	14.00	21.00					15.00			15.00			0.50	0.23		0.50	0.23	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	016	0		29	10	S5601_016_0	1		N	Preferred Brand	2	11	1	1	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											56.36	17	17	17				69.02	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		N	Non-Preferred Drug	2	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											77.95	37	37	37				64.17	37	37	37										37	37	37				37	37	37				37		37								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	016	0		29	10	S5601_016_0	1		N	Specialty Tier	2	11	1	1	5	1		010	10		010	1				30								30				10	31											1107.53	25						851.31	25												25						25						25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	017	0		29	10	S5601_017_0	1		Y	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		Y	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		Y	Generic	4	01	3	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								14.00	28.00	42.00					0.00	0.00	0.00											14.00	28.00	42.00				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												
S5601	017	0		29	10	S5601_017_0	1		Y	Generic	4	01	3	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								14.00	28.00	42.00					0.00	0.00	0.00											14.00	28.00	42.00				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		3
S5601	017	0		29	10	S5601_017_0	1		Y	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					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		Y	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											69.97	50	50	50				49.00	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		Y	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1385.30	33						1291.41	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	018	0		29	10	S5601_018_0	1		N	Preferred Generic	2	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					2.00	4.00	6.00											8.00	16.00	24.00				2.00	4.00	6.00					8.00			8.00			0.27	0.07		0.27	0.07	0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	018	0		29	10	S5601_018_0	1		N	Generic	2	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					7.00	14.00	21.00											15.00	30.00	45.00				7.00	14.00	21.00					15.00			15.00			0.50	0.23		0.50	0.23	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	018	0		29	10	S5601_018_0	1		N	Preferred Brand	2	11	1	1	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											51.69	17	17	17				67.11	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		N	Non-Preferred Drug	2	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											81.84	39	39	39				67.83	39	39	39										39	39	39				39	39	39				39		39								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	018	0		29	10	S5601_018_0	1		N	Specialty Tier	2	11	1	1	5	1		010	10		010	1				30								30				10	31											1108.43	25						895.17	25												25						25						25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	019	0		29	10	S5601_019_0	1		Y	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		Y	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		Y	Generic	4	01	3	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								14.00	28.00	42.00					0.00	0.00	0.00											14.00	28.00	42.00				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												
S5601	019	0		29	10	S5601_019_0	1		Y	Generic	4	01	3	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								14.00	28.00	42.00					0.00	0.00	0.00											14.00	28.00	42.00				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		3
S5601	019	0		29	10	S5601_019_0	1		Y	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					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		Y	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											60.75	50	50	50				50.03	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		Y	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											2086.87	33						1441.62	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	020	0		29	10	S5601_020_0	1		N	Preferred Generic	2	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					2.00	4.00	6.00											8.00	16.00	24.00				2.00	4.00	6.00					8.00			8.00			0.27	0.07		0.27	0.07	0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	020	0		29	10	S5601_020_0	1		N	Generic	2	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					7.00	14.00	21.00											15.00	30.00	45.00				7.00	14.00	21.00					15.00			15.00			0.50	0.23		0.50	0.23	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	020	0		29	10	S5601_020_0	1		N	Preferred Brand	2	11	1	1	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											50.37	17	17	17				69.18	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		N	Non-Preferred Drug	2	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											66.93	39	39	39				63.56	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		N	Specialty Tier	2	11	1	1	5	1		010	10		010	1				30								30				10	31											1025.28	25						834.05	25												25						25						25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	021	0		29	10	S5601_021_0	1		Y	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		Y	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		Y	Generic	4	01	3	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								14.00	28.00	42.00					0.00	0.00	0.00											14.00	28.00	42.00				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												
S5601	021	0		29	10	S5601_021_0	1		Y	Generic	4	01	3	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								14.00	28.00	42.00					0.00	0.00	0.00											14.00	28.00	42.00				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		3
S5601	021	0		29	10	S5601_021_0	1		Y	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					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		Y	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											56.90	50	50	50				49.10	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		Y	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1793.23	33						1201.56	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	022	0		29	10	S5601_022_0	2		N	Preferred Generic	2	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					2.00	4.00	6.00											8.00	16.00	24.00				2.00	4.00	6.00					8.00			8.00			0.27	0.07		0.27	0.07	0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	022	0		29	10	S5601_022_0	2		N	Generic	2	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					7.00	14.00	21.00											15.00	30.00	45.00				7.00	14.00	21.00					15.00			15.00			0.50	0.23		0.50	0.23	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	022	0		29	10	S5601_022_0	2		N	Preferred Brand	2	11	1	1	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											46.26	17	17	17				64.47	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		N	Non-Preferred Drug	2	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											77.44	37	37	37				68.23	37	37	37										37	37	37				37	37	37				37		37								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	022	0		29	10	S5601_022_0	2		N	Specialty Tier	2	11	1	1	5	1		010	10		010	1				30								30				10	31											900.18	25						801.84	25												25						25						25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	023	0		29	10	S5601_023_0	1		Y	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		Y	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		Y	Generic	4	01	3	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								14.00	28.00	42.00					0.00	0.00	0.00											14.00	28.00	42.00				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												
S5601	023	0		29	10	S5601_023_0	1		Y	Generic	4	01	3	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								14.00	28.00	42.00					0.00	0.00	0.00											14.00	28.00	42.00				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		3
S5601	023	0		29	10	S5601_023_0	1		Y	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					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		Y	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											73.79	50	50	50				58.28	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		Y	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1143.90	33						840.51	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	024	0		29	10	S5601_024_0	1		N	Preferred Generic	2	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					2.00	4.00	6.00											6.00	12.00	18.00				2.00	4.00	6.00					6.00			6.00			0.20	0.07		0.20	0.07	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	024	0		29	10	S5601_024_0	1		N	Generic	2	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					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												
S5601	024	0		29	10	S5601_024_0	1		N	Preferred Brand	2	11	1	1	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											55.10	17	17	17				68.56	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		N	Non-Preferred Drug	2	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											63.39	36	36	36				57.72	36	36	36										36	36	36				36	36	36				36		36								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	024	0		29	10	S5601_024_0	1		N	Specialty Tier	2	11	1	1	5	1		010	10		010	1				30								30				10	31											1136.65	25						910.65	25												25						25						25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	025	0		29	10	S5601_025_0	1		Y	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		Y	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		Y	Generic	4	01	3	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								14.00	28.00	42.00					0.00	0.00	0.00											14.00	28.00	42.00				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												
S5601	025	0		29	10	S5601_025_0	1		Y	Generic	4	01	3	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								14.00	28.00	42.00					0.00	0.00	0.00											14.00	28.00	42.00				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		3
S5601	025	0		29	10	S5601_025_0	1		Y	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					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		Y	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											52.00	50	50	50				42.72	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		Y	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1275.46	33						1047.52	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	026	0		29	10	S5601_026_0	1		N	Preferred Generic	2	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					2.00	4.00	6.00											8.00	16.00	24.00				2.00	4.00	6.00					8.00			8.00			0.27	0.07		0.27	0.07	0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	026	0		29	10	S5601_026_0	1		N	Generic	2	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					7.00	14.00	21.00											15.00	30.00	45.00				7.00	14.00	21.00					15.00			15.00			0.50	0.23		0.50	0.23	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	026	0		29	10	S5601_026_0	1		N	Preferred Brand	2	11	1	1	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											50.75	17	17	17				66.68	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		N	Non-Preferred Drug	2	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											68.56	36	36	36				56.61	36	36	36										36	36	36				36	36	36				36		36								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	026	0		29	10	S5601_026_0	1		N	Specialty Tier	2	11	1	1	5	1		010	10		010	1				30								30				10	31											1005.74	25						764.09	25												25						25						25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	027	0		29	10	S5601_027_0	1		Y	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		Y	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		Y	Generic	4	01	3	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								14.00	28.00	42.00					0.00	0.00	0.00											14.00	28.00	42.00				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												
S5601	027	0		29	10	S5601_027_0	1		Y	Generic	4	01	3	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								14.00	28.00	42.00					0.00	0.00	0.00											14.00	28.00	42.00				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		3
S5601	027	0		29	10	S5601_027_0	1		Y	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					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		Y	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											62.29	50	50	50				41.46	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		Y	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1558.27	33						1251.31	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	028	0		29	10	S5601_028_0	1		N	Preferred Generic	2	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					2.00	4.00	6.00											8.00	16.00	24.00				2.00	4.00	6.00					8.00			8.00			0.27	0.07		0.27	0.07	0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	028	0		29	10	S5601_028_0	1		N	Generic	2	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					7.00	14.00	21.00											15.00	30.00	45.00				7.00	14.00	21.00					15.00			15.00			0.50	0.23		0.50	0.23	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	028	0		29	10	S5601_028_0	1		N	Preferred Brand	2	11	1	1	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											49.71	17	17	17				70.22	17	17	17										17	17	17				17	17	17				17		17								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	028	0		29	10	S5601_028_0	1		N	Non-Preferred Drug	2	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											83.26	44	44	44				70.41	44	44	44										44	44	44				44	44	44				44		44								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	028	0		29	10	S5601_028_0	1		N	Specialty Tier	2	11	1	1	5	1		010	10		010	1				30								30				10	31											1213.75	25						780.09	25												25						25						25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	029	0		29	10	S5601_029_0	1		Y	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		Y	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		Y	Generic	4	01	3	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								14.00	28.00	42.00					0.00	0.00	0.00											14.00	28.00	42.00				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												
S5601	029	0		29	10	S5601_029_0	1		Y	Generic	4	01	3	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								14.00	28.00	42.00					0.00	0.00	0.00											14.00	28.00	42.00				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		3
S5601	029	0		29	10	S5601_029_0	1		Y	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					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		Y	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											72.03	50	50	50				52.20	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		Y	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1133.15	33						776.24	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	030	0		29	10	S5601_030_0	1		N	Preferred Generic	2	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					2.00	4.00	6.00											8.00	16.00	24.00				2.00	4.00	6.00					8.00			8.00			0.27	0.07		0.27	0.07	0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	030	0		29	10	S5601_030_0	1		N	Generic	2	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					7.00	14.00	21.00											15.00	30.00	45.00				7.00	14.00	21.00					15.00			15.00			0.50	0.23		0.50	0.23	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	030	0		29	10	S5601_030_0	1		N	Preferred Brand	2	11	1	1	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											51.23	17	17	17				69.78	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		N	Non-Preferred Drug	2	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											64.18	37	37	37				60.54	37	37	37										37	37	37				37	37	37				37		37								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	030	0		29	10	S5601_030_0	1		N	Specialty Tier	2	11	1	1	5	1		010	10		010	1				30								30				10	31											1096.63	25						865.75	25												25						25						25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	031	0		29	10	S5601_031_0	1		Y	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		Y	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		Y	Generic	4	01	3	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								14.00	28.00	42.00					0.00	0.00	0.00											14.00	28.00	42.00				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												
S5601	031	0		29	10	S5601_031_0	1		Y	Generic	4	01	3	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								14.00	28.00	42.00					0.00	0.00	0.00											14.00	28.00	42.00				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		3
S5601	031	0		29	10	S5601_031_0	1		Y	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					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		Y	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											54.36	50	50	50				43.56	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		Y	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1600.91	33						1115.26	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	032	0		29	10	S5601_032_0	1		N	Preferred Generic	2	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					2.00	4.00	6.00											6.00	12.00	18.00				2.00	4.00	6.00					6.00			6.00			0.20	0.07		0.20	0.07	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	032	0		29	10	S5601_032_0	1		N	Generic	2	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					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												
S5601	032	0		29	10	S5601_032_0	1		N	Preferred Brand	2	11	1	1	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											49.21	17	17	17				62.80	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		N	Non-Preferred Drug	2	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											70.64	35	35	35				64.02	35	35	35										35	35	35				35	35	35				35		35								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	032	0		29	10	S5601_032_0	1		N	Specialty Tier	2	11	1	1	5	1		010	10		010	1				30								30				10	31											938.40	25						876.24	25												25						25						25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	033	0		29	10	S5601_033_0	1		Y	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		Y	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		Y	Generic	4	01	3	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								14.00	28.00	42.00					0.00	0.00	0.00											14.00	28.00	42.00				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												
S5601	033	0		29	10	S5601_033_0	1		Y	Generic	4	01	3	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								14.00	28.00	42.00					0.00	0.00	0.00											14.00	28.00	42.00				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		3
S5601	033	0		29	10	S5601_033_0	1		Y	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					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		Y	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											57.22	50	50	50				44.69	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		Y	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1421.71	33						667.97	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	034	0		29	10	S5601_034_0	1		N	Preferred Generic	2	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					2.00	4.00	6.00											8.00	16.00	24.00				2.00	4.00	6.00					8.00			8.00			0.27	0.07		0.27	0.07	0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	034	0		29	10	S5601_034_0	1		N	Generic	2	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					7.00	14.00	21.00											15.00	30.00	45.00				7.00	14.00	21.00					15.00			15.00			0.50	0.23		0.50	0.23	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	034	0		29	10	S5601_034_0	1		N	Preferred Brand	2	11	1	1	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											52.83	17	17	17				68.27	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		N	Non-Preferred Drug	2	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											75.28	41	41	41				66.79	41	41	41										41	41	41				41	41	41				41		41								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	034	0		29	10	S5601_034_0	1		N	Specialty Tier	2	11	1	1	5	1		010	10		010	1				30								30				10	31											1081.25	25						773.07	25												25						25						25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	035	0		29	10	S5601_035_0	1		Y	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		Y	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		Y	Generic	4	01	3	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								14.00	28.00	42.00					0.00	0.00	0.00											14.00	28.00	42.00				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												
S5601	035	0		29	10	S5601_035_0	1		Y	Generic	4	01	3	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								14.00	28.00	42.00					0.00	0.00	0.00											14.00	28.00	42.00				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		3
S5601	035	0		29	10	S5601_035_0	1		Y	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					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		Y	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											69.77	50	50	50				59.69	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		Y	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1385.66	33						1128.23	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	036	0		29	10	S5601_036_0	1		N	Preferred Generic	2	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					2.00	4.00	6.00											6.00	12.00	18.00				2.00	4.00	6.00					6.00			6.00			0.20	0.07		0.20	0.07	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	036	0		29	10	S5601_036_0	1		N	Generic	2	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					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												
S5601	036	0		29	10	S5601_036_0	1		N	Preferred Brand	2	11	1	1	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											49.03	17	17	17				65.43	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		N	Non-Preferred Drug	2	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											72.84	35	35	35				62.00	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		N	Specialty Tier	2	11	1	1	5	1		010	10		010	1				30								30				10	31											998.87	25						777.45	25												25						25						25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	037	0		29	10	S5601_037_0	1		Y	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		Y	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		Y	Generic	4	01	3	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								14.00	28.00	42.00					0.00	0.00	0.00											14.00	28.00	42.00				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												
S5601	037	0		29	10	S5601_037_0	1		Y	Generic	4	01	3	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								14.00	28.00	42.00					0.00	0.00	0.00											14.00	28.00	42.00				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		3
S5601	037	0		29	10	S5601_037_0	1		Y	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					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		Y	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											58.01	50	50	50				42.79	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		Y	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1637.53	33						1016.03	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	038	0		29	10	S5601_038_0	1		N	Preferred Generic	2	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					2.00	4.00	6.00											7.00	14.00	21.00				2.00	4.00	6.00					7.00			7.00			0.23	0.07		0.23	0.07	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	038	0		29	10	S5601_038_0	1		N	Generic	2	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					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												
S5601	038	0		29	10	S5601_038_0	1		N	Preferred Brand	2	11	1	1	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											54.46	17	17	17				65.32	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		N	Non-Preferred Drug	2	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											59.86	35	35	35				54.73	35	35	35										35	35	35				35	35	35				35		35								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	038	0		29	10	S5601_038_0	1		N	Specialty Tier	2	11	1	1	5	1		010	10		010	1				30								30				10	31											1257.77	25						827.53	25												25						25						25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	040	0		29	10	S5601_040_0	1		N	Preferred Generic	2	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					2.00	4.00	6.00											8.00	16.00	24.00				2.00	4.00	6.00					8.00			8.00			0.27	0.07		0.27	0.07	0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	040	0		29	10	S5601_040_0	1		N	Generic	2	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					7.00	14.00	21.00											15.00	30.00	45.00				7.00	14.00	21.00					15.00			15.00			0.50	0.23		0.50	0.23	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	040	0		29	10	S5601_040_0	1		N	Preferred Brand	2	11	1	1	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											58.57	17	17	17				69.58	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		N	Non-Preferred Drug	2	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											62.50	35	35	35				56.27	35	35	35										35	35	35				35	35	35				35		35								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	040	0		29	10	S5601_040_0	1		N	Specialty Tier	2	11	1	1	5	1		010	10		010	1				30								30				10	31											1117.54	25						882.10	25												25						25						25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	041	0		29	10	S5601_041_0	1		Y	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		Y	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		Y	Generic	4	01	3	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								14.00	28.00	42.00					0.00	0.00	0.00											14.00	28.00	42.00				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												
S5601	041	0		29	10	S5601_041_0	1		Y	Generic	4	01	3	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								14.00	28.00	42.00					0.00	0.00	0.00											14.00	28.00	42.00				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		3
S5601	041	0		29	10	S5601_041_0	1		Y	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					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		Y	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											54.07	50	50	50				37.99	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		Y	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1489.55	33						1150.81	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	042	0		29	10	S5601_042_0	1		N	Preferred Generic	2	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					2.00	4.00	6.00											6.00	12.00	18.00				2.00	4.00	6.00					6.00			6.00			0.20	0.07		0.20	0.07	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	042	0		29	10	S5601_042_0	1		N	Generic	2	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					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												
S5601	042	0		29	10	S5601_042_0	1		N	Preferred Brand	2	11	1	1	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											54.40	17	17	17				67.43	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		N	Non-Preferred Drug	2	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											64.15	35	35	35				58.57	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		N	Specialty Tier	2	11	1	1	5	1		010	10		010	1				30								30				10	31											953.79	25						804.11	25												25						25						25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	044	0		29	10	S5601_044_0	1		N	Preferred Generic	2	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					2.00	4.00	6.00											8.00	16.00	24.00				2.00	4.00	6.00					8.00			8.00			0.27	0.07		0.27	0.07	0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	044	0		29	10	S5601_044_0	1		N	Generic	2	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					7.00	14.00	21.00											15.00	30.00	45.00				7.00	14.00	21.00					15.00			15.00			0.50	0.23		0.50	0.23	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	044	0		29	10	S5601_044_0	1		N	Preferred Brand	2	11	1	1	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											54.62	17	17	17				69.06	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		N	Non-Preferred Drug	2	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											89.97	42	42	42				74.98	42	42	42										42	42	42				42	42	42				42		42								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	044	0		29	10	S5601_044_0	1		N	Specialty Tier	2	11	1	1	5	1		010	10		010	1				30								30				10	31											1096.90	25						739.20	25												25						25						25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	045	0		29	10	S5601_045_0	1		Y	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		Y	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		Y	Generic	4	01	3	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								14.00	28.00	42.00					0.00	0.00	0.00											14.00	28.00	42.00				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												
S5601	045	0		29	10	S5601_045_0	1		Y	Generic	4	01	3	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								14.00	28.00	42.00					0.00	0.00	0.00											14.00	28.00	42.00				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		3
S5601	045	0		29	10	S5601_045_0	1		Y	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					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		Y	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											74.15	50	50	50				55.22	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		Y	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1546.01	33						1009.81	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	046	0		29	10	S5601_046_0	1		N	Preferred Generic	2	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					2.00	4.00	6.00											8.00	16.00	24.00				2.00	4.00	6.00					8.00			8.00			0.27	0.07		0.27	0.07	0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	046	0		29	10	S5601_046_0	1		N	Generic	2	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					7.00	14.00	21.00											15.00	30.00	45.00				7.00	14.00	21.00					15.00			15.00			0.50	0.23		0.50	0.23	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	046	0		29	10	S5601_046_0	1		N	Preferred Brand	2	11	1	1	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											59.22	17	17	17				67.15	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		N	Non-Preferred Drug	2	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											64.79	35	35	35				61.23	35	35	35										35	35	35				35	35	35				35		35								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	046	0		29	10	S5601_046_0	1		N	Specialty Tier	2	11	1	1	5	1		010	10		010	1				30								30				10	31											1154.79	25						1086.25	25												25						25						25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	048	0		29	10	S5601_048_0	1		N	Preferred Generic	2	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					2.00	4.00	6.00											8.00	16.00	24.00				2.00	4.00	6.00					8.00			8.00			0.27	0.07		0.27	0.07	0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	048	0		29	10	S5601_048_0	1		N	Generic	2	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					7.00	14.00	21.00											15.00	30.00	45.00				7.00	14.00	21.00					15.00			15.00			0.50	0.23		0.50	0.23	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	048	0		29	10	S5601_048_0	1		N	Preferred Brand	2	11	1	1	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											52.51	17	17	17				66.98	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		N	Non-Preferred Drug	2	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											67.47	35	35	35				64.42	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		N	Specialty Tier	2	11	1	1	5	1		010	10		010	1				30								30				10	31											1083.68	25						743.98	25												25						25						25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	049	0		29	10	S5601_049_0	1		Y	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		Y	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		Y	Generic	4	01	3	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								14.00	28.00	42.00					0.00	0.00	0.00											14.00	28.00	42.00				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												
S5601	049	0		29	10	S5601_049_0	1		Y	Generic	4	01	3	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								14.00	28.00	42.00					0.00	0.00	0.00											14.00	28.00	42.00				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		3
S5601	049	0		29	10	S5601_049_0	1		Y	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					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		Y	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											60.72	50	50	50				46.80	50	50	50										50	50	50				50	50	50				50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	049	0		29	10	S5601_049_0	1		Y	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1280.06	33						817.30	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	050	0		29	10	S5601_050_0	1		N	Preferred Generic	2	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					2.00	4.00	6.00											8.00	16.00	24.00				2.00	4.00	6.00					8.00			8.00			0.27	0.07		0.27	0.07	0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	050	0		29	10	S5601_050_0	1		N	Generic	2	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					7.00	14.00	21.00											15.00	30.00	45.00				7.00	14.00	21.00					15.00			15.00			0.50	0.23		0.50	0.23	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	050	0		29	10	S5601_050_0	1		N	Preferred Brand	2	11	1	1	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											50.38	17	17	17				63.16	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		N	Non-Preferred Drug	2	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											68.98	36	36	36				64.59	36	36	36										36	36	36				36	36	36				36		36								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	050	0		29	10	S5601_050_0	1		N	Specialty Tier	2	11	1	1	5	1		010	10		010	1				30								30				10	31											996.95	25						758.75	25												25						25						25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	051	0		29	10	S5601_051_0	1		Y	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		Y	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		Y	Generic	4	01	3	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								14.00	28.00	42.00					0.00	0.00	0.00											14.00	28.00	42.00				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												
S5601	051	0		29	10	S5601_051_0	1		Y	Generic	4	01	3	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								14.00	28.00	42.00					0.00	0.00	0.00											14.00	28.00	42.00				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		3
S5601	051	0		29	10	S5601_051_0	1		Y	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					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		Y	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											61.92	50	50	50				49.90	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		Y	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1136.78	33						634.04	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	052	0		29	10	S5601_052_0	1		N	Preferred Generic	2	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					2.00	4.00	6.00											8.00	16.00	24.00				2.00	4.00	6.00					8.00			8.00			0.27	0.07		0.27	0.07	0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	052	0		29	10	S5601_052_0	1		N	Generic	2	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					7.00	14.00	21.00											15.00	30.00	45.00				7.00	14.00	21.00					15.00			15.00			0.50	0.23		0.50	0.23	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	052	0		29	10	S5601_052_0	1		N	Preferred Brand	2	11	1	1	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											54.94	17	17	17				63.05	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		N	Non-Preferred Drug	2	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											67.28	38	38	38				62.03	38	38	38										38	38	38				38	38	38				38		38								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	052	0		29	10	S5601_052_0	1		N	Specialty Tier	2	11	1	1	5	1		010	10		010	1				30								30				10	31											1069.01	25						852.57	25												25						25						25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	053	0		29	10	S5601_053_0	1		Y	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		Y	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		Y	Generic	4	01	3	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								14.00	28.00	42.00					0.00	0.00	0.00											14.00	28.00	42.00				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												
S5601	053	0		29	10	S5601_053_0	1		Y	Generic	4	01	3	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								14.00	28.00	42.00					0.00	0.00	0.00											14.00	28.00	42.00				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		3
S5601	053	0		29	10	S5601_053_0	1		Y	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					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		Y	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											66.36	50	50	50				48.41	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		Y	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1411.53	33						971.99	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	054	0		29	10	S5601_054_0	1		N	Preferred Generic	2	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					2.00	4.00	6.00											8.00	16.00	24.00				2.00	4.00	6.00					8.00			8.00			0.27	0.07		0.27	0.07	0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	054	0		29	10	S5601_054_0	1		N	Generic	2	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					7.00	14.00	21.00											15.00	30.00	45.00				7.00	14.00	21.00					15.00			15.00			0.50	0.23		0.50	0.23	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	054	0		29	10	S5601_054_0	1		N	Preferred Brand	2	11	1	1	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											54.69	17	17	17				66.52	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		N	Non-Preferred Drug	2	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											78.69	36	36	36				68.62	36	36	36										36	36	36				36	36	36				36		36								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	054	0		29	10	S5601_054_0	1		N	Specialty Tier	2	11	1	1	5	1		010	10		010	1				30								30				10	31											1063.89	25						937.65	25												25						25						25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	055	0		29	10	S5601_055_0	1		Y	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		Y	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		Y	Generic	4	01	3	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								14.00	28.00	42.00					0.00	0.00	0.00											14.00	28.00	42.00				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												
S5601	055	0		29	10	S5601_055_0	1		Y	Generic	4	01	3	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								14.00	28.00	42.00					0.00	0.00	0.00											14.00	28.00	42.00				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		3
S5601	055	0		29	10	S5601_055_0	1		Y	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					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		Y	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											80.86	50	50	50				55.53	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		Y	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1513.26	33						836.23	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	056	0		29	10	S5601_056_0	2		N	Preferred Generic	2	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					2.00	4.00	6.00											8.00	16.00	24.00				2.00	4.00	6.00					8.00			8.00			0.27	0.07		0.27	0.07	0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	056	0		29	10	S5601_056_0	2		N	Generic	2	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					7.00	14.00	21.00											15.00	30.00	45.00				7.00	14.00	21.00					15.00			15.00			0.50	0.23		0.50	0.23	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	056	0		29	10	S5601_056_0	2		N	Preferred Brand	2	11	1	1	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											55.48	17	17	17				66.40	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		N	Non-Preferred Drug	2	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											97.61	44	44	44				83.53	44	44	44										44	44	44				44	44	44				44		44								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	056	0		29	10	S5601_056_0	2		N	Specialty Tier	2	11	1	1	5	1		010	10		010	1				30								30				10	31											1176.78	25						756.93	25												25						25						25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	057	0		29	10	S5601_057_0	1		Y	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		Y	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		Y	Generic	4	01	3	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								14.00	28.00	42.00					0.00	0.00	0.00											14.00	28.00	42.00				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												
S5601	057	0		29	10	S5601_057_0	1		Y	Generic	4	01	3	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								14.00	28.00	42.00					0.00	0.00	0.00											14.00	28.00	42.00				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		3
S5601	057	0		29	10	S5601_057_0	1		Y	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					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		Y	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											86.07	50	50	50				65.64	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		Y	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1690.84	33						992.03	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	058	0		29	10	S5601_058_0	1		N	Preferred Generic	2	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					2.00	4.00	6.00											8.00	16.00	24.00				2.00	4.00	6.00					8.00			8.00			0.27	0.07		0.27	0.07	0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	058	0		29	10	S5601_058_0	1		N	Generic	2	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					7.00	14.00	21.00											15.00	30.00	45.00				7.00	14.00	21.00					15.00			15.00			0.50	0.23		0.50	0.23	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	058	0		29	10	S5601_058_0	1		N	Preferred Brand	2	11	1	1	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											52.62	17	17	17				69.98	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		N	Non-Preferred Drug	2	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											80.98	40	40	40				69.52	40	40	40										40	40	40				40	40	40				40		40								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	058	0		29	10	S5601_058_0	1		N	Specialty Tier	2	11	1	1	5	1		010	10		010	1				30								30				10	31											994.74	25						684.04	25												25						25						25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	059	0		29	10	S5601_059_0	1		Y	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		Y	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		Y	Generic	4	01	3	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								14.00	28.00	42.00					0.00	0.00	0.00											14.00	28.00	42.00				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												
S5601	059	0		29	10	S5601_059_0	1		Y	Generic	4	01	3	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								14.00	28.00	42.00					0.00	0.00	0.00											14.00	28.00	42.00				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		3
S5601	059	0		29	10	S5601_059_0	1		Y	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					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		Y	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											70.17	50	50	50				57.33	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		Y	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1049.57	33						1213.80	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	060	0		29	10	S5601_060_0	1		N	Preferred Generic	2	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					2.00	4.00	6.00											8.00	16.00	24.00				2.00	4.00	6.00					8.00			8.00			0.27	0.07		0.27	0.07	0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	060	0		29	10	S5601_060_0	1		N	Generic	2	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					7.00	14.00	21.00											15.00	30.00	45.00				7.00	14.00	21.00					15.00			15.00			0.50	0.23		0.50	0.23	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	060	0		29	10	S5601_060_0	1		N	Preferred Brand	2	11	1	1	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											51.24	17	17	17				62.93	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		N	Non-Preferred Drug	2	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											68.04	37	37	37				61.94	37	37	37										37	37	37				37	37	37				37		37								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	060	0		29	10	S5601_060_0	1		N	Specialty Tier	2	11	1	1	5	1		010	10		010	1				30								30				10	31											1011.20	25						710.44	25												25						25						25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	061	0		29	10	S5601_061_0	1		Y	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		Y	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		Y	Generic	4	01	3	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								14.00	28.00	42.00					0.00	0.00	0.00											14.00	28.00	42.00				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												
S5601	061	0		29	10	S5601_061_0	1		Y	Generic	4	01	3	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								14.00	28.00	42.00					0.00	0.00	0.00											14.00	28.00	42.00				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		3
S5601	061	0		29	10	S5601_061_0	1		Y	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					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		Y	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											70.99	50	50	50				52.53	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		Y	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1597.12	33						1030.19	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	062	0		29	10	S5601_062_0	1		N	Preferred Generic	2	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					2.00	4.00	6.00											6.00	12.00	18.00				2.00	4.00	6.00					6.00			6.00			0.20	0.07		0.20	0.07	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	062	0		29	10	S5601_062_0	1		N	Generic	2	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					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												
S5601	062	0		29	10	S5601_062_0	1		N	Preferred Brand	2	11	1	1	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											57.27	17	17	17				68.08	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		N	Non-Preferred Drug	2	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											68.88	35	35	35				60.38	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		N	Specialty Tier	2	11	1	1	5	1		010	10		010	1				30								30				10	31											935.34	25						615.07	25												25						25						25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	063	0		29	10	S5601_063_0	1		Y	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		Y	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		Y	Generic	4	01	3	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								14.00	28.00	42.00					0.00	0.00	0.00											14.00	28.00	42.00				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												
S5601	063	0		29	10	S5601_063_0	1		Y	Generic	4	01	3	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								14.00	28.00	42.00					0.00	0.00	0.00											14.00	28.00	42.00				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		3
S5601	063	0		29	10	S5601_063_0	1		Y	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					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		Y	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											69.82	50	50	50				49.21	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		Y	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1346.79	33						884.66	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	064	0		29	10	S5601_064_0	1		N	Preferred Generic	2	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					2.00	4.00	6.00											6.00	12.00	18.00				2.00	4.00	6.00					6.00			6.00			0.20	0.07		0.20	0.07	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	064	0		29	10	S5601_064_0	1		N	Generic	2	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					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												
S5601	064	0		29	10	S5601_064_0	1		N	Preferred Brand	2	11	1	1	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											57.30	17	17	17				64.28	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		N	Non-Preferred Drug	2	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											80.31	35	35	35				67.23	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		N	Specialty Tier	2	11	1	1	5	1		010	10		010	1				30								30				10	31											873.52	25						682.83	25												25						25						25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	065	0		29	10	S5601_065_0	1		Y	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		Y	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		Y	Generic	4	01	3	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								14.00	28.00	42.00					0.00	0.00	0.00											14.00	28.00	42.00				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												
S5601	065	0		29	10	S5601_065_0	1		Y	Generic	4	01	3	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								14.00	28.00	42.00					0.00	0.00	0.00											14.00	28.00	42.00				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		3
S5601	065	0		29	10	S5601_065_0	1		Y	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					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		Y	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											83.82	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												
S5601	065	0		29	10	S5601_065_0	1		Y	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1102.26	33						999.60	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	066	0		29	10	S5601_066_0	1		N	Preferred Generic	2	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					2.00	4.00	6.00											8.00	16.00	24.00				2.00	4.00	6.00					8.00			8.00			0.27	0.07		0.27	0.07	0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	066	0		29	10	S5601_066_0	1		N	Generic	2	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					7.00	14.00	21.00											15.00	30.00	45.00				7.00	14.00	21.00					15.00			15.00			0.50	0.23		0.50	0.23	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	066	0		29	10	S5601_066_0	1		N	Preferred Brand	2	11	1	1	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											73.76	22	22	22				89.15	22	22	22										22	22	22				22	22	22				22		22								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	066	0		29	10	S5601_066_0	1		N	Non-Preferred Drug	2	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											97.87	30	30	30				59.80	30	30	30										30	30	30				30	30	30				30		30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	066	0		29	10	S5601_066_0	1		N	Specialty Tier	2	11	1	1	5	1		010	10		010	1				30								30				10	31											1034.78	25						657.77	25												25						25						25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	067	0		29	10	S5601_067_0	1		Y	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		Y	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		Y	Generic	4	01	3	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								14.00	28.00	42.00					0.00	0.00	0.00											14.00	28.00	42.00				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												
S5601	067	0		29	10	S5601_067_0	1		Y	Generic	4	01	3	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								14.00	28.00	42.00					0.00	0.00	0.00											14.00	28.00	42.00				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		3
S5601	067	0		29	10	S5601_067_0	1		Y	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					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		Y	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											75.33	50	50	50				56.35	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		Y	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1431.78	33						986.10	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	068	0		29	10	S5601_068_0	1		N	Preferred Generic	2	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					2.00	4.00	6.00											8.00	16.00	24.00				2.00	4.00	6.00					8.00			8.00			0.27	0.07		0.27	0.07	0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	068	0		29	10	S5601_068_0	1		N	Generic	2	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					7.00	14.00	21.00											15.00	30.00	45.00				7.00	14.00	21.00					15.00			15.00			0.50	0.23		0.50	0.23	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	068	0		29	10	S5601_068_0	1		N	Preferred Brand	2	11	1	1	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											48.08	17	17	17				66.91	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		N	Non-Preferred Drug	2	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											62.80	37	37	37				61.46	37	37	37										37	37	37				37	37	37				37		37								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	068	0		29	10	S5601_068_0	1		N	Specialty Tier	2	11	1	1	5	1		010	10		010	1				30								30				10	31											1079.18	25						765.76	25												25						25						25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	107	0		29	10	S5601_107_0	1		Y	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		Y	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		Y	Generic	4	01	3	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								14.00	28.00	42.00					0.00	0.00	0.00											14.00	28.00	42.00				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												
S5601	107	0		29	10	S5601_107_0	1		Y	Generic	4	01	3	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								14.00	28.00	42.00					0.00	0.00	0.00											14.00	28.00	42.00				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		3
S5601	107	0		29	10	S5601_107_0	1		Y	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					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		Y	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											51.52	50	50	50				32.93	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		Y	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1839.28	33						1030.30	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	108	0		29	10	S5601_108_0	1		Y	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		Y	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		Y	Generic	4	01	3	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								14.00	28.00	42.00					0.00	0.00	0.00											14.00	28.00	42.00				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												
S5601	108	0		29	10	S5601_108_0	1		Y	Generic	4	01	3	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								14.00	28.00	42.00					0.00	0.00	0.00											14.00	28.00	42.00				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		3
S5601	108	0		29	10	S5601_108_0	1		Y	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					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		Y	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											63.95	50	50	50				48.12	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		Y	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1448.23	33						1260.87	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	109	0		29	10	S5601_109_0	1		Y	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		Y	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		Y	Generic	4	01	3	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								14.00	28.00	42.00					0.00	0.00	0.00											14.00	28.00	42.00				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												
S5601	109	0		29	10	S5601_109_0	1		Y	Generic	4	01	3	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								14.00	28.00	42.00					0.00	0.00	0.00											14.00	28.00	42.00				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		3
S5601	109	0		29	10	S5601_109_0	1		Y	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					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		Y	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											82.02	50	50	50				58.28	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		Y	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											991.52	33						1105.82	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	176	0		29	10	S5601_176_0	1		Y	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					2.00	4.00	6.00											19.00	38.00	57.00				2.00	4.00	6.00					19.00			19.00			0.63	0.07		0.63	0.07	0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	176	0		29	10	S5601_176_0	1		Y	Generic	4	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					15.00	30.00	45.00											20.00	40.00	60.00				15.00	30.00	45.00					20.00			20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	176	0		29	10	S5601_176_0	1		Y	Preferred Brand	4	11	1	1	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											69.40	25	25	25				77.69	25	25	25										25	25	25				25	25	25				25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	176	0		29	10	S5601_176_0	1		Y	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				55.65	50	50	50										50	50	50				50	50	50				50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	176	0		29	10	S5601_176_0	1		Y	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1247.86	25						1008.33	25												25						25						25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	177	0		29	10	S5601_177_0	1		Y	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					2.00	4.00	6.00											19.00	38.00	57.00				2.00	4.00	6.00					19.00			19.00			0.63	0.07		0.63	0.07	0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	177	0		29	10	S5601_177_0	1		Y	Generic	4	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					15.00	30.00	45.00											20.00	40.00	60.00				15.00	30.00	45.00					20.00			20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	177	0		29	10	S5601_177_0	1		Y	Preferred Brand	4	11	1	1	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											79.34	25	25	25				87.88	25	25	25										25	25	25				25	25	25				25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	177	0		29	10	S5601_177_0	1		Y	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											85.47	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	177	0		29	10	S5601_177_0	1		Y	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											734.78	25						468.44	25												25						25						25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	178	0		29	10	S5601_178_0	1		Y	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					2.00	4.00	6.00											19.00	38.00	57.00				2.00	4.00	6.00					19.00			19.00			0.63	0.07		0.63	0.07	0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	178	0		29	10	S5601_178_0	1		Y	Generic	4	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					15.00	30.00	45.00											20.00	40.00	60.00				15.00	30.00	45.00					20.00			20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	178	0		29	10	S5601_178_0	1		Y	Preferred Brand	4	11	1	1	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											82.83	25	25	25				88.10	25	25	25										25	25	25				25	25	25				25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	178	0		29	10	S5601_178_0	1		Y	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											86.66	50	50	50				62.09	50	50	50										50	50	50				50	50	50				50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	178	0		29	10	S5601_178_0	1		Y	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											861.58	25						539.80	25												25						25						25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	179	0		29	10	S5601_179_0	1		Y	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					2.00	4.00	6.00											19.00	38.00	57.00				2.00	4.00	6.00					19.00			19.00			0.63	0.07		0.63	0.07	0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	179	0		29	10	S5601_179_0	1		Y	Generic	4	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					15.00	30.00	45.00											20.00	40.00	60.00				15.00	30.00	45.00					20.00			20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	179	0		29	10	S5601_179_0	1		Y	Preferred Brand	4	11	1	1	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											72.95	25	25	25				84.16	25	25	25										25	25	25				25	25	25				25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	179	0		29	10	S5601_179_0	1		Y	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											87.45	50	50	50				60.12	50	50	50										50	50	50				50	50	50				50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	179	0		29	10	S5601_179_0	1		Y	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											995.05	25						552.59	25												25						25						25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	180	0		29	10	S5601_180_0	1		Y	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					2.00	4.00	6.00											19.00	38.00	57.00				2.00	4.00	6.00					19.00			19.00			0.63	0.07		0.63	0.07	0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	180	0		29	10	S5601_180_0	1		Y	Generic	4	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					15.00	30.00	45.00											20.00	40.00	60.00				15.00	30.00	45.00					20.00			20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	180	0		29	10	S5601_180_0	1		Y	Preferred Brand	4	11	1	1	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											65.79	25	25	25				86.66	25	25	25										25	25	25				25	25	25				25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	180	0		29	10	S5601_180_0	1		Y	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											82.84	50	50	50				56.42	50	50	50										50	50	50				50	50	50				50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	180	0		29	10	S5601_180_0	1		Y	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1132.07	25						681.14	25												25						25						25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	181	0		29	10	S5601_181_0	1		Y	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					2.00	4.00	6.00											19.00	38.00	57.00				2.00	4.00	6.00					19.00			19.00			0.63	0.07		0.63	0.07	0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	181	0		29	10	S5601_181_0	1		Y	Generic	4	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					15.00	30.00	45.00											20.00	40.00	60.00				15.00	30.00	45.00					20.00			20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	181	0		29	10	S5601_181_0	1		Y	Preferred Brand	4	11	1	1	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											73.00	25	25	25				87.53	25	25	25										25	25	25				25	25	25				25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	181	0		29	10	S5601_181_0	1		Y	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											81.25	50	50	50				55.65	50	50	50										50	50	50				50	50	50				50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	181	0		29	10	S5601_181_0	1		Y	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1086.49	25						608.90	25												25						25						25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	182	0		29	10	S5601_182_0	1		Y	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					2.00	4.00	6.00											19.00	38.00	57.00				2.00	4.00	6.00					19.00			19.00			0.63	0.07		0.63	0.07	0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	182	0		29	10	S5601_182_0	1		Y	Generic	4	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					15.00	30.00	45.00											20.00	40.00	60.00				15.00	30.00	45.00					20.00			20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	182	0		29	10	S5601_182_0	1		Y	Preferred Brand	4	11	1	1	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											69.88	25	25	25				82.96	25	25	25										25	25	25				25	25	25				25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	182	0		29	10	S5601_182_0	1		Y	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											77.46	50	50	50				57.10	50	50	50										50	50	50				50	50	50				50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	182	0		29	10	S5601_182_0	1		Y	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1310.30	25						880.49	25												25						25						25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	183	0		29	10	S5601_183_0	1		Y	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					2.00	4.00	6.00											19.00	38.00	57.00				2.00	4.00	6.00					19.00			19.00			0.63	0.07		0.63	0.07	0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	183	0		29	10	S5601_183_0	1		Y	Generic	4	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					15.00	30.00	45.00											20.00	40.00	60.00				15.00	30.00	45.00					20.00			20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	183	0		29	10	S5601_183_0	1		Y	Preferred Brand	4	11	1	1	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											75.84	25	25	25				87.09	25	25	25										25	25	25				25	25	25				25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	183	0		29	10	S5601_183_0	1		Y	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											85.27	50	50	50				49.62	50	50	50										50	50	50				50	50	50				50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	183	0		29	10	S5601_183_0	1		Y	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1199.82	25						585.39	25												25						25						25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	184	0		29	10	S5601_184_0	1		Y	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					2.00	4.00	6.00											19.00	38.00	57.00				2.00	4.00	6.00					19.00			19.00			0.63	0.07		0.63	0.07	0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	184	0		29	10	S5601_184_0	1		Y	Generic	4	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					15.00	30.00	45.00											20.00	40.00	60.00				15.00	30.00	45.00					20.00			20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	184	0		29	10	S5601_184_0	1		Y	Preferred Brand	4	11	1	1	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											70.67	25	25	25				84.28	25	25	25										25	25	25				25	25	25				25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	184	0		29	10	S5601_184_0	1		Y	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											95.34	50	50	50				52.67	50	50	50										50	50	50				50	50	50				50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	184	0		29	10	S5601_184_0	1		Y	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1459.66	25						714.48	25												25						25						25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	185	0		29	10	S5601_185_0	1		Y	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					2.00	4.00	6.00											19.00	38.00	57.00				2.00	4.00	6.00					19.00			19.00			0.63	0.07		0.63	0.07	0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	185	0		29	10	S5601_185_0	1		Y	Generic	4	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					15.00	30.00	45.00											20.00	40.00	60.00				15.00	30.00	45.00					20.00			20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	185	0		29	10	S5601_185_0	1		Y	Preferred Brand	4	11	1	1	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											63.52	25	25	25				85.65	25	25	25										25	25	25				25	25	25				25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	185	0		29	10	S5601_185_0	1		Y	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											61.79	50	50	50				52.23	50	50	50										50	50	50				50	50	50				50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	185	0		29	10	S5601_185_0	1		Y	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1361.34	25						679.15	25												25						25						25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	186	0		29	10	S5601_186_0	1		Y	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					2.00	4.00	6.00											19.00	38.00	57.00				2.00	4.00	6.00					19.00			19.00			0.63	0.07		0.63	0.07	0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	186	0		29	10	S5601_186_0	1		Y	Generic	4	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					15.00	30.00	45.00											20.00	40.00	60.00				15.00	30.00	45.00					20.00			20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	186	0		29	10	S5601_186_0	1		Y	Preferred Brand	4	11	1	1	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											64.23	25	25	25				84.84	25	25	25										25	25	25				25	25	25				25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	186	0		29	10	S5601_186_0	1		Y	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											75.74	50	50	50				52.62	50	50	50										50	50	50				50	50	50				50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	186	0		29	10	S5601_186_0	1		Y	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1001.34	25						563.50	25												25						25						25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	187	0		29	10	S5601_187_0	1		Y	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					2.00	4.00	6.00											19.00	38.00	57.00				2.00	4.00	6.00					19.00			19.00			0.63	0.07		0.63	0.07	0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	187	0		29	10	S5601_187_0	1		Y	Generic	4	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					15.00	30.00	45.00											20.00	40.00	60.00				15.00	30.00	45.00					20.00			20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	187	0		29	10	S5601_187_0	1		Y	Preferred Brand	4	11	1	1	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											61.73	25	25	25				80.25	25	25	25										25	25	25				25	25	25				25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	187	0		29	10	S5601_187_0	1		Y	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											61.19	50	50	50				51.51	50	50	50										50	50	50				50	50	50				50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	187	0		29	10	S5601_187_0	1		Y	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1357.59	25						694.88	25												25						25						25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	188	0		29	10	S5601_188_0	1		Y	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					2.00	4.00	6.00											19.00	38.00	57.00				2.00	4.00	6.00					19.00			19.00			0.63	0.07		0.63	0.07	0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	188	0		29	10	S5601_188_0	1		Y	Generic	4	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					15.00	30.00	45.00											20.00	40.00	60.00				15.00	30.00	45.00					20.00			20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	188	0		29	10	S5601_188_0	1		Y	Preferred Brand	4	11	1	1	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											72.50	25	25	25				80.78	25	25	25										25	25	25				25	25	25				25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	188	0		29	10	S5601_188_0	1		Y	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											76.42	50	50	50				54.84	50	50	50										50	50	50				50	50	50				50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	188	0		29	10	S5601_188_0	1		Y	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1269.68	25						696.58	25												25						25						25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	189	0		29	10	S5601_189_0	1		Y	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					2.00	4.00	6.00											19.00	38.00	57.00				2.00	4.00	6.00					19.00			19.00			0.63	0.07		0.63	0.07	0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	189	0		29	10	S5601_189_0	1		Y	Generic	4	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					15.00	30.00	45.00											20.00	40.00	60.00				15.00	30.00	45.00					20.00			20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	189	0		29	10	S5601_189_0	1		Y	Preferred Brand	4	11	1	1	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											68.73	25	25	25				84.28	25	25	25										25	25	25				25	25	25				25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	189	0		29	10	S5601_189_0	1		Y	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											79.25	50	50	50				55.31	50	50	50										50	50	50				50	50	50				50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	189	0		29	10	S5601_189_0	1		Y	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1060.91	25						559.83	25												25						25						25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	190	0		29	10	S5601_190_0	1		Y	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					2.00	4.00	6.00											19.00	38.00	57.00				2.00	4.00	6.00					19.00			19.00			0.63	0.07		0.63	0.07	0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	190	0		29	10	S5601_190_0	1		Y	Generic	4	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					15.00	30.00	45.00											20.00	40.00	60.00				15.00	30.00	45.00					20.00			20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	190	0		29	10	S5601_190_0	1		Y	Preferred Brand	4	11	1	1	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											61.75	25	25	25				82.40	25	25	25										25	25	25				25	25	25				25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	190	0		29	10	S5601_190_0	1		Y	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											68.94	50	50	50				53.47	50	50	50										50	50	50				50	50	50				50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	190	0		29	10	S5601_190_0	1		Y	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1186.90	25						718.20	25												25						25						25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	191	0		29	10	S5601_191_0	1		Y	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					2.00	4.00	6.00											19.00	38.00	57.00				2.00	4.00	6.00					19.00			19.00			0.63	0.07		0.63	0.07	0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	191	0		29	10	S5601_191_0	1		Y	Generic	4	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					15.00	30.00	45.00											20.00	40.00	60.00				15.00	30.00	45.00					20.00			20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	191	0		29	10	S5601_191_0	1		Y	Preferred Brand	4	11	1	1	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											69.17	25	25	25				83.08	25	25	25										25	25	25				25	25	25				25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	191	0		29	10	S5601_191_0	1		Y	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											65.80	50	50	50				52.43	50	50	50										50	50	50				50	50	50				50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	191	0		29	10	S5601_191_0	1		Y	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1130.19	25						667.46	25												25						25						25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	192	0		29	10	S5601_192_0	1		Y	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					2.00	4.00	6.00											19.00	38.00	57.00				2.00	4.00	6.00					19.00			19.00			0.63	0.07		0.63	0.07	0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	192	0		29	10	S5601_192_0	1		Y	Generic	4	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					15.00	30.00	45.00											20.00	40.00	60.00				15.00	30.00	45.00					20.00			20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	192	0		29	10	S5601_192_0	1		Y	Preferred Brand	4	11	1	1	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											63.77	25	25	25				83.49	25	25	25										25	25	25				25	25	25				25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	192	0		29	10	S5601_192_0	1		Y	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											67.69	50	50	50				55.28	50	50	50										50	50	50				50	50	50				50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	192	0		29	10	S5601_192_0	1		Y	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1210.00	25						468.96	25												25						25						25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	193	0		29	10	S5601_193_0	1		Y	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					2.00	4.00	6.00											19.00	38.00	57.00				2.00	4.00	6.00					19.00			19.00			0.63	0.07		0.63	0.07	0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	193	0		29	10	S5601_193_0	1		Y	Generic	4	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					15.00	30.00	45.00											20.00	40.00	60.00				15.00	30.00	45.00					20.00			20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	193	0		29	10	S5601_193_0	1		Y	Preferred Brand	4	11	1	1	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											70.22	25	25	25				79.35	25	25	25										25	25	25				25	25	25				25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	193	0		29	10	S5601_193_0	1		Y	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											63.50	50	50	50				50.87	50	50	50										50	50	50				50	50	50				50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	193	0		29	10	S5601_193_0	1		Y	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1258.00	25						825.65	25												25						25						25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	194	0		29	10	S5601_194_0	1		Y	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					2.00	4.00	6.00											19.00	38.00	57.00				2.00	4.00	6.00					19.00			19.00			0.63	0.07		0.63	0.07	0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	194	0		29	10	S5601_194_0	1		Y	Generic	4	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					15.00	30.00	45.00											20.00	40.00	60.00				15.00	30.00	45.00					20.00			20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	194	0		29	10	S5601_194_0	1		Y	Preferred Brand	4	11	1	1	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											73.92	25	25	25				80.94	25	25	25										25	25	25				25	25	25				25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	194	0		29	10	S5601_194_0	1		Y	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											60.34	50	50	50				47.22	50	50	50										50	50	50				50	50	50				50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	194	0		29	10	S5601_194_0	1		Y	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1870.95	25						1075.55	25												25						25						25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	195	0		29	10	S5601_195_0	1		Y	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					2.00	4.00	6.00											19.00	38.00	57.00				2.00	4.00	6.00					19.00			19.00			0.63	0.07		0.63	0.07	0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	195	0		29	10	S5601_195_0	1		Y	Generic	4	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					15.00	30.00	45.00											20.00	40.00	60.00				15.00	30.00	45.00					20.00			20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	195	0		29	10	S5601_195_0	1		Y	Preferred Brand	4	11	1	1	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											74.35	25	25	25				82.65	25	25	25										25	25	25				25	25	25				25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	195	0		29	10	S5601_195_0	1		Y	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											61.97	50	50	50				50.45	50	50	50										50	50	50				50	50	50				50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	195	0		29	10	S5601_195_0	1		Y	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											968.66	25						707.35	25												25						25						25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	196	0		29	10	S5601_196_0	1		Y	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					2.00	4.00	6.00											19.00	38.00	57.00				2.00	4.00	6.00					19.00			19.00			0.63	0.07		0.63	0.07	0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	196	0		29	10	S5601_196_0	1		Y	Generic	4	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					15.00	30.00	45.00											20.00	40.00	60.00				15.00	30.00	45.00					20.00			20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	196	0		29	10	S5601_196_0	1		Y	Preferred Brand	4	11	1	1	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											72.85	25	25	25				82.63	25	25	25										25	25	25				25	25	25				25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	196	0		29	10	S5601_196_0	1		Y	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											66.36	50	50	50				52.05	50	50	50										50	50	50				50	50	50				50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	196	0		29	10	S5601_196_0	1		Y	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1381.11	25						710.39	25												25						25						25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	197	0		29	10	S5601_197_0	1		Y	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					2.00	4.00	6.00											19.00	38.00	57.00				2.00	4.00	6.00					19.00			19.00			0.63	0.07		0.63	0.07	0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	197	0		29	10	S5601_197_0	1		Y	Generic	4	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					15.00	30.00	45.00											20.00	40.00	60.00				15.00	30.00	45.00					20.00			20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	197	0		29	10	S5601_197_0	1		Y	Preferred Brand	4	11	1	1	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											69.67	25	25	25				83.20	25	25	25										25	25	25				25	25	25				25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	197	0		29	10	S5601_197_0	1		Y	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											76.29	50	50	50				54.40	50	50	50										50	50	50				50	50	50				50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	197	0		29	10	S5601_197_0	1		Y	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1063.05	25						638.69	25												25						25						25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	198	0		29	10	S5601_198_0	1		Y	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					2.00	4.00	6.00											19.00	38.00	57.00				2.00	4.00	6.00					19.00			19.00			0.63	0.07		0.63	0.07	0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	198	0		29	10	S5601_198_0	1		Y	Generic	4	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					15.00	30.00	45.00											20.00	40.00	60.00				15.00	30.00	45.00					20.00			20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	198	0		29	10	S5601_198_0	1		Y	Preferred Brand	4	11	1	1	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											69.20	25	25	25				81.26	25	25	25										25	25	25				25	25	25				25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	198	0		29	10	S5601_198_0	1		Y	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											72.10	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												
S5601	198	0		29	10	S5601_198_0	1		Y	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1005.81	25						1039.12	25												25						25						25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	199	0		29	10	S5601_199_0	1		Y	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					2.00	4.00	6.00											19.00	38.00	57.00				2.00	4.00	6.00					19.00			19.00			0.63	0.07		0.63	0.07	0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	199	0		29	10	S5601_199_0	1		Y	Generic	4	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					15.00	30.00	45.00											20.00	40.00	60.00				15.00	30.00	45.00					20.00			20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	199	0		29	10	S5601_199_0	1		Y	Preferred Brand	4	11	1	1	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											76.50	25	25	25				82.89	25	25	25										25	25	25				25	25	25				25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	199	0		29	10	S5601_199_0	1		Y	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											58.69	50	50	50				51.51	50	50	50										50	50	50				50	50	50				50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	199	0		29	10	S5601_199_0	1		Y	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											951.50	25						382.86	25												25						25						25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	200	0		29	10	S5601_200_0	1		Y	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					2.00	4.00	6.00											19.00	38.00	57.00				2.00	4.00	6.00					19.00			19.00			0.63	0.07		0.63	0.07	0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	200	0		29	10	S5601_200_0	1		Y	Generic	4	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					15.00	30.00	45.00											20.00	40.00	60.00				15.00	30.00	45.00					20.00			20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	200	0		29	10	S5601_200_0	1		Y	Preferred Brand	4	11	1	1	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											80.03	25	25	25				88.56	25	25	25										25	25	25				25	25	25				25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	200	0		29	10	S5601_200_0	1		Y	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											57.31	50	50	50				54.83	50	50	50										50	50	50				50	50	50				50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	200	0		29	10	S5601_200_0	1		Y	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1068.29	25						616.81	25												25						25						25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	201	0		29	10	S5601_201_0	1		Y	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					2.00	4.00	6.00											19.00	38.00	57.00				2.00	4.00	6.00					19.00			19.00			0.63	0.07		0.63	0.07	0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	201	0		29	10	S5601_201_0	1		Y	Generic	4	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					15.00	30.00	45.00											20.00	40.00	60.00				15.00	30.00	45.00					20.00			20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	201	0		29	10	S5601_201_0	1		Y	Preferred Brand	4	11	1	1	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											76.87	25	25	25				82.54	25	25	25										25	25	25				25	25	25				25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	201	0		29	10	S5601_201_0	1		Y	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											87.32	50	50	50				58.63	50	50	50										50	50	50				50	50	50				50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	201	0		29	10	S5601_201_0	1		Y	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1052.52	25						624.10	25												25						25						25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	202	0		29	10	S5601_202_0	1		Y	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					2.00	4.00	6.00											19.00	38.00	57.00				2.00	4.00	6.00					19.00			19.00			0.63	0.07		0.63	0.07	0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	202	0		29	10	S5601_202_0	1		Y	Generic	4	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					15.00	30.00	45.00											20.00	40.00	60.00				15.00	30.00	45.00					20.00			20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	202	0		29	10	S5601_202_0	1		Y	Preferred Brand	4	11	1	1	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											78.37	25	25	25				87.53	25	25	25										25	25	25				25	25	25				25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	202	0		29	10	S5601_202_0	1		Y	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											89.96	50	50	50				61.45	50	50	50										50	50	50				50	50	50				50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	202	0		29	10	S5601_202_0	1		Y	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1552.32	25						879.67	25												25						25						25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	203	0		29	10	S5601_203_0	1		Y	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					2.00	4.00	6.00											19.00	38.00	57.00				2.00	4.00	6.00					19.00			19.00			0.63	0.07		0.63	0.07	0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	203	0		29	10	S5601_203_0	1		Y	Generic	4	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					15.00	30.00	45.00											20.00	40.00	60.00				15.00	30.00	45.00					20.00			20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	203	0		29	10	S5601_203_0	1		Y	Preferred Brand	4	11	1	1	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											60.31	25	25	25				84.97	25	25	25										25	25	25				25	25	25				25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	203	0		29	10	S5601_203_0	1		Y	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											81.62	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												
S5601	203	0		29	10	S5601_203_0	1		Y	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1485.89	25						540.41	25												25						25						25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	204	0		29	10	S5601_204_0	1		Y	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					2.00	4.00	6.00											19.00	38.00	57.00				2.00	4.00	6.00					19.00			19.00			0.63	0.07		0.63	0.07	0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	204	0		29	10	S5601_204_0	1		Y	Generic	4	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					15.00	30.00	45.00											20.00	40.00	60.00				15.00	30.00	45.00					20.00			20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	204	0		29	10	S5601_204_0	1		Y	Preferred Brand	4	11	1	1	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											68.24	25	25	25				86.86	25	25	25										25	25	25				25	25	25				25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	204	0		29	10	S5601_204_0	1		Y	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											79.58	50	50	50				58.29	50	50	50										50	50	50				50	50	50				50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	204	0		29	10	S5601_204_0	1		Y	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1484.84	25						811.71	25												25						25						25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	205	0		29	10	S5601_205_0	1		Y	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					2.00	4.00	6.00											19.00	38.00	57.00				2.00	4.00	6.00					19.00			19.00			0.63	0.07		0.63	0.07	0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	205	0		29	10	S5601_205_0	1		Y	Generic	4	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					15.00	30.00	45.00											20.00	40.00	60.00				15.00	30.00	45.00					20.00			20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	205	0		29	10	S5601_205_0	1		Y	Preferred Brand	4	11	1	1	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											76.18	25	25	25				83.05	25	25	25										25	25	25				25	25	25				25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	205	0		29	10	S5601_205_0	1		Y	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											76.34	50	50	50				60.64	50	50	50										50	50	50				50	50	50				50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	205	0		29	10	S5601_205_0	1		Y	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1184.61	25						402.91	25												25						25						25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	206	0		29	10	S5601_206_0	1		Y	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					2.00	4.00	6.00											19.00	38.00	57.00				2.00	4.00	6.00					19.00			19.00			0.63	0.07		0.63	0.07	0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	206	0		29	10	S5601_206_0	1		Y	Generic	4	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					15.00	30.00	45.00											20.00	40.00	60.00				15.00	30.00	45.00					20.00			20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	206	0		29	10	S5601_206_0	1		Y	Preferred Brand	4	11	1	1	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											78.51	25	25	25				81.59	25	25	25										25	25	25				25	25	25				25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	206	0		29	10	S5601_206_0	1		Y	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											73.86	50	50	50				57.99	50	50	50										50	50	50				50	50	50				50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	206	0		29	10	S5601_206_0	1		Y	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1020.71	25						572.71	25												25						25						25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	207	0		29	10	S5601_207_0	1		Y	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					2.00	4.00	6.00											19.00	38.00	57.00				2.00	4.00	6.00					19.00			19.00			0.63	0.07		0.63	0.07	0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	207	0		29	10	S5601_207_0	1		Y	Generic	4	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					15.00	30.00	45.00											20.00	40.00	60.00				15.00	30.00	45.00					20.00			20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	207	0		29	10	S5601_207_0	1		Y	Preferred Brand	4	11	1	1	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											77.07	25	25	25				83.38	25	25	25										25	25	25				25	25	25				25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	207	0		29	10	S5601_207_0	1		Y	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											93.94	50	50	50				60.87	50	50	50										50	50	50				50	50	50				50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	207	0		29	10	S5601_207_0	1		Y	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1032.82	25						633.42	25												25						25						25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	208	0		29	10	S5601_208_0	1		Y	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					2.00	4.00	6.00											19.00	38.00	57.00				2.00	4.00	6.00					19.00			19.00			0.63	0.07		0.63	0.07	0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	208	0		29	10	S5601_208_0	1		Y	Generic	4	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					15.00	30.00	45.00											20.00	40.00	60.00				15.00	30.00	45.00					20.00			20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	208	0		29	10	S5601_208_0	1		Y	Preferred Brand	4	11	1	1	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											73.73	25	25	25				79.25	25	25	25										25	25	25				25	25	25				25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	208	0		29	10	S5601_208_0	1		Y	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											78.07	50	50	50				58.33	50	50	50										50	50	50				50	50	50				50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	208	0		29	10	S5601_208_0	1		Y	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1281.55	25						820.20	25												25						25						25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	209	0		29	10	S5601_209_0	1		Y	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					2.00	4.00	6.00											19.00	38.00	57.00				2.00	4.00	6.00					19.00			19.00			0.63	0.07		0.63	0.07	0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	209	0		29	10	S5601_209_0	1		Y	Generic	4	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					15.00	30.00	45.00											20.00	40.00	60.00				15.00	30.00	45.00					20.00			20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	209	0		29	10	S5601_209_0	1		Y	Preferred Brand	4	11	1	1	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											76.20	25	25	25				90.51	25	25	25										25	25	25				25	25	25				25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	209	0		29	10	S5601_209_0	1		Y	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											76.96	50	50	50				59.96	50	50	50										50	50	50				50	50	50				50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	209	0		29	10	S5601_209_0	1		Y	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1127.49	25						704.11	25												25						25						25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	210	0		29	10	S5601_210_0	1		Y	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	1		Y	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	1		Y	Generic	4	01	3	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								14.00	28.00	42.00					0.00	0.00	0.00											14.00	28.00	42.00				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												
S5601	210	0		29	10	S5601_210_0	1		Y	Generic	4	01	3	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								14.00	28.00	42.00					0.00	0.00	0.00											14.00	28.00	42.00				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		3
S5601	210	0		29	10	S5601_210_0	1		Y	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					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	1		Y	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											76.35	50	50	50				60.04	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	1		Y	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1424.80	33						1019.99	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5609	001	0		29	10	S5609_001_0	5			Preferred Generic	3	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								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												
S5609	001	0		29	10	S5609_001_0	5			Generic	3	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								20.00	40.00	60.00					13.00	26.00	39.00					13.00	26.00	39.00																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	5			Preferred Brand	3	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					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												
S5609	001	0		29	10	S5609_001_0	5			Non-Preferred Drug	3	11	1	1	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											74.21	45	45	45				65.97	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	5			Specialty Tier	3	11	1	1	5	1		010	01	010		1				30					30						30		31											862.84	25						862.84	25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5609	002	0		29	10	S5609_002_0	5			Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	3.00	6.00	6.00																			3.00	6.00	6.00																3.00				3.00		0.10			0.10			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5609	002	0		29	10	S5609_002_0	5			Preferred Generic	4	01	1	2	1	3	111		01	111		1	30	60	90				1	2	30	60	90				30		31	3.00	6.00	6.00																			3.00	6.00	6.00																3.00				3.00		0.10			0.10			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
S5609	002	0		29	10	S5609_002_0	5			Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	10.00	20.00	20.00																			10.00	20.00	20.00																10.00				10.00		0.33			0.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5609	002	0		29	10	S5609_002_0	5			Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	47.00	94.00	117.50																			47.00	94.00	117.50																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5609	002	0		29	10	S5609_002_0	5			Non-Preferred Drug	4	11	1	1	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31				65.97	40	40	40																		40	40	40															40			40								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5609	002	0		29	10	S5609_002_0	5			Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				1138.94	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	003	0		29	10	S5617_003_0	3			Preferred Generic	3	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								5.00	10.00	15.00					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												
S5617	003	0		29	10	S5617_003_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					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												
S5617	003	0		29	10	S5617_003_0	3			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					24.00	48.00	72.00											30.00	60.00	90.00				24.00	48.00	72.00				30.00				30.00			1.00	0.80		1.00	0.80	0.97	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	003	0		29	10	S5617_003_0	3			Non-Preferred Drug	3	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											97.35	50	50	50				94.87	50	50	50										50	50	50				50	50	50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	003	0		29	10	S5617_003_0	3			Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	003	0		29	10	S5617_003_0	3			Select Care Drugs	3	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								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	008	0		29	10	S5617_008_0	3			Preferred Generic	3	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								6.00	12.00	18.00					1.00	2.00	3.00											6.00	12.00	18.00				1.00	2.00	0.00				6.00				6.00			0.20	0.03		0.20	0.03	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	008	0		29	10	S5617_008_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					7.00	14.00	21.00											10.00	20.00	30.00				7.00	14.00	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												
S5617	008	0		29	10	S5617_008_0	3			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					28.00	56.00	84.00											36.00	72.00	108.00				28.00	56.00	84.00				36.00				36.00			1.20	0.93		1.20	0.93	1.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	008	0		29	10	S5617_008_0	3			Non-Preferred Drug	3	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											98.18	47	47	47				83.12	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	008	0		29	10	S5617_008_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, Select Care Drugs												
S5617	008	0		29	10	S5617_008_0	3			Select Care Drugs	3	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								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	013	0		29	10	S5617_013_0	3			Preferred Generic	3	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								5.00	10.00	15.00					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												
S5617	013	0		29	10	S5617_013_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					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, Select Care Drugs												
S5617	013	0		29	10	S5617_013_0	3			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	013	0		29	10	S5617_013_0	3			Non-Preferred Drug	3	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											92.84	47	47	47				98.40	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	013	0		29	10	S5617_013_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, Select Care Drugs												
S5617	013	0		29	10	S5617_013_0	3			Select Care Drugs	3	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								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	018	0		29	10	S5617_018_0	3			Preferred Generic	3	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								6.00	12.00	18.00					1.00	2.00	3.00											6.00	12.00	18.00				1.00	2.00	0.00				6.00				6.00			0.20	0.03		0.20	0.03	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	018	0		29	10	S5617_018_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					7.00	14.00	21.00											10.00	20.00	30.00				7.00	14.00	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												
S5617	018	0		29	10	S5617_018_0	3			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					25.00	50.00	75.00											30.00	60.00	90.00				25.00	50.00	75.00				30.00				30.00			1.00	0.83		1.00	0.83	0.97	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	018	0		29	10	S5617_018_0	3			Non-Preferred Drug	3	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											84.26	48	48	48				99.83	48	48	48										48	48	48				48	48	48			48			48								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	018	0		29	10	S5617_018_0	3			Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	018	0		29	10	S5617_018_0	3			Select Care Drugs	3	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								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	3			Preferred Generic	3	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								6.00	12.00	18.00					1.00	2.00	3.00											6.00	12.00	18.00				1.00	2.00	0.00				6.00				6.00			0.20	0.03		0.20	0.03	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	053	0		29	10	S5617_053_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					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												
S5617	053	0		29	10	S5617_053_0	3			Preferred Brand	3	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								35.00	70.00	105.00					32.00	64.00	96.00											35.00	70.00	105.00				32.00	64.00	96.00				35.00				35.00			1.17	1.07		1.17	1.07	1.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	053	0		29	10	S5617_053_0	3			Non-Preferred Drug	3	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											98.13	47	47	47				80.50	47	47	47										47	47	47				47	47	47			47			47								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	053	0		29	10	S5617_053_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, Select Care Drugs												
S5617	053	0		29	10	S5617_053_0	3			Select Care Drugs	3	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								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	068	0		29	10	S5617_068_0	3			Preferred Generic	3	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								6.00	12.00	18.00					1.00	2.00	3.00											6.00	12.00	18.00				1.00	2.00	0.00				6.00				6.00			0.20	0.03		0.20	0.03	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	068	0		29	10	S5617_068_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					8.00	16.00	24.00											10.00	20.00	30.00				8.00	16.00	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, Select Care Drugs												
S5617	068	0		29	10	S5617_068_0	3			Preferred Brand	3	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								38.00	76.00	114.00					35.00	70.00	105.00											38.00	76.00	114.00				35.00	70.00	105.00				38.00				38.00			1.27	1.17		1.27	1.17	1.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	068	0		29	10	S5617_068_0	3			Non-Preferred Drug	3	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											89.74	50	50	50				79.63	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	068	0		29	10	S5617_068_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, Select Care Drugs												
S5617	068	0		29	10	S5617_068_0	3			Select Care Drugs	3	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								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	3			Preferred Generic	3	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								6.00	12.00	18.00					1.00	2.00	3.00											6.00	12.00	18.00				1.00	2.00	0.00				6.00				6.00			0.20	0.03		0.20	0.03	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	088	0		29	10	S5617_088_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					6.00	12.00	18.00											10.00	20.00	30.00				6.00	12.00	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												
S5617	088	0		29	10	S5617_088_0	3			Preferred Brand	3	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								35.00	70.00	105.00					32.00	64.00	96.00											35.00	70.00	105.00				32.00	64.00	96.00				35.00				35.00			1.17	1.07		1.17	1.07	1.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	088	0		29	10	S5617_088_0	3			Non-Preferred Drug	3	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											99.65	48	48	48				83.04	48	48	48										48	48	48				48	48	48			48			48								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	088	0		29	10	S5617_088_0	3			Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	088	0		29	10	S5617_088_0	3			Select Care Drugs	3	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								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	103	0		29	10	S5617_103_0	3			Preferred Generic	3	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								5.00	10.00	15.00					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												
S5617	103	0		29	10	S5617_103_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					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, Select Care Drugs												
S5617	103	0		29	10	S5617_103_0	3			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	103	0		29	10	S5617_103_0	3			Non-Preferred Drug	3	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											97.65	49	49	49				98.35	49	49	49										49	49	49				49	49	49			49			49								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	103	0		29	10	S5617_103_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, Select Care Drugs												
S5617	103	0		29	10	S5617_103_0	3			Select Care Drugs	3	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								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	108	0		29	10	S5617_108_0	3			Preferred Generic	3	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								6.00	12.00	18.00					1.00	2.00	3.00											6.00	12.00	18.00				1.00	2.00	0.00				6.00				6.00			0.20	0.03		0.20	0.03	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	108	0		29	10	S5617_108_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					6.00	12.00	18.00											10.00	20.00	30.00				6.00	12.00	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												
S5617	108	0		29	10	S5617_108_0	3			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					32.00	64.00	96.00											36.00	72.00	108.00				32.00	64.00	96.00				36.00				36.00			1.20	1.07		1.20	1.07	1.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	108	0		29	10	S5617_108_0	3			Non-Preferred Drug	3	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											98.53	49	49	49				86.35	49	49	49										49	49	49				49	49	49			49			49								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	108	0		29	10	S5617_108_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, Select Care Drugs												
S5617	108	0		29	10	S5617_108_0	3			Select Care Drugs	3	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								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	3			Preferred Generic	3	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								5.00	10.00	15.00					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												
S5617	113	0		29	10	S5617_113_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					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												
S5617	113	0		29	10	S5617_113_0	3			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	113	0		29	10	S5617_113_0	3			Non-Preferred Drug	3	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											99.68	47	47	47				89.04	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	113	0		29	10	S5617_113_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, Select Care Drugs												
S5617	113	0		29	10	S5617_113_0	3			Select Care Drugs	3	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								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	118	0		29	10	S5617_118_0	3			Preferred Generic	3	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								6.00	12.00	18.00					1.00	2.00	3.00											6.00	12.00	18.00				1.00	2.00	0.00				6.00				6.00			0.20	0.03		0.20	0.03	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	118	0		29	10	S5617_118_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					6.00	12.00	18.00											10.00	20.00	30.00				6.00	12.00	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												
S5617	118	0		29	10	S5617_118_0	3			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					25.00	50.00	75.00											30.00	60.00	90.00				25.00	50.00	75.00				30.00				30.00			1.00	0.83		1.00	0.83	0.97	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	118	0		29	10	S5617_118_0	3			Non-Preferred Drug	3	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											81.34	50	50	50				67.90	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	118	0		29	10	S5617_118_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, Select Care Drugs												
S5617	118	0		29	10	S5617_118_0	3			Select Care Drugs	3	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								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	3			Preferred Generic	3	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								6.00	12.00	18.00					1.00	2.00	3.00											6.00	12.00	18.00				1.00	2.00	0.00				6.00				6.00			0.20	0.03		0.20	0.03	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	123	0		29	10	S5617_123_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					7.00	14.00	21.00											10.00	20.00	30.00				7.00	14.00	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												
S5617	123	0		29	10	S5617_123_0	3			Preferred Brand	3	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								34.00	68.00	102.00					28.00	56.00	84.00											34.00	68.00	102.00				28.00	56.00	84.00				34.00				34.00			1.13	0.93		1.13	0.93	1.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	123	0		29	10	S5617_123_0	3			Non-Preferred Drug	3	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											91.89	50	50	50				78.29	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	123	0		29	10	S5617_123_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, Select Care Drugs												
S5617	123	0		29	10	S5617_123_0	3			Select Care Drugs	3	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								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	3			Preferred Generic	3	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								17.00	34.00	51.00					1.00	2.00	3.00											17.00	34.00	51.00				1.00	2.00	0.00				17.00				17.00			0.57	0.03		0.57	0.03	0.55	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	128	0		29	10	S5617_128_0	3			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					18.00	36.00	54.00											20.00	40.00	60.00				18.00	36.00	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, Select Care Drugs												
S5617	128	0		29	10	S5617_128_0	3			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	3			Non-Preferred Drug	3	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											99.36	41	41	41				91.67	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	128	0		29	10	S5617_128_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, Select Care Drugs												
S5617	128	0		29	10	S5617_128_0	3			Select Care Drugs	3	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								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	3			Preferred Generic	3	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								6.00	12.00	18.00					1.00	2.00	3.00											6.00	12.00	18.00				1.00	2.00	0.00				6.00				6.00			0.20	0.03		0.20	0.03	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	133	0		29	10	S5617_133_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					8.00	16.00	24.00											10.00	20.00	30.00				8.00	16.00	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, Select Care Drugs												
S5617	133	0		29	10	S5617_133_0	3			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					34.00	68.00	102.00											40.00	80.00	120.00				34.00	68.00	102.00				40.00				40.00			1.33	1.13		1.33	1.13	1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	133	0		29	10	S5617_133_0	3			Non-Preferred Drug	3	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											99.55	44	44	44				85.37	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	133	0		29	10	S5617_133_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, Select Care Drugs												
S5617	133	0		29	10	S5617_133_0	3			Select Care Drugs	3	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								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	3			Preferred Generic	3	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								9.00	18.00	27.00					1.00	2.00	3.00											9.00	18.00	27.00				1.00	2.00	0.00				9.00				9.00			0.30	0.03		0.30	0.03	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	138	0		29	10	S5617_138_0	3			Generic	3	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								18.00	36.00	54.00					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, Select Care Drugs												
S5617	138	0		29	10	S5617_138_0	3			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	138	0		29	10	S5617_138_0	3			Non-Preferred Drug	3	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											98.07	40	40	40				72.71	40	40	40										40	40	40				40	40	40			40			40								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	138	0		29	10	S5617_138_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, Select Care Drugs												
S5617	138	0		29	10	S5617_138_0	3			Select Care Drugs	3	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								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	3			Preferred Generic	3	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								6.00	12.00	18.00					1.00	2.00	3.00											6.00	12.00	18.00				1.00	2.00	0.00				6.00				6.00			0.20	0.03		0.20	0.03	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	143	0		29	10	S5617_143_0	3			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					7.00	14.00	21.00											15.00	30.00	45.00				7.00	14.00	0.00				15.00				15.00			0.50	0.23		0.50	0.23	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	143	0		29	10	S5617_143_0	3			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	143	0		29	10	S5617_143_0	3			Non-Preferred Drug	3	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											99.88	43	43	43				91.85	43	43	43										43	43	43				43	43	43			43			43								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	143	0		29	10	S5617_143_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, Select Care Drugs												
S5617	143	0		29	10	S5617_143_0	3			Select Care Drugs	3	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								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	3			Preferred Generic	3	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								6.00	12.00	18.00					1.00	2.00	3.00											6.00	12.00	18.00				1.00	2.00	0.00				6.00				6.00			0.20	0.03		0.20	0.03	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	148	0		29	10	S5617_148_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					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												
S5617	148	0		29	10	S5617_148_0	3			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					26.00	52.00	78.00											30.00	60.00	90.00				26.00	52.00	78.00				30.00				30.00			1.00	0.87		1.00	0.87	0.97	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	148	0		29	10	S5617_148_0	3			Non-Preferred Drug	3	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											98.84	50	50	50				89.10	50	50	50										50	50	50				50	50	50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	148	0		29	10	S5617_148_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, Select Care Drugs												
S5617	148	0		29	10	S5617_148_0	3			Select Care Drugs	3	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								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	3			Preferred Generic	3	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								6.00	12.00	18.00					1.00	2.00	3.00											6.00	12.00	18.00				1.00	2.00	0.00				6.00				6.00			0.20	0.03		0.20	0.03	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	153	0		29	10	S5617_153_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					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												
S5617	153	0		29	10	S5617_153_0	3			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					25.00	50.00	75.00											30.00	60.00	90.00				25.00	50.00	75.00				30.00				30.00			1.00	0.83		1.00	0.83	0.97	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	153	0		29	10	S5617_153_0	3			Non-Preferred Drug	3	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											98.05	45	45	45				95.21	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	153	0		29	10	S5617_153_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, Select Care Drugs												
S5617	153	0		29	10	S5617_153_0	3			Select Care Drugs	3	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								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	158	0		29	10	S5617_158_0	3			Preferred Generic	3	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								6.00	12.00	18.00					1.00	2.00	3.00											6.00	12.00	18.00				1.00	2.00	0.00				6.00				6.00			0.20	0.03		0.20	0.03	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	158	0		29	10	S5617_158_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					6.00	12.00	18.00											10.00	20.00	30.00				6.00	12.00	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												
S5617	158	0		29	10	S5617_158_0	3			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	158	0		29	10	S5617_158_0	3			Non-Preferred Drug	3	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											94.39	50	50	50				72.81	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	158	0		29	10	S5617_158_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, Select Care Drugs												
S5617	158	0		29	10	S5617_158_0	3			Select Care Drugs	3	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								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	163	0		29	10	S5617_163_0	3			Preferred Generic	3	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								6.00	12.00	18.00					1.00	2.00	3.00											6.00	12.00	18.00				1.00	2.00	0.00				6.00				6.00			0.20	0.03		0.20	0.03	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	163	0		29	10	S5617_163_0	3			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					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, Select Care Drugs												
S5617	163	0		29	10	S5617_163_0	3			Preferred Brand	3	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	163	0		29	10	S5617_163_0	3			Non-Preferred Drug	3	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											97.80	43	43	43				85.20	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	163	0		29	10	S5617_163_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, Select Care Drugs												
S5617	163	0		29	10	S5617_163_0	3			Select Care Drugs	3	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								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	3			Preferred Generic	3	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								6.00	12.00	18.00					1.00	2.00	3.00											6.00	12.00	18.00				1.00	2.00	0.00				6.00				6.00			0.20	0.03		0.20	0.03	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	214	0		29	10	S5617_214_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					7.00	14.00	21.00											10.00	20.00	30.00				7.00	14.00	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												
S5617	214	0		29	10	S5617_214_0	3			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					26.00	52.00	78.00											33.00	66.00	99.00				26.00	52.00	78.00				33.00				33.00			1.10	0.87		1.10	0.87	1.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	214	0		29	10	S5617_214_0	3			Non-Preferred Drug	3	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											98.73	48	48	48				91.00	48	48	48										48	48	48				48	48	48			48			48								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	214	0		29	10	S5617_214_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, Select Care Drugs												
S5617	214	0		29	10	S5617_214_0	3			Select Care Drugs	3	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								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	215	0		29	10	S5617_215_0	3			Preferred Generic	3	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								5.00	10.00	15.00					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												
S5617	215	0		29	10	S5617_215_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					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												
S5617	215	0		29	10	S5617_215_0	3			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					22.00	44.00	66.00											30.00	60.00	90.00				22.00	44.00	66.00				30.00				30.00			1.00	0.73		1.00	0.73	0.97	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	215	0		29	10	S5617_215_0	3			Non-Preferred Drug	3	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											90.55	50	50	50				92.03	50	50	50										50	50	50				50	50	50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	215	0		29	10	S5617_215_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, Select Care Drugs												
S5617	215	0		29	10	S5617_215_0	3			Select Care Drugs	3	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								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	216	0		29	10	S5617_216_0	3			Preferred Generic	3	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								6.00	12.00	18.00					1.00	2.00	3.00											6.00	12.00	18.00				1.00	2.00	0.00				6.00				6.00			0.20	0.03		0.20	0.03	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	216	0		29	10	S5617_216_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					8.00	16.00	24.00											10.00	20.00	30.00				8.00	16.00	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, Select Care Drugs												
S5617	216	0		29	10	S5617_216_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					38.00	76.00	114.00											45.00	90.00	135.00				38.00	76.00	114.00				45.00				45.00			1.50	1.27		1.50	1.27	1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	216	0		29	10	S5617_216_0	3			Non-Preferred Drug	3	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											90.46	50	50	50				74.56	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	216	0		29	10	S5617_216_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, Select Care Drugs												
S5617	216	0		29	10	S5617_216_0	3			Select Care Drugs	3	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								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	3			Preferred Generic	3	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								6.00	12.00	18.00					1.00	2.00	3.00											6.00	12.00	18.00				1.00	2.00	0.00				6.00				6.00			0.20	0.03		0.20	0.03	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	217	0		29	10	S5617_217_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					7.00	14.00	21.00											10.00	20.00	30.00				7.00	14.00	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												
S5617	217	0		29	10	S5617_217_0	3			Preferred Brand	3	11	1	2	3	1		111	01		111	1				30	60	90	2	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, Select Care Drugs												
S5617	217	0		29	10	S5617_217_0	3			Non-Preferred Drug	3	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											98.27	47	47	47				82.73	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	217	0		29	10	S5617_217_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, Select Care Drugs												
S5617	217	0		29	10	S5617_217_0	3			Select Care Drugs	3	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								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	218	0		29	10	S5617_218_0	3			Preferred Generic	3	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								6.00	12.00	18.00					1.00	2.00	3.00											6.00	12.00	18.00				1.00	2.00	0.00				6.00				6.00			0.20	0.03		0.20	0.03	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	218	0		29	10	S5617_218_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					6.00	12.00	18.00											10.00	20.00	30.00				6.00	12.00	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												
S5617	218	0		29	10	S5617_218_0	3			Preferred Brand	3	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								38.00	76.00	114.00					35.00	70.00	105.00											38.00	76.00	114.00				35.00	70.00	105.00				38.00				38.00			1.27	1.17		1.27	1.17	1.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	218	0		29	10	S5617_218_0	3			Non-Preferred Drug	3	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											99.70	46	46	46				78.53	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	218	0		29	10	S5617_218_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, Select Care Drugs												
S5617	218	0		29	10	S5617_218_0	3			Select Care Drugs	3	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								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	3			Preferred Generic	3	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								6.00	12.00	18.00					1.00	2.00	3.00											6.00	12.00	18.00				1.00	2.00	0.00				6.00				6.00			0.20	0.03		0.20	0.03	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	219	0		29	10	S5617_219_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					6.00	12.00	18.00											10.00	20.00	30.00				6.00	12.00	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												
S5617	219	0		29	10	S5617_219_0	3			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					31.00	62.00	93.00											36.00	72.00	108.00				31.00	62.00	93.00				36.00				36.00			1.20	1.03		1.20	1.03	1.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	219	0		29	10	S5617_219_0	3			Non-Preferred Drug	3	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											95.68	50	50	50				81.67	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	219	0		29	10	S5617_219_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, Select Care Drugs												
S5617	219	0		29	10	S5617_219_0	3			Select Care Drugs	3	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								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	3			Preferred Generic	3	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								5.00	10.00	15.00					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												
S5617	220	0		29	10	S5617_220_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					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												
S5617	220	0		29	10	S5617_220_0	3			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					24.00	48.00	72.00											30.00	60.00	90.00				24.00	48.00	72.00				30.00				30.00			1.00	0.80		1.00	0.80	0.97	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	220	0		29	10	S5617_220_0	3			Non-Preferred Drug	3	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											92.90	50	50	50				86.85	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	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, Select Care Drugs												
S5617	220	0		29	10	S5617_220_0	3			Select Care Drugs	3	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								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	3			Preferred Generic	3	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								5.00	10.00	15.00					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												
S5617	221	0		29	10	S5617_221_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					3.00	6.00	9.00											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, Select Care Drugs												
S5617	221	0		29	10	S5617_221_0	3			Preferred Brand	3	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								29.00	58.00	87.00					20.00	40.00	60.00											29.00	58.00	87.00				20.00	40.00	60.00				29.00				29.00			0.97	0.67		0.97	0.67	0.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	221	0		29	10	S5617_221_0	3			Non-Preferred Drug	3	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											98.05	48	48	48				96.88	48	48	48										48	48	48				48	48	48			48			48								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	221	0		29	10	S5617_221_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, Select Care Drugs												
S5617	221	0		29	10	S5617_221_0	3			Select Care Drugs	3	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								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	222	0		29	10	S5617_222_0	3			Preferred Generic	3	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								5.00	10.00	15.00					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												
S5617	222	0		29	10	S5617_222_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					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												
S5617	222	0		29	10	S5617_222_0	3			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	222	0		29	10	S5617_222_0	3			Non-Preferred Drug	3	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											98.41	49	49	49				90.37	49	49	49										49	49	49				49	49	49			49			49								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	222	0		29	10	S5617_222_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, Select Care Drugs												
S5617	222	0		29	10	S5617_222_0	3			Select Care Drugs	3	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								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	223	0		29	10	S5617_223_0	3			Preferred Generic	3	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								4.00	8.00	12.00					1.00	2.00	3.00											4.00	8.00	12.00				1.00	2.00	0.00				4.00				4.00			0.13	0.03		0.13	0.03	0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	223	0		29	10	S5617_223_0	3			Generic	3	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								5.00	10.00	15.00					3.00	6.00	9.00											5.00	10.00	15.00				3.00	6.00	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, Select Care Drugs												
S5617	223	0		29	10	S5617_223_0	3			Preferred Brand	3	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								29.00	58.00	87.00					20.00	40.00	60.00											29.00	58.00	87.00				20.00	40.00	60.00				29.00				29.00			0.97	0.67		0.97	0.67	0.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	223	0		29	10	S5617_223_0	3			Non-Preferred Drug	3	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											95.45	50	50	50				93.06	50	50	50										50	50	50				50	50	50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	223	0		29	10	S5617_223_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, Select Care Drugs												
S5617	223	0		29	10	S5617_223_0	3			Select Care Drugs	3	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								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	224	0		29	10	S5617_224_0	3			Preferred Generic	3	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								6.00	12.00	18.00					1.00	2.00	3.00											6.00	12.00	18.00				1.00	2.00	0.00				6.00				6.00			0.20	0.03		0.20	0.03	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	224	0		29	10	S5617_224_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					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												
S5617	224	0		29	10	S5617_224_0	3			Preferred Brand	3	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								32.00	64.00	96.00					30.00	60.00	90.00											32.00	64.00	96.00				30.00	60.00	90.00				32.00				32.00			1.07	1.00		1.07	1.00	1.03	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	224	0		29	10	S5617_224_0	3			Non-Preferred Drug	3	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											87.37	50	50	50				83.78	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	224	0		29	10	S5617_224_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, Select Care Drugs												
S5617	224	0		29	10	S5617_224_0	3			Select Care Drugs	3	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								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	3			Preferred Generic	3	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								6.00	12.00	18.00					1.00	2.00	3.00											6.00	12.00	18.00				1.00	2.00	0.00				6.00				6.00			0.20	0.03		0.20	0.03	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	225	0		29	10	S5617_225_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					7.00	14.00	21.00											10.00	20.00	30.00				7.00	14.00	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												
S5617	225	0		29	10	S5617_225_0	3			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					34.00	68.00	102.00											37.00	74.00	111.00				34.00	68.00	102.00				37.00				37.00			1.23	1.13		1.23	1.13	1.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	225	0		29	10	S5617_225_0	3			Non-Preferred Drug	3	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											91.27	50	50	50				76.92	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	225	0		29	10	S5617_225_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, Select Care Drugs												
S5617	225	0		29	10	S5617_225_0	3			Select Care Drugs	3	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								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	3			Preferred Generic	3	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								6.00	12.00	18.00					1.00	2.00	3.00											6.00	12.00	18.00				1.00	2.00	0.00				6.00				6.00			0.20	0.03		0.20	0.03	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	226	0		29	10	S5617_226_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					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												
S5617	226	0		29	10	S5617_226_0	3			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	226	0		29	10	S5617_226_0	3			Non-Preferred Drug	3	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											90.91	50	50	50				76.39	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	226	0		29	10	S5617_226_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, Select Care Drugs												
S5617	226	0		29	10	S5617_226_0	3			Select Care Drugs	3	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								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	3			Preferred Generic	3	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								6.00	12.00	18.00					1.00	2.00	3.00											6.00	12.00	18.00				1.00	2.00	0.00				6.00				6.00			0.20	0.03		0.20	0.03	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	227	0		29	10	S5617_227_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					6.00	12.00	18.00											10.00	20.00	30.00				6.00	12.00	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												
S5617	227	0		29	10	S5617_227_0	3			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					26.00	52.00	78.00											30.00	60.00	90.00				26.00	52.00	78.00				30.00				30.00			1.00	0.87		1.00	0.87	0.97	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	227	0		29	10	S5617_227_0	3			Non-Preferred Drug	3	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											97.35	46	46	46				99.42	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	227	0		29	10	S5617_227_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, Select Care Drugs												
S5617	227	0		29	10	S5617_227_0	3			Select Care Drugs	3	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								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	246	0		29	10	S5617_246_0	4		Y	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								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	4		Y	Preferred Generic	4	01	1	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					4.00	8.00	12.00											15.00	30.00	45.00				4.00	8.00	0.00				15.00				15.00			0.50	0.13		0.50	0.13	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
S5617	246	0		29	10	S5617_246_0	4		Y	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	2.00				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	4		Y	Generic	4	01	1	2	2	3		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	2.00				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	4		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					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	246	0		29	10	S5617_246_0	4		Y	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											80.15	50	50	50				60.49	50	50	50										50	50	50				50	50	50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	246	0		29	10	S5617_246_0	4		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												31							31												31						31					31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	246	0		29	10	S5617_246_0	4		Y	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								11.00	22.00	33.00					0.00	0.00	0.00											11.00	22.00	33.00				0.00	0.00	0.00				11.00				11.00			0.37	0.00		0.37	0.00	0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	247	0		29	10	S5617_247_0	3		Y	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					4.00	8.00	12.00											15.00	30.00	45.00				4.00	8.00	0.00				15.00				15.00			0.50	0.13		0.50	0.13	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	247	0		29	10	S5617_247_0	3		Y	Preferred Generic	4	01	1	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					4.00	8.00	12.00											15.00	30.00	45.00				4.00	8.00	0.00				15.00				15.00			0.50	0.13		0.50	0.13	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
S5617	247	0		29	10	S5617_247_0	3		Y	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	2.00				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	3		Y	Generic	4	01	1	2	2	3		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	2.00				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	3		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					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	247	0		29	10	S5617_247_0	3		Y	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											75.21	50	50	50				65.17	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	3		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												31							31												31						31					31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	247	0		29	10	S5617_247_0	3		Y	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								11.00	22.00	33.00					0.00	0.00	0.00											11.00	22.00	33.00				0.00	0.00	0.00				11.00				11.00			0.37	0.00		0.37	0.00	0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	248	0		29	10	S5617_248_0	3		Y	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					4.00	8.00	12.00											15.00	30.00	45.00				4.00	8.00	0.00				15.00				15.00			0.50	0.13		0.50	0.13	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	248	0		29	10	S5617_248_0	3		Y	Preferred Generic	4	01	1	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					4.00	8.00	12.00											15.00	30.00	45.00				4.00	8.00	0.00				15.00				15.00			0.50	0.13		0.50	0.13	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
S5617	248	0		29	10	S5617_248_0	3		Y	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	2.00				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	3		Y	Generic	4	01	1	2	2	3		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	2.00				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	3		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					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	248	0		29	10	S5617_248_0	3		Y	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											83.27	50	50	50				74.23	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	3		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												31							31												31						31					31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	248	0		29	10	S5617_248_0	3		Y	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								11.00	22.00	33.00					0.00	0.00	0.00											11.00	22.00	33.00				0.00	0.00	0.00				11.00				11.00			0.37	0.00		0.37	0.00	0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	249	0		29	10	S5617_249_0	3		Y	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					4.00	8.00	12.00											15.00	30.00	45.00				4.00	8.00	0.00				15.00				15.00			0.50	0.13		0.50	0.13	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	249	0		29	10	S5617_249_0	3		Y	Preferred Generic	4	01	1	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					4.00	8.00	12.00											15.00	30.00	45.00				4.00	8.00	0.00				15.00				15.00			0.50	0.13		0.50	0.13	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
S5617	249	0		29	10	S5617_249_0	3		Y	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	2.00				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	3		Y	Generic	4	01	1	2	2	3		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	2.00				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	3		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					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	249	0		29	10	S5617_249_0	3		Y	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											86.93	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, Select Care Drugs												
S5617	249	0		29	10	S5617_249_0	3		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												31							31												31						31					31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	249	0		29	10	S5617_249_0	3		Y	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								11.00	22.00	33.00					0.00	0.00	0.00											11.00	22.00	33.00				0.00	0.00	0.00				11.00				11.00			0.37	0.00		0.37	0.00	0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	250	0		29	10	S5617_250_0	3		Y	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					4.00	8.00	12.00											15.00	30.00	45.00				4.00	8.00	0.00				15.00				15.00			0.50	0.13		0.50	0.13	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	250	0		29	10	S5617_250_0	3		Y	Preferred Generic	4	01	1	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					4.00	8.00	12.00											15.00	30.00	45.00				4.00	8.00	0.00				15.00				15.00			0.50	0.13		0.50	0.13	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
S5617	250	0		29	10	S5617_250_0	3		Y	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	2.00				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	3		Y	Generic	4	01	1	2	2	3		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	2.00				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	3		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					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	250	0		29	10	S5617_250_0	3		Y	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											83.40	50	50	50				65.93	50	50	50										50	50	50				50	50	50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	250	0		29	10	S5617_250_0	3		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												31							31												31						31					31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	250	0		29	10	S5617_250_0	3		Y	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								11.00	22.00	33.00					0.00	0.00	0.00											11.00	22.00	33.00				0.00	0.00	0.00				11.00				11.00			0.37	0.00		0.37	0.00	0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	251	0		29	10	S5617_251_0	3		Y	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					4.00	8.00	12.00											15.00	30.00	45.00				4.00	8.00	0.00				15.00				15.00			0.50	0.13		0.50	0.13	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	251	0		29	10	S5617_251_0	3		Y	Preferred Generic	4	01	1	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					4.00	8.00	12.00											15.00	30.00	45.00				4.00	8.00	0.00				15.00				15.00			0.50	0.13		0.50	0.13	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
S5617	251	0		29	10	S5617_251_0	3		Y	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	2.00				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	3		Y	Generic	4	01	1	2	2	3		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	2.00				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	3		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					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	251	0		29	10	S5617_251_0	3		Y	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											76.43	50	50	50				64.38	50	50	50										50	50	50				50	50	50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	251	0		29	10	S5617_251_0	3		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												31							31												31						31					31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	251	0		29	10	S5617_251_0	3		Y	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								11.00	22.00	33.00					0.00	0.00	0.00											11.00	22.00	33.00				0.00	0.00	0.00				11.00				11.00			0.37	0.00		0.37	0.00	0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	252	0		29	10	S5617_252_0	3		Y	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					4.00	8.00	12.00											15.00	30.00	45.00				4.00	8.00	0.00				15.00				15.00			0.50	0.13		0.50	0.13	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	252	0		29	10	S5617_252_0	3		Y	Preferred Generic	4	01	1	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					4.00	8.00	12.00											15.00	30.00	45.00				4.00	8.00	0.00				15.00				15.00			0.50	0.13		0.50	0.13	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
S5617	252	0		29	10	S5617_252_0	3		Y	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	2.00				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	3		Y	Generic	4	01	1	2	2	3		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	2.00				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	3		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					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	252	0		29	10	S5617_252_0	3		Y	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											82.44	50	50	50				61.79	50	50	50										50	50	50				50	50	50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	252	0		29	10	S5617_252_0	3		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												31							31												31						31					31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	252	0		29	10	S5617_252_0	3		Y	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								11.00	22.00	33.00					0.00	0.00	0.00											11.00	22.00	33.00				0.00	0.00	0.00				11.00				11.00			0.37	0.00		0.37	0.00	0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	253	0		29	10	S5617_253_0	3		Y	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					4.00	8.00	12.00											15.00	30.00	45.00				4.00	8.00	0.00				15.00				15.00			0.50	0.13		0.50	0.13	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	253	0		29	10	S5617_253_0	3		Y	Preferred Generic	4	01	1	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					4.00	8.00	12.00											15.00	30.00	45.00				4.00	8.00	0.00				15.00				15.00			0.50	0.13		0.50	0.13	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
S5617	253	0		29	10	S5617_253_0	3		Y	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	2.00				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	3		Y	Generic	4	01	1	2	2	3		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	2.00				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	3		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					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	253	0		29	10	S5617_253_0	3		Y	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											77.32	50	50	50				63.97	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	3		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												31							31												31						31					31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	253	0		29	10	S5617_253_0	3		Y	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								11.00	22.00	33.00					0.00	0.00	0.00											11.00	22.00	33.00				0.00	0.00	0.00				11.00				11.00			0.37	0.00		0.37	0.00	0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	254	0		29	10	S5617_254_0	3		Y	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					4.00	8.00	12.00											15.00	30.00	45.00				4.00	8.00	0.00				15.00				15.00			0.50	0.13		0.50	0.13	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	254	0		29	10	S5617_254_0	3		Y	Preferred Generic	4	01	1	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					4.00	8.00	12.00											15.00	30.00	45.00				4.00	8.00	0.00				15.00				15.00			0.50	0.13		0.50	0.13	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
S5617	254	0		29	10	S5617_254_0	3		Y	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	2.00				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	3		Y	Generic	4	01	1	2	2	3		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	2.00				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	3		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					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	254	0		29	10	S5617_254_0	3		Y	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											86.67	50	50	50				65.15	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	254	0		29	10	S5617_254_0	3		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												31							31												31						31					31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	254	0		29	10	S5617_254_0	3		Y	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								11.00	22.00	33.00					0.00	0.00	0.00											11.00	22.00	33.00				0.00	0.00	0.00				11.00				11.00			0.37	0.00		0.37	0.00	0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	255	0		29	10	S5617_255_0	3		Y	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					4.00	8.00	12.00											15.00	30.00	45.00				4.00	8.00	0.00				15.00				15.00			0.50	0.13		0.50	0.13	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	255	0		29	10	S5617_255_0	3		Y	Preferred Generic	4	01	1	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					4.00	8.00	12.00											15.00	30.00	45.00				4.00	8.00	0.00				15.00				15.00			0.50	0.13		0.50	0.13	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
S5617	255	0		29	10	S5617_255_0	3		Y	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	2.00				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	3		Y	Generic	4	01	1	2	2	3		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	2.00				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	3		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					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	255	0		29	10	S5617_255_0	3		Y	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											80.10	50	50	50				65.70	50	50	50										50	50	50				50	50	50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	255	0		29	10	S5617_255_0	3		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												31							31												31						31					31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	255	0		29	10	S5617_255_0	3		Y	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								11.00	22.00	33.00					0.00	0.00	0.00											11.00	22.00	33.00				0.00	0.00	0.00				11.00				11.00			0.37	0.00		0.37	0.00	0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	256	0		29	10	S5617_256_0	3		Y	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					4.00	8.00	12.00											15.00	30.00	45.00				4.00	8.00	0.00				15.00				15.00			0.50	0.13		0.50	0.13	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	256	0		29	10	S5617_256_0	3		Y	Preferred Generic	4	01	1	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					4.00	8.00	12.00											15.00	30.00	45.00				4.00	8.00	0.00				15.00				15.00			0.50	0.13		0.50	0.13	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
S5617	256	0		29	10	S5617_256_0	3		Y	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	2.00				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	3		Y	Generic	4	01	1	2	2	3		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	2.00				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	3		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					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	256	0		29	10	S5617_256_0	3		Y	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											79.75	50	50	50				69.09	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	256	0		29	10	S5617_256_0	3		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												31							31												31						31					31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	256	0		29	10	S5617_256_0	3		Y	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								11.00	22.00	33.00					0.00	0.00	0.00											11.00	22.00	33.00				0.00	0.00	0.00				11.00				11.00			0.37	0.00		0.37	0.00	0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	257	0		29	10	S5617_257_0	3		Y	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					4.00	8.00	12.00											15.00	30.00	45.00				4.00	8.00	0.00				15.00				15.00			0.50	0.13		0.50	0.13	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	257	0		29	10	S5617_257_0	3		Y	Preferred Generic	4	01	1	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					4.00	8.00	12.00											15.00	30.00	45.00				4.00	8.00	0.00				15.00				15.00			0.50	0.13		0.50	0.13	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
S5617	257	0		29	10	S5617_257_0	3		Y	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	2.00				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	3		Y	Generic	4	01	1	2	2	3		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	2.00				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	3		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					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	257	0		29	10	S5617_257_0	3		Y	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											79.90	50	50	50				63.94	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	257	0		29	10	S5617_257_0	3		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												31							31												31						31					31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	257	0		29	10	S5617_257_0	3		Y	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								11.00	22.00	33.00					0.00	0.00	0.00											11.00	22.00	33.00				0.00	0.00	0.00				11.00				11.00			0.37	0.00		0.37	0.00	0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	258	0		29	10	S5617_258_0	3		Y	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					4.00	8.00	12.00											15.00	30.00	45.00				4.00	8.00	0.00				15.00				15.00			0.50	0.13		0.50	0.13	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	258	0		29	10	S5617_258_0	3		Y	Preferred Generic	4	01	1	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					4.00	8.00	12.00											15.00	30.00	45.00				4.00	8.00	0.00				15.00				15.00			0.50	0.13		0.50	0.13	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
S5617	258	0		29	10	S5617_258_0	3		Y	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	2.00				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	3		Y	Generic	4	01	1	2	2	3		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	2.00				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	3		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					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	258	0		29	10	S5617_258_0	3		Y	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											71.02	50	50	50				61.56	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	258	0		29	10	S5617_258_0	3		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												31							31												31						31					31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	258	0		29	10	S5617_258_0	3		Y	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								11.00	22.00	33.00					0.00	0.00	0.00											11.00	22.00	33.00				0.00	0.00	0.00				11.00				11.00			0.37	0.00		0.37	0.00	0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	259	0		29	10	S5617_259_0	3		Y	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					4.00	8.00	12.00											15.00	30.00	45.00				4.00	8.00	0.00				15.00				15.00			0.50	0.13		0.50	0.13	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	259	0		29	10	S5617_259_0	3		Y	Preferred Generic	4	01	1	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					4.00	8.00	12.00											15.00	30.00	45.00				4.00	8.00	0.00				15.00				15.00			0.50	0.13		0.50	0.13	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
S5617	259	0		29	10	S5617_259_0	3		Y	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	2.00				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	3		Y	Generic	4	01	1	2	2	3		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	2.00				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	3		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					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	259	0		29	10	S5617_259_0	3		Y	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											84.20	50	50	50				63.23	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	3		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												31							31												31						31					31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	259	0		29	10	S5617_259_0	3		Y	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								11.00	22.00	33.00					0.00	0.00	0.00											11.00	22.00	33.00				0.00	0.00	0.00				11.00				11.00			0.37	0.00		0.37	0.00	0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	260	0		29	10	S5617_260_0	3		Y	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					4.00	8.00	12.00											15.00	30.00	45.00				4.00	8.00	0.00				15.00				15.00			0.50	0.13		0.50	0.13	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	260	0		29	10	S5617_260_0	3		Y	Preferred Generic	4	01	1	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					4.00	8.00	12.00											15.00	30.00	45.00				4.00	8.00	0.00				15.00				15.00			0.50	0.13		0.50	0.13	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
S5617	260	0		29	10	S5617_260_0	3		Y	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	2.00				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	3		Y	Generic	4	01	1	2	2	3		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	2.00				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	3		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					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	260	0		29	10	S5617_260_0	3		Y	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											81.71	50	50	50				63.71	50	50	50										50	50	50				50	50	50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	260	0		29	10	S5617_260_0	3		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												31							31												31						31					31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	260	0		29	10	S5617_260_0	3		Y	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								11.00	22.00	33.00					0.00	0.00	0.00											11.00	22.00	33.00				0.00	0.00	0.00				11.00				11.00			0.37	0.00		0.37	0.00	0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	261	0		29	10	S5617_261_0	3		Y	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					4.00	8.00	12.00											15.00	30.00	45.00				4.00	8.00	0.00				15.00				15.00			0.50	0.13		0.50	0.13	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	261	0		29	10	S5617_261_0	3		Y	Preferred Generic	4	01	1	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					4.00	8.00	12.00											15.00	30.00	45.00				4.00	8.00	0.00				15.00				15.00			0.50	0.13		0.50	0.13	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
S5617	261	0		29	10	S5617_261_0	3		Y	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	2.00				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	3		Y	Generic	4	01	1	2	2	3		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	2.00				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	3		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					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	261	0		29	10	S5617_261_0	3		Y	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											75.42	50	50	50				54.72	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	261	0		29	10	S5617_261_0	3		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												31							31												31						31					31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	261	0		29	10	S5617_261_0	3		Y	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								11.00	22.00	33.00					0.00	0.00	0.00											11.00	22.00	33.00				0.00	0.00	0.00				11.00				11.00			0.37	0.00		0.37	0.00	0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	262	0		29	10	S5617_262_0	3		Y	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					4.00	8.00	12.00											15.00	30.00	45.00				4.00	8.00	0.00				15.00				15.00			0.50	0.13		0.50	0.13	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	262	0		29	10	S5617_262_0	3		Y	Preferred Generic	4	01	1	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					4.00	8.00	12.00											15.00	30.00	45.00				4.00	8.00	0.00				15.00				15.00			0.50	0.13		0.50	0.13	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
S5617	262	0		29	10	S5617_262_0	3		Y	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	2.00				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	3		Y	Generic	4	01	1	2	2	3		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	2.00				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	3		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					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	262	0		29	10	S5617_262_0	3		Y	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											81.89	50	50	50				63.35	50	50	50										50	50	50				50	50	50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	262	0		29	10	S5617_262_0	3		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												31							31												31						31					31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	262	0		29	10	S5617_262_0	3		Y	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								11.00	22.00	33.00					0.00	0.00	0.00											11.00	22.00	33.00				0.00	0.00	0.00				11.00				11.00			0.37	0.00		0.37	0.00	0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	263	0		29	10	S5617_263_0	3		Y	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					4.00	8.00	12.00											15.00	30.00	45.00				4.00	8.00	0.00				15.00				15.00			0.50	0.13		0.50	0.13	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	263	0		29	10	S5617_263_0	3		Y	Preferred Generic	4	01	1	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					4.00	8.00	12.00											15.00	30.00	45.00				4.00	8.00	0.00				15.00				15.00			0.50	0.13		0.50	0.13	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
S5617	263	0		29	10	S5617_263_0	3		Y	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	2.00				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	3		Y	Generic	4	01	1	2	2	3		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	2.00				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	3		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					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	263	0		29	10	S5617_263_0	3		Y	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											69.34	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, Select Care Drugs												
S5617	263	0		29	10	S5617_263_0	3		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												31							31												31						31					31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	263	0		29	10	S5617_263_0	3		Y	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								11.00	22.00	33.00					0.00	0.00	0.00											11.00	22.00	33.00				0.00	0.00	0.00				11.00				11.00			0.37	0.00		0.37	0.00	0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	264	0		29	10	S5617_264_0	3		Y	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					4.00	8.00	12.00											15.00	30.00	45.00				4.00	8.00	0.00				15.00				15.00			0.50	0.13		0.50	0.13	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	264	0		29	10	S5617_264_0	3		Y	Preferred Generic	4	01	1	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					4.00	8.00	12.00											15.00	30.00	45.00				4.00	8.00	0.00				15.00				15.00			0.50	0.13		0.50	0.13	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
S5617	264	0		29	10	S5617_264_0	3		Y	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	2.00				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	3		Y	Generic	4	01	1	2	2	3		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	2.00				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	3		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					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	264	0		29	10	S5617_264_0	3		Y	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											84.22	50	50	50				65.34	50	50	50										50	50	50				50	50	50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	264	0		29	10	S5617_264_0	3		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												31							31												31						31					31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	264	0		29	10	S5617_264_0	3		Y	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								11.00	22.00	33.00					0.00	0.00	0.00											11.00	22.00	33.00				0.00	0.00	0.00				11.00				11.00			0.37	0.00		0.37	0.00	0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	265	0		29	10	S5617_265_0	3		Y	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					4.00	8.00	12.00											15.00	30.00	45.00				4.00	8.00	0.00				15.00				15.00			0.50	0.13		0.50	0.13	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	265	0		29	10	S5617_265_0	3		Y	Preferred Generic	4	01	1	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					4.00	8.00	12.00											15.00	30.00	45.00				4.00	8.00	0.00				15.00				15.00			0.50	0.13		0.50	0.13	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
S5617	265	0		29	10	S5617_265_0	3		Y	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	2.00				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	3		Y	Generic	4	01	1	2	2	3		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	2.00				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	3		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					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	265	0		29	10	S5617_265_0	3		Y	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											79.85	50	50	50				61.39	50	50	50										50	50	50				50	50	50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	265	0		29	10	S5617_265_0	3		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												31							31												31						31					31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	265	0		29	10	S5617_265_0	3		Y	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								11.00	22.00	33.00					0.00	0.00	0.00											11.00	22.00	33.00				0.00	0.00	0.00				11.00				11.00			0.37	0.00		0.37	0.00	0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	266	0		29	10	S5617_266_0	3		Y	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					4.00	8.00	12.00											15.00	30.00	45.00				4.00	8.00	0.00				15.00				15.00			0.50	0.13		0.50	0.13	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	266	0		29	10	S5617_266_0	3		Y	Preferred Generic	4	01	1	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					4.00	8.00	12.00											15.00	30.00	45.00				4.00	8.00	0.00				15.00				15.00			0.50	0.13		0.50	0.13	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
S5617	266	0		29	10	S5617_266_0	3		Y	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	2.00				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	3		Y	Generic	4	01	1	2	2	3		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	2.00				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	3		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					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	266	0		29	10	S5617_266_0	3		Y	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											79.65	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, Select Care Drugs												
S5617	266	0		29	10	S5617_266_0	3		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												31							31												31						31					31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	266	0		29	10	S5617_266_0	3		Y	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								11.00	22.00	33.00					0.00	0.00	0.00											11.00	22.00	33.00				0.00	0.00	0.00				11.00				11.00			0.37	0.00		0.37	0.00	0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	267	0		29	10	S5617_267_0	3		Y	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					4.00	8.00	12.00											15.00	30.00	45.00				4.00	8.00	0.00				15.00				15.00			0.50	0.13		0.50	0.13	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	267	0		29	10	S5617_267_0	3		Y	Preferred Generic	4	01	1	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					4.00	8.00	12.00											15.00	30.00	45.00				4.00	8.00	0.00				15.00				15.00			0.50	0.13		0.50	0.13	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
S5617	267	0		29	10	S5617_267_0	3		Y	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	2.00				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	3		Y	Generic	4	01	1	2	2	3		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	2.00				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	3		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					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	267	0		29	10	S5617_267_0	3		Y	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											87.89	50	50	50				67.17	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	3		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												31							31												31						31					31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	267	0		29	10	S5617_267_0	3		Y	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								11.00	22.00	33.00					0.00	0.00	0.00											11.00	22.00	33.00				0.00	0.00	0.00				11.00				11.00			0.37	0.00		0.37	0.00	0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	268	0		29	10	S5617_268_0	3		Y	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					4.00	8.00	12.00											15.00	30.00	45.00				4.00	8.00	0.00				15.00				15.00			0.50	0.13		0.50	0.13	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	268	0		29	10	S5617_268_0	3		Y	Preferred Generic	4	01	1	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					4.00	8.00	12.00											15.00	30.00	45.00				4.00	8.00	0.00				15.00				15.00			0.50	0.13		0.50	0.13	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
S5617	268	0		29	10	S5617_268_0	3		Y	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	2.00				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	3		Y	Generic	4	01	1	2	2	3		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	2.00				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	3		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					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	268	0		29	10	S5617_268_0	3		Y	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											79.68	50	50	50				73.33	50	50	50										50	50	50				50	50	50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	268	0		29	10	S5617_268_0	3		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												31							31												31						31					31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	268	0		29	10	S5617_268_0	3		Y	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								11.00	22.00	33.00					0.00	0.00	0.00											11.00	22.00	33.00				0.00	0.00	0.00				11.00				11.00			0.37	0.00		0.37	0.00	0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	269	0		29	10	S5617_269_0	3		Y	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					4.00	8.00	12.00											15.00	30.00	45.00				4.00	8.00	0.00				15.00				15.00			0.50	0.13		0.50	0.13	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	269	0		29	10	S5617_269_0	3		Y	Preferred Generic	4	01	1	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					4.00	8.00	12.00											15.00	30.00	45.00				4.00	8.00	0.00				15.00				15.00			0.50	0.13		0.50	0.13	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
S5617	269	0		29	10	S5617_269_0	3		Y	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	2.00				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	3		Y	Generic	4	01	1	2	2	3		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	2.00				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	3		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					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	269	0		29	10	S5617_269_0	3		Y	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											77.36	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	269	0		29	10	S5617_269_0	3		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												31							31												31						31					31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	269	0		29	10	S5617_269_0	3		Y	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								11.00	22.00	33.00					0.00	0.00	0.00											11.00	22.00	33.00				0.00	0.00	0.00				11.00				11.00			0.37	0.00		0.37	0.00	0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	270	0		29	10	S5617_270_0	3		Y	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					4.00	8.00	12.00											15.00	30.00	45.00				4.00	8.00	0.00				15.00				15.00			0.50	0.13		0.50	0.13	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	270	0		29	10	S5617_270_0	3		Y	Preferred Generic	4	01	1	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					4.00	8.00	12.00											15.00	30.00	45.00				4.00	8.00	0.00				15.00				15.00			0.50	0.13		0.50	0.13	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
S5617	270	0		29	10	S5617_270_0	3		Y	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	2.00				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	3		Y	Generic	4	01	1	2	2	3		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	2.00				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	3		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					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	270	0		29	10	S5617_270_0	3		Y	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											70.55	50	50	50				63.82	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	270	0		29	10	S5617_270_0	3		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												31							31												31						31					31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	270	0		29	10	S5617_270_0	3		Y	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								11.00	22.00	33.00					0.00	0.00	0.00											11.00	22.00	33.00				0.00	0.00	0.00				11.00				11.00			0.37	0.00		0.37	0.00	0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	271	0		29	10	S5617_271_0	3		Y	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					4.00	8.00	12.00											15.00	30.00	45.00				4.00	8.00	0.00				15.00				15.00			0.50	0.13		0.50	0.13	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	271	0		29	10	S5617_271_0	3		Y	Preferred Generic	4	01	1	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					4.00	8.00	12.00											15.00	30.00	45.00				4.00	8.00	0.00				15.00				15.00			0.50	0.13		0.50	0.13	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
S5617	271	0		29	10	S5617_271_0	3		Y	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	2.00				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	3		Y	Generic	4	01	1	2	2	3		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	2.00				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	3		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					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	271	0		29	10	S5617_271_0	3		Y	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											84.42	50	50	50				70.39	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	271	0		29	10	S5617_271_0	3		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												31							31												31						31					31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	271	0		29	10	S5617_271_0	3		Y	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								11.00	22.00	33.00					0.00	0.00	0.00											11.00	22.00	33.00				0.00	0.00	0.00				11.00				11.00			0.37	0.00		0.37	0.00	0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	272	0		29	10	S5617_272_0	3		Y	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					4.00	8.00	12.00											15.00	30.00	45.00				4.00	8.00	0.00				15.00				15.00			0.50	0.13		0.50	0.13	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	272	0		29	10	S5617_272_0	3		Y	Preferred Generic	4	01	1	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					4.00	8.00	12.00											15.00	30.00	45.00				4.00	8.00	0.00				15.00				15.00			0.50	0.13		0.50	0.13	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
S5617	272	0		29	10	S5617_272_0	3		Y	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	2.00				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	3		Y	Generic	4	01	1	2	2	3		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	2.00				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	3		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					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	272	0		29	10	S5617_272_0	3		Y	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											98.86	48	48	48				63.24	48	48	48										48	48	48				48	48	48			48			48								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	272	0		29	10	S5617_272_0	3		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												31							31												31						31					31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	272	0		29	10	S5617_272_0	3		Y	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								11.00	22.00	33.00					0.00	0.00	0.00											11.00	22.00	33.00				0.00	0.00	0.00				11.00				11.00			0.37	0.00		0.37	0.00	0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	273	0		29	10	S5617_273_0	3		Y	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					4.00	8.00	12.00											15.00	30.00	45.00				4.00	8.00	0.00				15.00				15.00			0.50	0.13		0.50	0.13	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	273	0		29	10	S5617_273_0	3		Y	Preferred Generic	4	01	1	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					4.00	8.00	12.00											15.00	30.00	45.00				4.00	8.00	0.00				15.00				15.00			0.50	0.13		0.50	0.13	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
S5617	273	0		29	10	S5617_273_0	3		Y	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	2.00				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	3		Y	Generic	4	01	1	2	2	3		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	2.00				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	3		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					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	273	0		29	10	S5617_273_0	3		Y	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											81.03	50	50	50				61.75	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	273	0		29	10	S5617_273_0	3		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												31							31												31						31					31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	273	0		29	10	S5617_273_0	3		Y	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								11.00	22.00	33.00					0.00	0.00	0.00											11.00	22.00	33.00				0.00	0.00	0.00				11.00				11.00			0.37	0.00		0.37	0.00	0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	274	0		29	10	S5617_274_0	3		Y	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					4.00	8.00	12.00											15.00	30.00	45.00				4.00	8.00	0.00				15.00				15.00			0.50	0.13		0.50	0.13	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	274	0		29	10	S5617_274_0	3		Y	Preferred Generic	4	01	1	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					4.00	8.00	12.00											15.00	30.00	45.00				4.00	8.00	0.00				15.00				15.00			0.50	0.13		0.50	0.13	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
S5617	274	0		29	10	S5617_274_0	3		Y	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	2.00				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	3		Y	Generic	4	01	1	2	2	3		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	2.00				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	3		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					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	274	0		29	10	S5617_274_0	3		Y	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											92.47	50	50	50				71.61	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	274	0		29	10	S5617_274_0	3		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												31							31												31						31					31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	274	0		29	10	S5617_274_0	3		Y	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								11.00	22.00	33.00					0.00	0.00	0.00											11.00	22.00	33.00				0.00	0.00	0.00				11.00				11.00			0.37	0.00		0.37	0.00	0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	275	0		29	10	S5617_275_0	3		Y	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					4.00	8.00	12.00											15.00	30.00	45.00				4.00	8.00	0.00				15.00				15.00			0.50	0.13		0.50	0.13	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	275	0		29	10	S5617_275_0	3		Y	Preferred Generic	4	01	1	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					4.00	8.00	12.00											15.00	30.00	45.00				4.00	8.00	0.00				15.00				15.00			0.50	0.13		0.50	0.13	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
S5617	275	0		29	10	S5617_275_0	3		Y	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	2.00				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	3		Y	Generic	4	01	1	2	2	3		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	2.00				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	3		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					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	275	0		29	10	S5617_275_0	3		Y	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											74.88	50	50	50				55.20	50	50	50										50	50	50				50	50	50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	275	0		29	10	S5617_275_0	3		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												31							31												31						31					31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	275	0		29	10	S5617_275_0	3		Y	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								11.00	22.00	33.00					0.00	0.00	0.00											11.00	22.00	33.00				0.00	0.00	0.00				11.00				11.00			0.37	0.00		0.37	0.00	0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	276	0		29	10	S5617_276_0	3		Y	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					4.00	8.00	12.00											15.00	30.00	45.00				4.00	8.00	0.00				15.00				15.00			0.50	0.13		0.50	0.13	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	276	0		29	10	S5617_276_0	3		Y	Preferred Generic	4	01	1	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					4.00	8.00	12.00											15.00	30.00	45.00				4.00	8.00	0.00				15.00				15.00			0.50	0.13		0.50	0.13	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
S5617	276	0		29	10	S5617_276_0	3		Y	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	2.00				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	3		Y	Generic	4	01	1	2	2	3		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	2.00				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	3		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					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	276	0		29	10	S5617_276_0	3		Y	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											78.72	50	50	50				57.18	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	276	0		29	10	S5617_276_0	3		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												31							31												31						31					31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	276	0		29	10	S5617_276_0	3		Y	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								11.00	22.00	33.00					0.00	0.00	0.00											11.00	22.00	33.00				0.00	0.00	0.00				11.00				11.00			0.37	0.00		0.37	0.00	0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	277	0		29	10	S5617_277_0	3		Y	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					4.00	8.00	12.00											15.00	30.00	45.00				4.00	8.00	0.00				15.00				15.00			0.50	0.13		0.50	0.13	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	277	0		29	10	S5617_277_0	3		Y	Preferred Generic	4	01	1	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					4.00	8.00	12.00											15.00	30.00	45.00				4.00	8.00	0.00				15.00				15.00			0.50	0.13		0.50	0.13	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
S5617	277	0		29	10	S5617_277_0	3		Y	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	2.00				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	3		Y	Generic	4	01	1	2	2	3		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	2.00				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	3		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					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	277	0		29	10	S5617_277_0	3		Y	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											85.22	50	50	50				66.12	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	277	0		29	10	S5617_277_0	3		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												31							31												31						31					31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	277	0		29	10	S5617_277_0	3		Y	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								11.00	22.00	33.00					0.00	0.00	0.00											11.00	22.00	33.00				0.00	0.00	0.00				11.00				11.00			0.37	0.00		0.37	0.00	0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	278	0		29	10	S5617_278_0	3		Y	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					4.00	8.00	12.00											15.00	30.00	45.00				4.00	8.00	0.00				15.00				15.00			0.50	0.13		0.50	0.13	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	278	0		29	10	S5617_278_0	3		Y	Preferred Generic	4	01	1	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					4.00	8.00	12.00											15.00	30.00	45.00				4.00	8.00	0.00				15.00				15.00			0.50	0.13		0.50	0.13	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
S5617	278	0		29	10	S5617_278_0	3		Y	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	2.00				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	3		Y	Generic	4	01	1	2	2	3		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	2.00				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	3		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					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	278	0		29	10	S5617_278_0	3		Y	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											98.53	46	46	46				86.22	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	278	0		29	10	S5617_278_0	3		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												31							31												31						31					31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	278	0		29	10	S5617_278_0	3		Y	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								11.00	22.00	33.00					0.00	0.00	0.00											11.00	22.00	33.00				0.00	0.00	0.00				11.00				11.00			0.37	0.00		0.37	0.00	0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	279	0		29	10	S5617_279_0	3		Y	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					4.00	8.00	12.00											15.00	30.00	45.00				4.00	8.00	0.00				15.00				15.00			0.50	0.13		0.50	0.13	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	279	0		29	10	S5617_279_0	3		Y	Preferred Generic	4	01	1	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					4.00	8.00	12.00											15.00	30.00	45.00				4.00	8.00	0.00				15.00				15.00			0.50	0.13		0.50	0.13	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
S5617	279	0		29	10	S5617_279_0	3		Y	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	2.00				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	3		Y	Generic	4	01	1	2	2	3		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	2.00				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	3		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					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	279	0		29	10	S5617_279_0	3		Y	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											78.03	50	50	50				68.10	50	50	50										50	50	50				50	50	50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	279	0		29	10	S5617_279_0	3		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												31							31												31						31					31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	279	0		29	10	S5617_279_0	3		Y	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								11.00	22.00	33.00					0.00	0.00	0.00											11.00	22.00	33.00				0.00	0.00	0.00				11.00				11.00			0.37	0.00		0.37	0.00	0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	348	0		29	10	S5617_348_0	3			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					16.00	32.00	48.00											19.00	38.00	57.00				16.00	32.00	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, Select Care Drugs												
S5617	348	0		29	10	S5617_348_0	3			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					19.00	38.00	57.00											20.00	40.00	60.00				19.00	38.00	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, Select Care Drugs												
S5617	348	0		29	10	S5617_348_0	3			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	348	0		29	10	S5617_348_0	3			Non-Preferred Drug	3	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											91.51	50	50	50				69.24	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	348	0		29	10	S5617_348_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, Select Care Drugs												
S5617	348	0		29	10	S5617_348_0	3			Select Care Drugs	3	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								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	3		Y	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					4.00	8.00	12.00											15.00	30.00	45.00				4.00	8.00	0.00				15.00				15.00			0.50	0.13		0.50	0.13	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	349	0		29	10	S5617_349_0	3		Y	Preferred Generic	4	01	1	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					4.00	8.00	12.00											15.00	30.00	45.00				4.00	8.00	0.00				15.00				15.00			0.50	0.13		0.50	0.13	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
S5617	349	0		29	10	S5617_349_0	3		Y	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	2.00				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	3		Y	Generic	4	01	1	2	2	3		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	2.00				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	3		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					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	349	0		29	10	S5617_349_0	3		Y	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											98.21	39	39	39				86.26	39	39	39										39	39	39				39	39	39			39			39								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	349	0		29	10	S5617_349_0	3		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												31							31												31						31					31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	349	0		29	10	S5617_349_0	3		Y	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								11.00	22.00	33.00					0.00	0.00	0.00											11.00	22.00	33.00				0.00	0.00	0.00				11.00				11.00			0.37	0.00		0.37	0.00	0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	351	0		29	10	S5617_351_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											15.00	30.00	45.00				0.00	0.00	0.00				15.00				15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	351	0		29	10	S5617_351_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	6.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	351	0		29	10	S5617_351_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					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												
S5617	351	0		29	10	S5617_351_0	4			Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											75.52	50	50	50				74.60	50	50	50										50	50	50				50	50	50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	351	0		29	10	S5617_351_0	4			Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	352	0		29	10	S5617_352_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				15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	352	0		29	10	S5617_352_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					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	6.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	352	0		29	10	S5617_352_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					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												
S5617	352	0		29	10	S5617_352_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											73.30	50	50	50				71.51	50	50	50										50	50	50				50	50	50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	352	0		29	10	S5617_352_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												
S5617	353	0		29	10	S5617_353_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				15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	353	0		29	10	S5617_353_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					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	6.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	353	0		29	10	S5617_353_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					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												
S5617	353	0		29	10	S5617_353_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											73.46	50	50	50				72.31	50	50	50										50	50	50				50	50	50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	353	0		29	10	S5617_353_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												
S5617	354	0		29	10	S5617_354_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				15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	354	0		29	10	S5617_354_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					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	6.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	354	0		29	10	S5617_354_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					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												
S5617	354	0		29	10	S5617_354_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											70.81	50	50	50				69.26	50	50	50										50	50	50				50	50	50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	354	0		29	10	S5617_354_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												
S5617	355	0		29	10	S5617_355_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				15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	355	0		29	10	S5617_355_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					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	6.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	355	0		29	10	S5617_355_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					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												
S5617	355	0		29	10	S5617_355_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											71.00	50	50	50				69.38	50	50	50										50	50	50				50	50	50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	355	0		29	10	S5617_355_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												
S5617	356	0		29	10	S5617_356_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				15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	356	0		29	10	S5617_356_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					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	6.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	356	0		29	10	S5617_356_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					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												
S5617	356	0		29	10	S5617_356_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											71.36	50	50	50				69.81	50	50	50										50	50	50				50	50	50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	356	0		29	10	S5617_356_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												
S5617	357	0		29	10	S5617_357_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				15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	357	0		29	10	S5617_357_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					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	6.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	357	0		29	10	S5617_357_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					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												
S5617	357	0		29	10	S5617_357_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											68.87	50	50	50				67.23	50	50	50										50	50	50				50	50	50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	357	0		29	10	S5617_357_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												
S5617	358	0		29	10	S5617_358_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				15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	358	0		29	10	S5617_358_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					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	6.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	358	0		29	10	S5617_358_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					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												
S5617	358	0		29	10	S5617_358_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											67.60	50	50	50				65.74	50	50	50										50	50	50				50	50	50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	358	0		29	10	S5617_358_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												
S5617	359	0		29	10	S5617_359_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				15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	359	0		29	10	S5617_359_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					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	6.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	359	0		29	10	S5617_359_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					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												
S5617	359	0		29	10	S5617_359_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											69.30	50	50	50				67.68	50	50	50										50	50	50				50	50	50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	359	0		29	10	S5617_359_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												
S5617	360	0		29	10	S5617_360_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				15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	360	0		29	10	S5617_360_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					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	6.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	360	0		29	10	S5617_360_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					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												
S5617	360	0		29	10	S5617_360_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											67.79	50	50	50				66.09	50	50	50										50	50	50				50	50	50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	360	0		29	10	S5617_360_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												
S5617	361	0		29	10	S5617_361_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				15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	361	0		29	10	S5617_361_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					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	6.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	361	0		29	10	S5617_361_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					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												
S5617	361	0		29	10	S5617_361_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											68.44	50	50	50				67.66	50	50	50										50	50	50				50	50	50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	361	0		29	10	S5617_361_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												
S5617	362	0		29	10	S5617_362_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				15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	362	0		29	10	S5617_362_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					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	6.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	362	0		29	10	S5617_362_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					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												
S5617	362	0		29	10	S5617_362_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											62.34	50	50	50				60.37	50	50	50										50	50	50				50	50	50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	362	0		29	10	S5617_362_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												
S5617	363	0		29	10	S5617_363_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				15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	363	0		29	10	S5617_363_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					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	6.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	363	0		29	10	S5617_363_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					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												
S5617	363	0		29	10	S5617_363_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											72.73	50	50	50				71.41	50	50	50										50	50	50				50	50	50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	363	0		29	10	S5617_363_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												
S5617	364	0		29	10	S5617_364_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				15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	364	0		29	10	S5617_364_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					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	6.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	364	0		29	10	S5617_364_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					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												
S5617	364	0		29	10	S5617_364_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											68.86	50	50	50				67.04	50	50	50										50	50	50				50	50	50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	364	0		29	10	S5617_364_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												
S5617	365	0		29	10	S5617_365_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				15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	365	0		29	10	S5617_365_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					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	6.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	365	0		29	10	S5617_365_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					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												
S5617	365	0		29	10	S5617_365_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											63.68	50	50	50				61.79	50	50	50										50	50	50				50	50	50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	365	0		29	10	S5617_365_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												
S5617	366	0		29	10	S5617_366_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				15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	366	0		29	10	S5617_366_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					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	6.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	366	0		29	10	S5617_366_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					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												
S5617	366	0		29	10	S5617_366_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											63.02	50	50	50				61.17	50	50	50										50	50	50				50	50	50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	366	0		29	10	S5617_366_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												
S5617	367	0		29	10	S5617_367_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				15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	367	0		29	10	S5617_367_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					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	6.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	367	0		29	10	S5617_367_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					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												
S5617	367	0		29	10	S5617_367_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											66.83	50	50	50				65.30	50	50	50										50	50	50				50	50	50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	367	0		29	10	S5617_367_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												
S5617	368	0		29	10	S5617_368_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				15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	368	0		29	10	S5617_368_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					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	6.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	368	0		29	10	S5617_368_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					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												
S5617	368	0		29	10	S5617_368_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											63.08	50	50	50				60.95	50	50	50										50	50	50				50	50	50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	368	0		29	10	S5617_368_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												
S5617	369	0		29	10	S5617_369_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				15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	369	0		29	10	S5617_369_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					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	6.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	369	0		29	10	S5617_369_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					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												
S5617	369	0		29	10	S5617_369_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											62.27	50	50	50				60.24	50	50	50										50	50	50				50	50	50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	369	0		29	10	S5617_369_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												
S5617	370	0		29	10	S5617_370_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				15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	370	0		29	10	S5617_370_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					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	6.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	370	0		29	10	S5617_370_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					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												
S5617	370	0		29	10	S5617_370_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											62.01	50	50	50				59.79	50	50	50										50	50	50				50	50	50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	370	0		29	10	S5617_370_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												
S5617	371	0		29	10	S5617_371_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				15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	371	0		29	10	S5617_371_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					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	6.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	371	0		29	10	S5617_371_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					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												
S5617	371	0		29	10	S5617_371_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											61.41	50	50	50				59.39	50	50	50										50	50	50				50	50	50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	371	0		29	10	S5617_371_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												
S5617	372	0		29	10	S5617_372_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				15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	372	0		29	10	S5617_372_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					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	6.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	372	0		29	10	S5617_372_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					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												
S5617	372	0		29	10	S5617_372_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											67.54	50	50	50				65.74	50	50	50										50	50	50				50	50	50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	372	0		29	10	S5617_372_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												
S5617	373	0		29	10	S5617_373_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				15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	373	0		29	10	S5617_373_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					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	6.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	373	0		29	10	S5617_373_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					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												
S5617	373	0		29	10	S5617_373_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											60.63	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												
S5617	373	0		29	10	S5617_373_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												
S5617	374	0		29	10	S5617_374_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				15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	374	0		29	10	S5617_374_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					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	6.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	374	0		29	10	S5617_374_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					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												
S5617	374	0		29	10	S5617_374_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											62.38	50	50	50				60.29	50	50	50										50	50	50				50	50	50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	374	0		29	10	S5617_374_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												
S5617	375	0		29	10	S5617_375_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				15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	375	0		29	10	S5617_375_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					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	6.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	375	0		29	10	S5617_375_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					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												
S5617	375	0		29	10	S5617_375_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											65.40	50	50	50				63.72	50	50	50										50	50	50				50	50	50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	375	0		29	10	S5617_375_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												
S5617	376	0		29	10	S5617_376_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				15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	376	0		29	10	S5617_376_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					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	6.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	376	0		29	10	S5617_376_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					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												
S5617	376	0		29	10	S5617_376_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											77.64	50	50	50				75.47	50	50	50										50	50	50				50	50	50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	376	0		29	10	S5617_376_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												
S5617	377	0		29	10	S5617_377_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				15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	377	0		29	10	S5617_377_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					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	6.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	377	0		29	10	S5617_377_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					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												
S5617	377	0		29	10	S5617_377_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											79.12	50	50	50				77.48	50	50	50										50	50	50				50	50	50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	377	0		29	10	S5617_377_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												
S5617	378	0		29	10	S5617_378_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				15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	378	0		29	10	S5617_378_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					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	6.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	378	0		29	10	S5617_378_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					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												
S5617	378	0		29	10	S5617_378_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											77.49	50	50	50				75.50	50	50	50										50	50	50				50	50	50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	378	0		29	10	S5617_378_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												
S5617	379	0		29	10	S5617_379_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				15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	379	0		29	10	S5617_379_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					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	6.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	379	0		29	10	S5617_379_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					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												
S5617	379	0		29	10	S5617_379_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											74.10	50	50	50				72.13	50	50	50										50	50	50				50	50	50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	379	0		29	10	S5617_379_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												
S5617	380	0		29	10	S5617_380_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				15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	380	0		29	10	S5617_380_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					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	6.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	380	0		29	10	S5617_380_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					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												
S5617	380	0		29	10	S5617_380_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											78.93	50	50	50				77.18	50	50	50										50	50	50				50	50	50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	380	0		29	10	S5617_380_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												
S5617	381	0		29	10	S5617_381_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				15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	381	0		29	10	S5617_381_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					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	6.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	381	0		29	10	S5617_381_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					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												
S5617	381	0		29	10	S5617_381_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											68.52	50	50	50				66.66	50	50	50										50	50	50				50	50	50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	381	0		29	10	S5617_381_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												
S5617	382	0		29	10	S5617_382_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				15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	382	0		29	10	S5617_382_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					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	6.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	382	0		29	10	S5617_382_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					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												
S5617	382	0		29	10	S5617_382_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											76.52	50	50	50				74.71	50	50	50										50	50	50				50	50	50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	382	0		29	10	S5617_382_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												
S5617	383	0		29	10	S5617_383_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				15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	383	0		29	10	S5617_383_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					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	6.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	383	0		29	10	S5617_383_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					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												
S5617	383	0		29	10	S5617_383_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											84.74	50	50	50				81.87	50	50	50										50	50	50				50	50	50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	383	0		29	10	S5617_383_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												
S5617	384	0		29	10	S5617_384_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				15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	384	0		29	10	S5617_384_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					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	6.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	384	0		29	10	S5617_384_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					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												
S5617	384	0		29	10	S5617_384_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											77.42	50	50	50				75.61	50	50	50										50	50	50				50	50	50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	384	0		29	10	S5617_384_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												
S5617	385	0		29	10	S5617_385_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				15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	385	0		29	10	S5617_385_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					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	6.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	385	0		29	10	S5617_385_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					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												
S5617	385	0		29	10	S5617_385_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											72.75	50	50	50				70.13	50	50	50										50	50	50				50	50	50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	385	0		29	10	S5617_385_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	001	0		29	10	S5715_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					1.00	2.00	3.00											10.00	20.00	30.00				1.00	2.00	3.00				10.00				10.00			0.33	0.03		0.33	0.03	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5715	001	0		29	10	S5715_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					1.00	2.00	3.00											10.00	20.00	30.00				1.00	2.00	3.00				10.00				10.00			0.33	0.03		0.33	0.03	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
S5715	001	0		29	10	S5715_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					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												
S5715	001	0		29	10	S5715_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					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												
S5715	001	0		29	10	S5715_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											94.67	40	40	40				98.93	36	36	36										40	40	40				36	36	36			40			40								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5715	001	0		29	10	S5715_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												
S5715	003	0		29	10	S5715_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					1.00	2.00	3.00											10.00	20.00	30.00				1.00	2.00	3.00				10.00				10.00			0.33	0.03		0.33	0.03	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5715	003	0		29	10	S5715_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								10.00	20.00	30.00					1.00	2.00	3.00											10.00	20.00	30.00				1.00	2.00	3.00				10.00				10.00			0.33	0.03		0.33	0.03	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
S5715	003	0		29	10	S5715_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					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												
S5715	003	0		29	10	S5715_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					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												
S5715	003	0		29	10	S5715_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											90.90	37	37	37				97.37	34	34	34										37	37	37				34	34	34			37			37								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5715	003	0		29	10	S5715_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												
S5715	005	0		29	10	S5715_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					1.00	2.00	3.00											10.00	20.00	30.00				1.00	2.00	3.00				10.00				10.00			0.33	0.03		0.33	0.03	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5715	005	0		29	10	S5715_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								10.00	20.00	30.00					1.00	2.00	3.00											10.00	20.00	30.00				1.00	2.00	3.00				10.00				10.00			0.33	0.03		0.33	0.03	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
S5715	005	0		29	10	S5715_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					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												
S5715	005	0		29	10	S5715_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					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												
S5715	005	0		29	10	S5715_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											98.72	36	36	36				98.53	32	32	32										36	36	36				32	32	32			36			36								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5715	005	0		29	10	S5715_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												
S5715	010	0		29	10	S5715_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								10.00	20.00	30.00					1.00	2.00	3.00											10.00	20.00	30.00				1.00	2.00	3.00				10.00				10.00			0.33	0.03		0.33	0.03	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5715	010	0		29	10	S5715_010_0	4			Preferred Generic	4	01	1	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					1.00	2.00	3.00											10.00	20.00	30.00				1.00	2.00	3.00				10.00				10.00			0.33	0.03		0.33	0.03	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
S5715	010	0		29	10	S5715_010_0	4			Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	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												
S5715	010	0		29	10	S5715_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					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												
S5715	010	0		29	10	S5715_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											97.76	38	38	38				99.13	36	36	36										38	38	38				36	36	36			38			38								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5715	010	0		29	10	S5715_010_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	012	0		29	10	S5715_012_0	5			Preferred Generic	2	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	3.00				13.00				13.00			0.43	0.03		0.43	0.03	0.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5715	012	0		29	10	S5715_012_0	5			Generic	2	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								19.00	38.00	57.00					7.00	14.00	21.00											19.00	38.00	57.00				7.00	14.00	21.00				19.00				19.00			0.63	0.23		0.63	0.23	0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5715	012	0		29	10	S5715_012_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					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												
S5715	012	0		29	10	S5715_012_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											97.79	50	50	50				84.80	47	47	47										50	50	50				47	47	47			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5715	012	0		29	10	S5715_012_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												
S5715	013	0		29	10	S5715_013_0	5			Preferred Generic	2	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								13.00	26.00	39.00					1.00	2.00	3.00											13.00	26.00	39.00				1.00	2.00	3.00				13.00				13.00			0.43	0.03		0.43	0.03	0.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5715	013	0		29	10	S5715_013_0	5			Generic	2	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								16.00	32.00	48.00					4.00	8.00	12.00											16.00	32.00	48.00				4.00	8.00	12.00				16.00				16.00			0.53	0.13		0.53	0.13	0.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5715	013	0		29	10	S5715_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								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												
S5715	013	0		29	10	S5715_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											93.99	40	40	40				74.90	37	37	37										40	40	40				37	37	37			40			40								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5715	013	0		29	10	S5715_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												
S5715	014	0		29	10	S5715_014_0	5			Preferred Generic	2	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	3.00				13.00				13.00			0.43	0.03		0.43	0.03	0.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5715	014	0		29	10	S5715_014_0	5			Generic	2	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								16.00	32.00	48.00					4.00	8.00	12.00											16.00	32.00	48.00				4.00	8.00	12.00				16.00				16.00			0.53	0.13		0.53	0.13	0.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5715	014	0		29	10	S5715_014_0	5			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					30.00	60.00	90.00											42.00	84.00	126.00				30.00	60.00	90.00				42.00				42.00			1.40	1.00		1.40	1.00	1.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5715	014	0		29	10	S5715_014_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											75.58	37	37	37				65.87	34	34	34										37	37	37				34	34	34			37			37								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5715	014	0		29	10	S5715_014_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												
S5715	015	0		29	10	S5715_015_0	5			Preferred Generic	2	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	3.00				13.00				13.00			0.43	0.03		0.43	0.03	0.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5715	015	0		29	10	S5715_015_0	5			Generic	2	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								16.00	32.00	48.00					4.00	8.00	12.00											16.00	32.00	48.00				4.00	8.00	12.00				16.00				16.00			0.53	0.13		0.53	0.13	0.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5715	015	0		29	10	S5715_015_0	5			Preferred Brand	2	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								40.00	80.00	120.00					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												
S5715	015	0		29	10	S5715_015_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											61.20	34	34	34				54.56	31	31	31										34	34	34				31	31	31			34			34								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5715	015	0		29	10	S5715_015_0	5			Specialty Tier	2	11	1	1	5	1		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	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												
S5715	018	0		29	10	S5715_018_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					4.00	8.00	12.00											20.00	40.00	60.00				4.00	8.00	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												
S5715	018	0		29	10	S5715_018_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					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												
S5715	018	0		29	10	S5715_018_0	5			Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											88.34	41	41	41				98.34	38	38	38										41	41	41				38	38	38			41			41								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5715	018	0		29	10	S5715_018_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	019	0		29	10	S5715_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								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00				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		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												
S5715	019	0		29	10	S5715_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					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												
S5715	019	0		29	10	S5715_019_0	4			Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											98.27	49	49	49				84.21	46	46	46										49	49	49				46	46	46			49			49								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												
S5715	020	0		29	10	S5715_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								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00				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	020	0		29	10	S5715_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					4.00	8.00	12.00											20.00	40.00	60.00				4.00	8.00	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												
S5715	020	0		29	10	S5715_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											47.00	94.00	141.00				42.00	84.00	126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5715	020	0		29	10	S5715_020_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											81.87	43	43	43				68.73	40	40	40										43	43	43				40	40	40			43			43								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5715	020	0		29	10	S5715_020_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	021	0		29	10	S5715_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								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00				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	021	0		29	10	S5715_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					4.00	8.00	12.00											20.00	40.00	60.00				4.00	8.00	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												
S5715	021	0		29	10	S5715_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											47.00	94.00	141.00				42.00	84.00	126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5715	021	0		29	10	S5715_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											58.19	32	32	32				46.98	29	29	29										32	32	32				29	29	29			32			32								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5715	021	0		29	10	S5715_021_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	2			Preferred Generic	3	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								3.00	6.00	9.00					1.00	2.00	3.00					1.00	2.00	3.00																3.00				3.00			0.10	0.03	0.03			0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5726	013	0		29	10	S5726_013_0	2			Generic	3	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					3.00	6.00	9.00					3.00	6.00	9.00																5.00				5.00			0.17	0.10	0.10			0.15	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5726	013	0		29	10	S5726_013_0	2			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												
S5726	013	0		29	10	S5726_013_0	2			Non-Preferred Drug	3	11	1	1	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34											76.71	42	42	42				76.71	42	42	42				42	42	42															42			42								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5726	013	0		29	10	S5726_013_0	2			Specialty Tier	3	11	1	1	5	1		010	01	010		1				30					30						30		34												25							25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5726	014	0		29	10	S5726_014_0	3		Y	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	3		Y	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					4.00	8.00	12.00					4.00	8.00	12.00																20.00				20.00			0.67	0.13	0.13			0.59	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5726	014	0		29	10	S5726_014_0	3		Y	Preferred Brand	4	11	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	3		Y	Non-Preferred Drug	4	11	1	1	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34											65.66	50	50	50				65.66	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	3		Y	Specialty Tier	4	11	1	1	5	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	3			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					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												
S5743	001	0		29	10	S5743_001_0	3			Generic	3	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								19.00	38.00	57.00					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												
S5743	001	0		29	10	S5743_001_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					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												
S5743	001	0		29	10	S5743_001_0	3			Non-Preferred Drug	3	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											97.83	50	50	50				87.18	45	45	45										50	50	50				45	45	45			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5743	001	0		29	10	S5743_001_0	3			Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31											930.80	25						927.87	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5743	004	0		29	10	S5743_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	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	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	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	3			Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	40.00					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	3			Generic	4	01	1	2	2	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	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	3			Preferred Brand	4	11	1	1	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											47.44	25	25	25				40.59	20	20	20										25	25	25				20	20	20			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5743	004	0		29	10	S5743_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											95.70	45	45	45				81.73	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	3			Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											1416.64	33						1254.42	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5743	008	0		29	10	S5743_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								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												
S5743	008	0		29	10	S5743_008_0	3			Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	30.00					2.00	4.00	4.00											15.00	30.00	30.00				2.00	4.00	4.00				15.00				15.00			0.50	0.07		0.50	0.07	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5743	008	0		29	10	S5743_008_0	3			Preferred Brand	4	11	1	1	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											50.99	25	25	25				42.01	21	21	21										25	25	25				21	21	21			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5743	008	0		29	10	S5743_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											93.95	50	50	50				71.75	40	40	40										50	50	50				40	40	40			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5743	008	0		29	10	S5743_008_0	3			Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											1470.61	25						1397.07	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5795	002	0		29	10	S5795_002_0	1			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	1			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	1			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	1			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	1			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	1			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	1			Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				1020.15	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5795	003	0		29	10	S5795_003_0	3			Preferred Generic	3	01	1	2	1	1	110		01	110		1	30		100				1	2	30		100				30		31	6.00		18.00																			6.00		18.00																6.00				6.00		0.20			0.20			0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5795	003	0		29	10	S5795_003_0	3			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	3			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	3			Non-Preferred Drug	3	11	1	1	4	1	110		01	110		1	30		100				1	2	30		100				30		31				98.57	45		45																		45		45															45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5795	003	0		29	10	S5795_003_0	3			Specialty Tier	3	11	1	1	5	1	010		01	010		1	30								30						30		31				1265.99	25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5805	001	0		29	10	S5805_001_0	3		Y	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	2	2						90	30		31								15.00		45.00					7.00		21.00													45.00						0.00				15.00				15.00			0.50	0.23				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5805	001	0		29	10	S5805_001_0	3		Y	Preferred Generic	4	01	1	2	1	3		110	01		100	1				30		90	2	2						90	30		31								15.00		45.00					7.00		21.00													45.00						0.00				15.00				15.00			0.50	0.23				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
S5805	001	0		29	10	S5805_001_0	3		Y	Generic	4	01	3	2	2	1		110	01		100	1				30		90	2	2						90	30		31								20.00		60.00					12.00		36.00													60.00						0.00				20.00				20.00			0.66	0.40				0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5805	001	0		29	10	S5805_001_0	3		Y	Generic	4	01	3	2	2	3		110	01		100	1				30		90	2	2						90	30		31								20.00		60.00					12.00		36.00													60.00						0.00				20.00				20.00			0.66	0.40				0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
S5805	001	0		29	10	S5805_001_0	3		Y	Preferred Brand	4	11	1	2	3	1		110	01		100	1				30		90	2	2						90	30		31								47.00		141.00					47.00		141.00													141.00						126.00				47.00				47.00			1.56	1.56				1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5805	001	0		29	10	S5805_001_0	3		Y	Non-Preferred Drug	4	11	1	1	4	1		110	01		100	1				30		90	2	2						90	30		31											79.00	45		45				65.00	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		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											517.00	33						561.00	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	001	0		29	10	S5820_001_0	3		Y	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	2	2						90	30		31								15.00		45.00					7.00		21.00													45.00						0.00				15.00				15.00			0.50	0.23				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	001	0		29	10	S5820_001_0	3		Y	Preferred Generic	4	01	1	2	1	3		110	01		100	1				30		90	2	2						90	30		31								15.00		45.00					7.00		21.00													45.00						0.00				15.00				15.00			0.50	0.23				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
S5820	001	0		29	10	S5820_001_0	3		Y	Generic	4	01	3	2	2	1		110	01		100	1				30		90	2	2						90	30		31								20.00		60.00					12.00		36.00													60.00						0.00				20.00				20.00			0.66	0.40				0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	001	0		29	10	S5820_001_0	3		Y	Generic	4	01	3	2	2	3		110	01		100	1				30		90	2	2						90	30		31								20.00		60.00					12.00		36.00													60.00						0.00				20.00				20.00			0.66	0.40				0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
S5820	001	0		29	10	S5820_001_0	3		Y	Preferred Brand	4	11	1	2	3	1		110	01		100	1				30		90	2	2						90	30		31								47.00		141.00					47.00		141.00													141.00						126.00				47.00				47.00			1.56	1.56				1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	001	0		29	10	S5820_001_0	3		Y	Non-Preferred Drug	4	11	1	1	4	1		110	01		100	1				30		90	2	2						90	30		31											72.00	45		45				57.00	40		40												45						40			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	001	0		29	10	S5820_001_0	3		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											370.00	33						311.00	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	002	0		29	10	S5820_002_0	3		Y	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	2	2						90	30		31								15.00		45.00					7.00		21.00													45.00						0.00				15.00				15.00			0.50	0.23				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	002	0		29	10	S5820_002_0	3		Y	Preferred Generic	4	01	1	2	1	3		110	01		100	1				30		90	2	2						90	30		31								15.00		45.00					7.00		21.00													45.00						0.00				15.00				15.00			0.50	0.23				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
S5820	002	0		29	10	S5820_002_0	3		Y	Generic	4	01	3	2	2	1		110	01		100	1				30		90	2	2						90	30		31								20.00		60.00					12.00		36.00													60.00						0.00				20.00				20.00			0.66	0.40				0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	002	0		29	10	S5820_002_0	3		Y	Generic	4	01	3	2	2	3		110	01		100	1				30		90	2	2						90	30		31								20.00		60.00					12.00		36.00													60.00						0.00				20.00				20.00			0.66	0.40				0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
S5820	002	0		29	10	S5820_002_0	3		Y	Preferred Brand	4	11	1	2	3	1		110	01		100	1				30		90	2	2						90	30		31								47.00		141.00					47.00		141.00													141.00						126.00				47.00				47.00			1.56	1.56				1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	002	0		29	10	S5820_002_0	3		Y	Non-Preferred Drug	4	11	1	1	4	1		110	01		100	1				30		90	2	2						90	30		31											73.00	45		45				60.00	40		40												45						40			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	002	0		29	10	S5820_002_0	3		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											439.00	33						360.00	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	003	0		29	10	S5820_003_0	3		Y	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	2	2						90	30		31								15.00		45.00					7.00		21.00													45.00						0.00				15.00				15.00			0.50	0.23				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	003	0		29	10	S5820_003_0	3		Y	Preferred Generic	4	01	1	2	1	3		110	01		100	1				30		90	2	2						90	30		31								15.00		45.00					7.00		21.00													45.00						0.00				15.00				15.00			0.50	0.23				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
S5820	003	0		29	10	S5820_003_0	3		Y	Generic	4	01	3	2	2	1		110	01		100	1				30		90	2	2						90	30		31								20.00		60.00					12.00		36.00													60.00						0.00				20.00				20.00			0.66	0.40				0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	003	0		29	10	S5820_003_0	3		Y	Generic	4	01	3	2	2	3		110	01		100	1				30		90	2	2						90	30		31								20.00		60.00					12.00		36.00													60.00						0.00				20.00				20.00			0.66	0.40				0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
S5820	003	0		29	10	S5820_003_0	3		Y	Preferred Brand	4	11	1	2	3	1		110	01		100	1				30		90	2	2						90	30		31								47.00		141.00					47.00		141.00													141.00						126.00				47.00				47.00			1.56	1.56				1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	003	0		29	10	S5820_003_0	3		Y	Non-Preferred Drug	4	11	1	1	4	1		110	01		100	1				30		90	2	2						90	30		31											78.00	45		45				63.00	40		40												45						40			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	003	0		29	10	S5820_003_0	3		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											461.00	33						390.00	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	004	0		29	10	S5820_004_0	3		Y	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	2	2						90	30		31								15.00		45.00					7.00		21.00													45.00						0.00				15.00				15.00			0.50	0.23				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	004	0		29	10	S5820_004_0	3		Y	Preferred Generic	4	01	1	2	1	3		110	01		100	1				30		90	2	2						90	30		31								15.00		45.00					7.00		21.00													45.00						0.00				15.00				15.00			0.50	0.23				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
S5820	004	0		29	10	S5820_004_0	3		Y	Generic	4	01	3	2	2	1		110	01		100	1				30		90	2	2						90	30		31								20.00		60.00					12.00		36.00													60.00						0.00				20.00				20.00			0.66	0.40				0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	004	0		29	10	S5820_004_0	3		Y	Generic	4	01	3	2	2	3		110	01		100	1				30		90	2	2						90	30		31								20.00		60.00					12.00		36.00													60.00						0.00				20.00				20.00			0.66	0.40				0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
S5820	004	0		29	10	S5820_004_0	3		Y	Preferred Brand	4	11	1	2	3	1		110	01		100	1				30		90	2	2						90	30		31								47.00		141.00					47.00		141.00													141.00						126.00				47.00				47.00			1.56	1.56				1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	004	0		29	10	S5820_004_0	3		Y	Non-Preferred Drug	4	11	1	1	4	1		110	01		100	1				30		90	2	2						90	30		31											72.00	45		45				65.00	40		40												45						40			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	004	0		29	10	S5820_004_0	3		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											486.00	33						301.00	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	005	0		29	10	S5820_005_0	3		Y	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	2	2						90	30		31								15.00		45.00					7.00		21.00													45.00						0.00				15.00				15.00			0.50	0.23				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	005	0		29	10	S5820_005_0	3		Y	Preferred Generic	4	01	1	2	1	3		110	01		100	1				30		90	2	2						90	30		31								15.00		45.00					7.00		21.00													45.00						0.00				15.00				15.00			0.50	0.23				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
S5820	005	0		29	10	S5820_005_0	3		Y	Generic	4	01	3	2	2	1		110	01		100	1				30		90	2	2						90	30		31								20.00		60.00					12.00		36.00													60.00						0.00				20.00				20.00			0.66	0.40				0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	005	0		29	10	S5820_005_0	3		Y	Generic	4	01	3	2	2	3		110	01		100	1				30		90	2	2						90	30		31								20.00		60.00					12.00		36.00													60.00						0.00				20.00				20.00			0.66	0.40				0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
S5820	005	0		29	10	S5820_005_0	3		Y	Preferred Brand	4	11	1	2	3	1		110	01		100	1				30		90	2	2						90	30		31								47.00		141.00					47.00		141.00													141.00						126.00				47.00				47.00			1.56	1.56				1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	005	0		29	10	S5820_005_0	3		Y	Non-Preferred Drug	4	11	1	1	4	1		110	01		100	1				30		90	2	2						90	30		31											70.00	45		45				63.00	40		40												45						40			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	005	0		29	10	S5820_005_0	3		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											491.00	33						371.00	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	006	0		29	10	S5820_006_0	3		Y	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	2	2						90	30		31								15.00		45.00					7.00		21.00													45.00						0.00				15.00				15.00			0.50	0.23				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	006	0		29	10	S5820_006_0	3		Y	Preferred Generic	4	01	1	2	1	3		110	01		100	1				30		90	2	2						90	30		31								15.00		45.00					7.00		21.00													45.00						0.00				15.00				15.00			0.50	0.23				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
S5820	006	0		29	10	S5820_006_0	3		Y	Generic	4	01	3	2	2	1		110	01		100	1				30		90	2	2						90	30		31								20.00		60.00					12.00		36.00													60.00						0.00				20.00				20.00			0.66	0.40				0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	006	0		29	10	S5820_006_0	3		Y	Generic	4	01	3	2	2	3		110	01		100	1				30		90	2	2						90	30		31								20.00		60.00					12.00		36.00													60.00						0.00				20.00				20.00			0.66	0.40				0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
S5820	006	0		29	10	S5820_006_0	3		Y	Preferred Brand	4	11	1	2	3	1		110	01		100	1				30		90	2	2						90	30		31								47.00		141.00					47.00		141.00													141.00						126.00				47.00				47.00			1.56	1.56				1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	006	0		29	10	S5820_006_0	3		Y	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	006	0		29	10	S5820_006_0	3		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											533.00	33						449.00	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	007	0		29	10	S5820_007_0	3		Y	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	2	2						90	30		31								15.00		45.00					7.00		21.00													45.00						0.00				15.00				15.00			0.50	0.23				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	007	0		29	10	S5820_007_0	3		Y	Preferred Generic	4	01	1	2	1	3		110	01		100	1				30		90	2	2						90	30		31								15.00		45.00					7.00		21.00													45.00						0.00				15.00				15.00			0.50	0.23				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
S5820	007	0		29	10	S5820_007_0	3		Y	Generic	4	01	3	2	2	1		110	01		100	1				30		90	2	2						90	30		31								20.00		60.00					12.00		36.00													60.00						0.00				20.00				20.00			0.66	0.40				0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	007	0		29	10	S5820_007_0	3		Y	Generic	4	01	3	2	2	3		110	01		100	1				30		90	2	2						90	30		31								20.00		60.00					12.00		36.00													60.00						0.00				20.00				20.00			0.66	0.40				0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
S5820	007	0		29	10	S5820_007_0	3		Y	Preferred Brand	4	11	1	2	3	1		110	01		100	1				30		90	2	2						90	30		31								47.00		141.00					47.00		141.00													141.00						126.00				47.00				47.00			1.56	1.56				1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	007	0		29	10	S5820_007_0	3		Y	Non-Preferred Drug	4	11	1	1	4	1		110	01		100	1				30		90	2	2						90	30		31											75.00	45		45				60.00	40		40												45						40			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	007	0		29	10	S5820_007_0	3		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											418.00	33						468.00	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	008	0		29	10	S5820_008_0	3		Y	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	2	2						90	30		31								15.00		45.00					7.00		21.00													45.00						0.00				15.00				15.00			0.50	0.23				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	008	0		29	10	S5820_008_0	3		Y	Preferred Generic	4	01	1	2	1	3		110	01		100	1				30		90	2	2						90	30		31								15.00		45.00					7.00		21.00													45.00						0.00				15.00				15.00			0.50	0.23				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
S5820	008	0		29	10	S5820_008_0	3		Y	Generic	4	01	3	2	2	1		110	01		100	1				30		90	2	2						90	30		31								20.00		60.00					12.00		36.00													60.00						0.00				20.00				20.00			0.66	0.40				0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	008	0		29	10	S5820_008_0	3		Y	Generic	4	01	3	2	2	3		110	01		100	1				30		90	2	2						90	30		31								20.00		60.00					12.00		36.00													60.00						0.00				20.00				20.00			0.66	0.40				0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
S5820	008	0		29	10	S5820_008_0	3		Y	Preferred Brand	4	11	1	2	3	1		110	01		100	1				30		90	2	2						90	30		31								47.00		141.00					47.00		141.00													141.00						126.00				47.00				47.00			1.56	1.56				1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	008	0		29	10	S5820_008_0	3		Y	Non-Preferred Drug	4	11	1	1	4	1		110	01		100	1				30		90	2	2						90	30		31											79.00	45		45				61.00	40		40												45						40			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	008	0		29	10	S5820_008_0	3		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											528.00	33						422.00	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	009	0		29	10	S5820_009_0	3		Y	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	2	2						90	30		31								15.00		45.00					7.00		21.00													45.00						0.00				15.00				15.00			0.50	0.23				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	009	0		29	10	S5820_009_0	3		Y	Preferred Generic	4	01	1	2	1	3		110	01		100	1				30		90	2	2						90	30		31								15.00		45.00					7.00		21.00													45.00						0.00				15.00				15.00			0.50	0.23				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
S5820	009	0		29	10	S5820_009_0	3		Y	Generic	4	01	3	2	2	1		110	01		100	1				30		90	2	2						90	30		31								20.00		60.00					12.00		36.00													60.00						0.00				20.00				20.00			0.66	0.40				0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	009	0		29	10	S5820_009_0	3		Y	Generic	4	01	3	2	2	3		110	01		100	1				30		90	2	2						90	30		31								20.00		60.00					12.00		36.00													60.00						0.00				20.00				20.00			0.66	0.40				0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
S5820	009	0		29	10	S5820_009_0	3		Y	Preferred Brand	4	11	1	2	3	1		110	01		100	1				30		90	2	2						90	30		31								47.00		141.00					47.00		141.00													141.00						126.00				47.00				47.00			1.56	1.56				1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	009	0		29	10	S5820_009_0	3		Y	Non-Preferred Drug	4	11	1	1	4	1		110	01		100	1				30		90	2	2						90	30		31											76.00	45		45				64.00	40		40												45						40			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	009	0		29	10	S5820_009_0	3		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											571.00	33						489.00	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	010	0		29	10	S5820_010_0	3		Y	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	2	2						90	30		31								15.00		45.00					7.00		21.00													45.00						0.00				15.00				15.00			0.50	0.23				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	010	0		29	10	S5820_010_0	3		Y	Preferred Generic	4	01	1	2	1	3		110	01		100	1				30		90	2	2						90	30		31								15.00		45.00					7.00		21.00													45.00						0.00				15.00				15.00			0.50	0.23				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
S5820	010	0		29	10	S5820_010_0	3		Y	Generic	4	01	3	2	2	1		110	01		100	1				30		90	2	2						90	30		31								20.00		60.00					12.00		36.00													60.00						0.00				20.00				20.00			0.66	0.40				0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	010	0		29	10	S5820_010_0	3		Y	Generic	4	01	3	2	2	3		110	01		100	1				30		90	2	2						90	30		31								20.00		60.00					12.00		36.00													60.00						0.00				20.00				20.00			0.66	0.40				0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
S5820	010	0		29	10	S5820_010_0	3		Y	Preferred Brand	4	11	1	2	3	1		110	01		100	1				30		90	2	2						90	30		31								47.00		141.00					47.00		141.00													141.00						126.00				47.00				47.00			1.56	1.56				1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	010	0		29	10	S5820_010_0	3		Y	Non-Preferred Drug	4	11	1	1	4	1		110	01		100	1				30		90	2	2						90	30		31											74.00	45		45				63.00	40		40												45						40			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	010	0		29	10	S5820_010_0	3		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											555.00	33						468.00	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	011	0		29	10	S5820_011_0	3		Y	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	2	2						90	30		31								15.00		45.00					7.00		21.00													45.00						0.00				15.00				15.00			0.50	0.23				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	011	0		29	10	S5820_011_0	3		Y	Preferred Generic	4	01	1	2	1	3		110	01		100	1				30		90	2	2						90	30		31								15.00		45.00					7.00		21.00													45.00						0.00				15.00				15.00			0.50	0.23				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
S5820	011	0		29	10	S5820_011_0	3		Y	Generic	4	01	3	2	2	1		110	01		100	1				30		90	2	2						90	30		31								20.00		60.00					12.00		36.00													60.00						0.00				20.00				20.00			0.66	0.40				0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	011	0		29	10	S5820_011_0	3		Y	Generic	4	01	3	2	2	3		110	01		100	1				30		90	2	2						90	30		31								20.00		60.00					12.00		36.00													60.00						0.00				20.00				20.00			0.66	0.40				0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
S5820	011	0		29	10	S5820_011_0	3		Y	Preferred Brand	4	11	1	2	3	1		110	01		100	1				30		90	2	2						90	30		31								47.00		141.00					47.00		141.00													141.00						126.00				47.00				47.00			1.56	1.56				1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	011	0		29	10	S5820_011_0	3		Y	Non-Preferred Drug	4	11	1	1	4	1		110	01		100	1				30		90	2	2						90	30		31											75.00	45		45				62.00	40		40												45						40			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	011	0		29	10	S5820_011_0	3		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											541.00	33						471.00	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	012	0		29	10	S5820_012_0	3		Y	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	2	2						90	30		31								15.00		45.00					7.00		21.00													45.00						0.00				15.00				15.00			0.50	0.23				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	012	0		29	10	S5820_012_0	3		Y	Preferred Generic	4	01	1	2	1	3		110	01		100	1				30		90	2	2						90	30		31								15.00		45.00					7.00		21.00													45.00						0.00				15.00				15.00			0.50	0.23				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
S5820	012	0		29	10	S5820_012_0	3		Y	Generic	4	01	3	2	2	1		110	01		100	1				30		90	2	2						90	30		31								20.00		60.00					12.00		36.00													60.00						0.00				20.00				20.00			0.66	0.40				0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	012	0		29	10	S5820_012_0	3		Y	Generic	4	01	3	2	2	3		110	01		100	1				30		90	2	2						90	30		31								20.00		60.00					12.00		36.00													60.00						0.00				20.00				20.00			0.66	0.40				0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
S5820	012	0		29	10	S5820_012_0	3		Y	Preferred Brand	4	11	1	2	3	1		110	01		100	1				30		90	2	2						90	30		31								47.00		141.00					47.00		141.00													141.00						126.00				47.00				47.00			1.56	1.56				1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	012	0		29	10	S5820_012_0	3		Y	Non-Preferred Drug	4	11	1	1	4	1		110	01		100	1				30		90	2	2						90	30		31											73.00	45		45				58.00	40		40												45						40			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	012	0		29	10	S5820_012_0	3		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											452.00	33						360.00	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	013	0		29	10	S5820_013_0	3		Y	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	2	2						90	30		31								15.00		45.00					7.00		21.00													45.00						0.00				15.00				15.00			0.50	0.23				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	013	0		29	10	S5820_013_0	3		Y	Preferred Generic	4	01	1	2	1	3		110	01		100	1				30		90	2	2						90	30		31								15.00		45.00					7.00		21.00													45.00						0.00				15.00				15.00			0.50	0.23				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
S5820	013	0		29	10	S5820_013_0	3		Y	Generic	4	01	3	2	2	1		110	01		100	1				30		90	2	2						90	30		31								20.00		60.00					12.00		36.00													60.00						0.00				20.00				20.00			0.66	0.40				0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	013	0		29	10	S5820_013_0	3		Y	Generic	4	01	3	2	2	3		110	01		100	1				30		90	2	2						90	30		31								20.00		60.00					12.00		36.00													60.00						0.00				20.00				20.00			0.66	0.40				0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
S5820	013	0		29	10	S5820_013_0	3		Y	Preferred Brand	4	11	1	2	3	1		110	01		100	1				30		90	2	2						90	30		31								47.00		141.00					47.00		141.00													141.00						126.00				47.00				47.00			1.56	1.56				1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	013	0		29	10	S5820_013_0	3		Y	Non-Preferred Drug	4	11	1	1	4	1		110	01		100	1				30		90	2	2						90	30		31											68.00	45		45				62.00	40		40												45						40			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	013	0		29	10	S5820_013_0	3		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											441.00	33						363.00	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	014	0		29	10	S5820_014_0	3		Y	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	2	2						90	30		31								15.00		45.00					7.00		21.00													45.00						0.00				15.00				15.00			0.50	0.23				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	014	0		29	10	S5820_014_0	3		Y	Preferred Generic	4	01	1	2	1	3		110	01		100	1				30		90	2	2						90	30		31								15.00		45.00					7.00		21.00													45.00						0.00				15.00				15.00			0.50	0.23				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
S5820	014	0		29	10	S5820_014_0	3		Y	Generic	4	01	3	2	2	1		110	01		100	1				30		90	2	2						90	30		31								20.00		60.00					12.00		36.00													60.00						0.00				20.00				20.00			0.66	0.40				0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	014	0		29	10	S5820_014_0	3		Y	Generic	4	01	3	2	2	3		110	01		100	1				30		90	2	2						90	30		31								20.00		60.00					12.00		36.00													60.00						0.00				20.00				20.00			0.66	0.40				0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
S5820	014	0		29	10	S5820_014_0	3		Y	Preferred Brand	4	11	1	2	3	1		110	01		100	1				30		90	2	2						90	30		31								47.00		141.00					47.00		141.00													141.00						126.00				47.00				47.00			1.56	1.56				1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	014	0		29	10	S5820_014_0	3		Y	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	014	0		29	10	S5820_014_0	3		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											492.00	33						498.00	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	015	0		29	10	S5820_015_0	3		Y	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	2	2						90	30		31								15.00		45.00					7.00		21.00													45.00						0.00				15.00				15.00			0.50	0.23				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	015	0		29	10	S5820_015_0	3		Y	Preferred Generic	4	01	1	2	1	3		110	01		100	1				30		90	2	2						90	30		31								15.00		45.00					7.00		21.00													45.00						0.00				15.00				15.00			0.50	0.23				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
S5820	015	0		29	10	S5820_015_0	3		Y	Generic	4	01	3	2	2	1		110	01		100	1				30		90	2	2						90	30		31								20.00		60.00					12.00		36.00													60.00						0.00				20.00				20.00			0.66	0.40				0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	015	0		29	10	S5820_015_0	3		Y	Generic	4	01	3	2	2	3		110	01		100	1				30		90	2	2						90	30		31								20.00		60.00					12.00		36.00													60.00						0.00				20.00				20.00			0.66	0.40				0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
S5820	015	0		29	10	S5820_015_0	3		Y	Preferred Brand	4	11	1	2	3	1		110	01		100	1				30		90	2	2						90	30		31								47.00		141.00					47.00		141.00													141.00						126.00				47.00				47.00			1.56	1.56				1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	015	0		29	10	S5820_015_0	3		Y	Non-Preferred Drug	4	11	1	1	4	1		110	01		100	1				30		90	2	2						90	30		31											76.00	45		45				62.00	40		40												45						40			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	015	0		29	10	S5820_015_0	3		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											529.00	33						392.00	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	016	0		29	10	S5820_016_0	3		Y	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	2	2						90	30		31								15.00		45.00					7.00		21.00													45.00						0.00				15.00				15.00			0.50	0.23				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	016	0		29	10	S5820_016_0	3		Y	Preferred Generic	4	01	1	2	1	3		110	01		100	1				30		90	2	2						90	30		31								15.00		45.00					7.00		21.00													45.00						0.00				15.00				15.00			0.50	0.23				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
S5820	016	0		29	10	S5820_016_0	3		Y	Generic	4	01	3	2	2	1		110	01		100	1				30		90	2	2						90	30		31								20.00		60.00					12.00		36.00													60.00						0.00				20.00				20.00			0.66	0.40				0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	016	0		29	10	S5820_016_0	3		Y	Generic	4	01	3	2	2	3		110	01		100	1				30		90	2	2						90	30		31								20.00		60.00					12.00		36.00													60.00						0.00				20.00				20.00			0.66	0.40				0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
S5820	016	0		29	10	S5820_016_0	3		Y	Preferred Brand	4	11	1	2	3	1		110	01		100	1				30		90	2	2						90	30		31								47.00		141.00					47.00		141.00													141.00						126.00				47.00				47.00			1.56	1.56				1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	016	0		29	10	S5820_016_0	3		Y	Non-Preferred Drug	4	11	1	1	4	1		110	01		100	1				30		90	2	2						90	30		31											69.00	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	3		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											475.00	33						466.00	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	017	0		29	10	S5820_017_0	3		Y	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	2	2						90	30		31								15.00		45.00					7.00		21.00													45.00						0.00				15.00				15.00			0.50	0.23				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	017	0		29	10	S5820_017_0	3		Y	Preferred Generic	4	01	1	2	1	3		110	01		100	1				30		90	2	2						90	30		31								15.00		45.00					7.00		21.00													45.00						0.00				15.00				15.00			0.50	0.23				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
S5820	017	0		29	10	S5820_017_0	3		Y	Generic	4	01	3	2	2	1		110	01		100	1				30		90	2	2						90	30		31								20.00		60.00					12.00		36.00													60.00						0.00				20.00				20.00			0.66	0.40				0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	017	0		29	10	S5820_017_0	3		Y	Generic	4	01	3	2	2	3		110	01		100	1				30		90	2	2						90	30		31								20.00		60.00					12.00		36.00													60.00						0.00				20.00				20.00			0.66	0.40				0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
S5820	017	0		29	10	S5820_017_0	3		Y	Preferred Brand	4	11	1	2	3	1		110	01		100	1				30		90	2	2						90	30		31								47.00		141.00					47.00		141.00													141.00						126.00				47.00				47.00			1.56	1.56				1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	017	0		29	10	S5820_017_0	3		Y	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	017	0		29	10	S5820_017_0	3		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											487.00	33						447.00	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	018	0		29	10	S5820_018_0	3		Y	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	2	2						90	30		31								15.00		45.00					7.00		21.00													45.00						0.00				15.00				15.00			0.50	0.23				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	018	0		29	10	S5820_018_0	3		Y	Preferred Generic	4	01	1	2	1	3		110	01		100	1				30		90	2	2						90	30		31								15.00		45.00					7.00		21.00													45.00						0.00				15.00				15.00			0.50	0.23				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
S5820	018	0		29	10	S5820_018_0	3		Y	Generic	4	01	3	2	2	1		110	01		100	1				30		90	2	2						90	30		31								20.00		60.00					12.00		36.00													60.00						0.00				20.00				20.00			0.66	0.40				0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	018	0		29	10	S5820_018_0	3		Y	Generic	4	01	3	2	2	3		110	01		100	1				30		90	2	2						90	30		31								20.00		60.00					12.00		36.00													60.00						0.00				20.00				20.00			0.66	0.40				0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
S5820	018	0		29	10	S5820_018_0	3		Y	Preferred Brand	4	11	1	2	3	1		110	01		100	1				30		90	2	2						90	30		31								47.00		141.00					47.00		141.00													141.00						126.00				47.00				47.00			1.56	1.56				1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	018	0		29	10	S5820_018_0	3		Y	Non-Preferred Drug	4	11	1	1	4	1		110	01		100	1				30		90	2	2						90	30		31											75.00	45		45				61.00	40		40												45						40			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	018	0		29	10	S5820_018_0	3		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											455.00	33						447.00	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	019	0		29	10	S5820_019_0	3		Y	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	2	2						90	30		31								15.00		45.00					7.00		21.00													45.00						0.00				15.00				15.00			0.50	0.23				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	019	0		29	10	S5820_019_0	3		Y	Preferred Generic	4	01	1	2	1	3		110	01		100	1				30		90	2	2						90	30		31								15.00		45.00					7.00		21.00													45.00						0.00				15.00				15.00			0.50	0.23				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
S5820	019	0		29	10	S5820_019_0	3		Y	Generic	4	01	3	2	2	1		110	01		100	1				30		90	2	2						90	30		31								20.00		60.00					12.00		36.00													60.00						0.00				20.00				20.00			0.66	0.40				0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	019	0		29	10	S5820_019_0	3		Y	Generic	4	01	3	2	2	3		110	01		100	1				30		90	2	2						90	30		31								20.00		60.00					12.00		36.00													60.00						0.00				20.00				20.00			0.66	0.40				0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
S5820	019	0		29	10	S5820_019_0	3		Y	Preferred Brand	4	11	1	2	3	1		110	01		100	1				30		90	2	2						90	30		31								47.00		141.00					47.00		141.00													141.00						126.00				47.00				47.00			1.56	1.56				1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	019	0		29	10	S5820_019_0	3		Y	Non-Preferred Drug	4	11	1	1	4	1		110	01		100	1				30		90	2	2						90	30		31											79.00	45		45				59.00	40		40												45						40			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	019	0		29	10	S5820_019_0	3		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											439.00	33						438.00	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	020	0		29	10	S5820_020_0	3		Y	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	2	2						90	30		31								15.00		45.00					7.00		21.00													45.00						0.00				15.00				15.00			0.50	0.23				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	020	0		29	10	S5820_020_0	3		Y	Preferred Generic	4	01	1	2	1	3		110	01		100	1				30		90	2	2						90	30		31								15.00		45.00					7.00		21.00													45.00						0.00				15.00				15.00			0.50	0.23				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
S5820	020	0		29	10	S5820_020_0	3		Y	Generic	4	01	3	2	2	1		110	01		100	1				30		90	2	2						90	30		31								20.00		60.00					12.00		36.00													60.00						0.00				20.00				20.00			0.66	0.40				0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	020	0		29	10	S5820_020_0	3		Y	Generic	4	01	3	2	2	3		110	01		100	1				30		90	2	2						90	30		31								20.00		60.00					12.00		36.00													60.00						0.00				20.00				20.00			0.66	0.40				0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
S5820	020	0		29	10	S5820_020_0	3		Y	Preferred Brand	4	11	1	2	3	1		110	01		100	1				30		90	2	2						90	30		31								47.00		141.00					47.00		141.00													141.00						126.00				47.00				47.00			1.56	1.56				1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	020	0		29	10	S5820_020_0	3		Y	Non-Preferred Drug	4	11	1	1	4	1		110	01		100	1				30		90	2	2						90	30		31											78.00	45		45				61.00	40		40												45						40			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	020	0		29	10	S5820_020_0	3		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											567.00	33						523.00	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	021	0		29	10	S5820_021_0	3		Y	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	2	2						90	30		31								15.00		45.00					7.00		21.00													45.00						0.00				15.00				15.00			0.50	0.23				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	021	0		29	10	S5820_021_0	3		Y	Preferred Generic	4	01	1	2	1	3		110	01		100	1				30		90	2	2						90	30		31								15.00		45.00					7.00		21.00													45.00						0.00				15.00				15.00			0.50	0.23				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
S5820	021	0		29	10	S5820_021_0	3		Y	Generic	4	01	3	2	2	1		110	01		100	1				30		90	2	2						90	30		31								20.00		60.00					12.00		36.00													60.00						0.00				20.00				20.00			0.66	0.40				0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	021	0		29	10	S5820_021_0	3		Y	Generic	4	01	3	2	2	3		110	01		100	1				30		90	2	2						90	30		31								20.00		60.00					12.00		36.00													60.00						0.00				20.00				20.00			0.66	0.40				0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
S5820	021	0		29	10	S5820_021_0	3		Y	Preferred Brand	4	11	1	2	3	1		110	01		100	1				30		90	2	2						90	30		31								47.00		141.00					47.00		141.00													141.00						126.00				47.00				47.00			1.56	1.56				1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	021	0		29	10	S5820_021_0	3		Y	Non-Preferred Drug	4	11	1	1	4	1		110	01		100	1				30		90	2	2						90	30		31											77.00	45		45				66.00	40		40												45						40			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	021	0		29	10	S5820_021_0	3		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											503.00	33						478.00	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	022	0		29	10	S5820_022_0	3		Y	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	2	2						90	30		31								15.00		45.00					7.00		21.00													45.00						0.00				15.00				15.00			0.50	0.23				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	022	0		29	10	S5820_022_0	3		Y	Preferred Generic	4	01	1	2	1	3		110	01		100	1				30		90	2	2						90	30		31								15.00		45.00					7.00		21.00													45.00						0.00				15.00				15.00			0.50	0.23				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
S5820	022	0		29	10	S5820_022_0	3		Y	Generic	4	01	3	2	2	1		110	01		100	1				30		90	2	2						90	30		31								20.00		60.00					12.00		36.00													60.00						0.00				20.00				20.00			0.66	0.40				0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	022	0		29	10	S5820_022_0	3		Y	Generic	4	01	3	2	2	3		110	01		100	1				30		90	2	2						90	30		31								20.00		60.00					12.00		36.00													60.00						0.00				20.00				20.00			0.66	0.40				0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
S5820	022	0		29	10	S5820_022_0	3		Y	Preferred Brand	4	11	1	2	3	1		110	01		100	1				30		90	2	2						90	30		31								47.00		141.00					47.00		141.00													141.00						126.00				47.00				47.00			1.56	1.56				1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	022	0		29	10	S5820_022_0	3		Y	Non-Preferred Drug	4	11	1	1	4	1		110	01		100	1				30		90	2	2						90	30		31											85.00	45		45				61.00	40		40												45						40			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	022	0		29	10	S5820_022_0	3		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											398.00	33						388.00	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	023	0		29	10	S5820_023_0	3		Y	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	2	2						90	30		31								15.00		45.00					7.00		21.00													45.00						0.00				15.00				15.00			0.50	0.23				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	023	0		29	10	S5820_023_0	3		Y	Preferred Generic	4	01	1	2	1	3		110	01		100	1				30		90	2	2						90	30		31								15.00		45.00					7.00		21.00													45.00						0.00				15.00				15.00			0.50	0.23				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
S5820	023	0		29	10	S5820_023_0	3		Y	Generic	4	01	3	2	2	1		110	01		100	1				30		90	2	2						90	30		31								20.00		60.00					12.00		36.00													60.00						0.00				20.00				20.00			0.66	0.40				0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	023	0		29	10	S5820_023_0	3		Y	Generic	4	01	3	2	2	3		110	01		100	1				30		90	2	2						90	30		31								20.00		60.00					12.00		36.00													60.00						0.00				20.00				20.00			0.66	0.40				0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
S5820	023	0		29	10	S5820_023_0	3		Y	Preferred Brand	4	11	1	2	3	1		110	01		100	1				30		90	2	2						90	30		31								47.00		141.00					47.00		141.00													141.00						126.00				47.00				47.00			1.56	1.56				1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	023	0		29	10	S5820_023_0	3		Y	Non-Preferred Drug	4	11	1	1	4	1		110	01		100	1				30		90	2	2						90	30		31											77.00	45		45				66.00	40		40												45						40			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	023	0		29	10	S5820_023_0	3		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											355.00	33						435.00	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	024	0		29	10	S5820_024_0	3		Y	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	2	2						90	30		31								15.00		45.00					7.00		21.00													45.00						0.00				15.00				15.00			0.50	0.23				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	024	0		29	10	S5820_024_0	3		Y	Preferred Generic	4	01	1	2	1	3		110	01		100	1				30		90	2	2						90	30		31								15.00		45.00					7.00		21.00													45.00						0.00				15.00				15.00			0.50	0.23				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
S5820	024	0		29	10	S5820_024_0	3		Y	Generic	4	01	3	2	2	1		110	01		100	1				30		90	2	2						90	30		31								20.00		60.00					12.00		36.00													60.00						0.00				20.00				20.00			0.66	0.40				0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	024	0		29	10	S5820_024_0	3		Y	Generic	4	01	3	2	2	3		110	01		100	1				30		90	2	2						90	30		31								20.00		60.00					12.00		36.00													60.00						0.00				20.00				20.00			0.66	0.40				0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
S5820	024	0		29	10	S5820_024_0	3		Y	Preferred Brand	4	11	1	2	3	1		110	01		100	1				30		90	2	2						90	30		31								47.00		141.00					47.00		141.00													141.00						126.00				47.00				47.00			1.56	1.56				1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	024	0		29	10	S5820_024_0	3		Y	Non-Preferred Drug	4	11	1	1	4	1		110	01		100	1				30		90	2	2						90	30		31											79.00	45		45				65.00	40		40												45						40			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	024	0		29	10	S5820_024_0	3		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											444.00	33						337.00	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	025	0		29	10	S5820_025_0	3		Y	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	2	2						90	30		31								15.00		45.00					7.00		21.00													45.00						0.00				15.00				15.00			0.50	0.23				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	025	0		29	10	S5820_025_0	3		Y	Preferred Generic	4	01	1	2	1	3		110	01		100	1				30		90	2	2						90	30		31								15.00		45.00					7.00		21.00													45.00						0.00				15.00				15.00			0.50	0.23				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
S5820	025	0		29	10	S5820_025_0	3		Y	Generic	4	01	3	2	2	1		110	01		100	1				30		90	2	2						90	30		31								20.00		60.00					12.00		36.00													60.00						0.00				20.00				20.00			0.66	0.40				0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	025	0		29	10	S5820_025_0	3		Y	Generic	4	01	3	2	2	3		110	01		100	1				30		90	2	2						90	30		31								20.00		60.00					12.00		36.00													60.00						0.00				20.00				20.00			0.66	0.40				0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
S5820	025	0		29	10	S5820_025_0	3		Y	Preferred Brand	4	11	1	2	3	1		110	01		100	1				30		90	2	2						90	30		31								47.00		141.00					47.00		141.00													141.00						126.00				47.00				47.00			1.56	1.56				1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	025	0		29	10	S5820_025_0	3		Y	Non-Preferred Drug	4	11	1	1	4	1		110	01		100	1				30		90	2	2						90	30		31											74.00	45		45				62.00	40		40												45						40			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	025	0		29	10	S5820_025_0	3		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											421.00	33						463.00	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	026	0		29	10	S5820_026_0	4		Y	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	2	2						90	30		31								15.00		45.00					7.00		21.00													45.00						0.00				15.00				15.00			0.50	0.23				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	026	0		29	10	S5820_026_0	4		Y	Preferred Generic	4	01	1	2	1	3		110	01		100	1				30		90	2	2						90	30		31								15.00		45.00					7.00		21.00													45.00						0.00				15.00				15.00			0.50	0.23				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
S5820	026	0		29	10	S5820_026_0	4		Y	Generic	4	01	3	2	2	1		110	01		100	1				30		90	2	2						90	30		31								20.00		60.00					12.00		36.00													60.00						0.00				20.00				20.00			0.66	0.40				0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	026	0		29	10	S5820_026_0	4		Y	Generic	4	01	3	2	2	3		110	01		100	1				30		90	2	2						90	30		31								20.00		60.00					12.00		36.00													60.00						0.00				20.00				20.00			0.66	0.40				0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
S5820	026	0		29	10	S5820_026_0	4		Y	Preferred Brand	4	11	1	2	3	1		110	01		100	1				30		90	2	2						90	30		31								47.00		141.00					47.00		141.00													141.00						126.00				47.00				47.00			1.56	1.56				1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	026	0		29	10	S5820_026_0	4		Y	Non-Preferred Drug	4	11	1	1	4	1		110	01		100	1				30		90	2	2						90	30		31											75.00	45		45				69.00	40		40												45						40			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	026	0		29	10	S5820_026_0	4		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											416.00	33						458.00	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	027	0		29	10	S5820_027_0	4		Y	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	2	2						90	30		31								15.00		45.00					7.00		21.00													45.00						0.00				15.00				15.00			0.50	0.23				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	027	0		29	10	S5820_027_0	4		Y	Preferred Generic	4	01	1	2	1	3		110	01		100	1				30		90	2	2						90	30		31								15.00		45.00					7.00		21.00													45.00						0.00				15.00				15.00			0.50	0.23				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
S5820	027	0		29	10	S5820_027_0	4		Y	Generic	4	01	3	2	2	1		110	01		100	1				30		90	2	2						90	30		31								20.00		60.00					12.00		36.00													60.00						0.00				20.00				20.00			0.66	0.40				0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	027	0		29	10	S5820_027_0	4		Y	Generic	4	01	3	2	2	3		110	01		100	1				30		90	2	2						90	30		31								20.00		60.00					12.00		36.00													60.00						0.00				20.00				20.00			0.66	0.40				0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
S5820	027	0		29	10	S5820_027_0	4		Y	Preferred Brand	4	11	1	2	3	1		110	01		100	1				30		90	2	2						90	30		31								47.00		141.00					47.00		141.00													141.00						126.00				47.00				47.00			1.56	1.56				1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	027	0		29	10	S5820_027_0	4		Y	Non-Preferred Drug	4	11	1	1	4	1		110	01		100	1				30		90	2	2						90	30		31											75.00	45		45				66.00	40		40												45						40			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	027	0		29	10	S5820_027_0	4		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											543.00	33						449.00	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	028	0		29	10	S5820_028_0	4		Y	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	2	2						90	30		31								15.00		45.00					7.00		21.00													45.00						0.00				15.00				15.00			0.50	0.23				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	028	0		29	10	S5820_028_0	4		Y	Preferred Generic	4	01	1	2	1	3		110	01		100	1				30		90	2	2						90	30		31								15.00		45.00					7.00		21.00													45.00						0.00				15.00				15.00			0.50	0.23				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
S5820	028	0		29	10	S5820_028_0	4		Y	Generic	4	01	3	2	2	1		110	01		100	1				30		90	2	2						90	30		31								20.00		60.00					12.00		36.00													60.00						0.00				20.00				20.00			0.66	0.40				0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	028	0		29	10	S5820_028_0	4		Y	Generic	4	01	3	2	2	3		110	01		100	1				30		90	2	2						90	30		31								20.00		60.00					12.00		36.00													60.00						0.00				20.00				20.00			0.66	0.40				0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
S5820	028	0		29	10	S5820_028_0	4		Y	Preferred Brand	4	11	1	2	3	1		110	01		100	1				30		90	2	2						90	30		31								47.00		141.00					47.00		141.00													141.00						126.00				47.00				47.00			1.56	1.56				1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	028	0		29	10	S5820_028_0	4		Y	Non-Preferred Drug	4	11	1	1	4	1		110	01		100	1				30		90	2	2						90	30		31											76.00	45		45				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	4		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											578.00	33						328.00	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	029	0		29	10	S5820_029_0	4		Y	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	2	2						90	30		31								15.00		45.00					7.00		21.00													45.00						0.00				15.00				15.00			0.50	0.23				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	029	0		29	10	S5820_029_0	4		Y	Preferred Generic	4	01	1	2	1	3		110	01		100	1				30		90	2	2						90	30		31								15.00		45.00					7.00		21.00													45.00						0.00				15.00				15.00			0.50	0.23				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
S5820	029	0		29	10	S5820_029_0	4		Y	Generic	4	01	3	2	2	1		110	01		100	1				30		90	2	2						90	30		31								20.00		60.00					12.00		36.00													60.00						0.00				20.00				20.00			0.66	0.40				0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	029	0		29	10	S5820_029_0	4		Y	Generic	4	01	3	2	2	3		110	01		100	1				30		90	2	2						90	30		31								20.00		60.00					12.00		36.00													60.00						0.00				20.00				20.00			0.66	0.40				0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
S5820	029	0		29	10	S5820_029_0	4		Y	Preferred Brand	4	11	1	2	3	1		110	01		100	1				30		90	2	2						90	30		31								47.00		141.00					47.00		141.00													141.00						126.00				47.00				47.00			1.56	1.56				1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	029	0		29	10	S5820_029_0	4		Y	Non-Preferred Drug	4	11	1	1	4	1		110	01		100	1				30		90	2	2						90	30		31											73.00	45		45				58.00	40		40												45						40			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	029	0		29	10	S5820_029_0	4		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											501.00	33						324.00	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	030	0		29	10	S5820_030_0	4		Y	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	2	2						90	30		31								15.00		45.00					7.00		21.00													45.00						0.00				15.00				15.00			0.50	0.23				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	030	0		29	10	S5820_030_0	4		Y	Preferred Generic	4	01	1	2	1	3		110	01		100	1				30		90	2	2						90	30		31								15.00		45.00					7.00		21.00													45.00						0.00				15.00				15.00			0.50	0.23				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
S5820	030	0		29	10	S5820_030_0	4		Y	Generic	4	01	3	2	2	1		110	01		100	1				30		90	2	2						90	30		31								20.00		60.00					12.00		36.00													60.00						0.00				20.00				20.00			0.66	0.40				0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	030	0		29	10	S5820_030_0	4		Y	Generic	4	01	3	2	2	3		110	01		100	1				30		90	2	2						90	30		31								20.00		60.00					12.00		36.00													60.00						0.00				20.00				20.00			0.66	0.40				0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
S5820	030	0		29	10	S5820_030_0	4		Y	Preferred Brand	4	11	1	2	3	1		110	01		100	1				30		90	2	2						90	30		31								47.00		141.00					47.00		141.00													141.00						126.00				47.00				47.00			1.56	1.56				1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	030	0		29	10	S5820_030_0	4		Y	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	030	0		29	10	S5820_030_0	4		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											534.00	33						365.00	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	031	0		29	10	S5820_031_0	3		Y	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	2	2						90	30		31								15.00		45.00					7.00		21.00													45.00						0.00				15.00				15.00			0.50	0.23				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	031	0		29	10	S5820_031_0	3		Y	Preferred Generic	4	01	1	2	1	3		110	01		100	1				30		90	2	2						90	30		31								15.00		45.00					7.00		21.00													45.00						0.00				15.00				15.00			0.50	0.23				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
S5820	031	0		29	10	S5820_031_0	3		Y	Generic	4	01	3	2	2	1		110	01		100	1				30		90	2	2						90	30		31								20.00		60.00					12.00		36.00													60.00						0.00				20.00				20.00			0.66	0.40				0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	031	0		29	10	S5820_031_0	3		Y	Generic	4	01	3	2	2	3		110	01		100	1				30		90	2	2						90	30		31								20.00		60.00					12.00		36.00													60.00						0.00				20.00				20.00			0.66	0.40				0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
S5820	031	0		29	10	S5820_031_0	3		Y	Preferred Brand	4	11	1	2	3	1		110	01		100	1				30		90	2	2						90	30		31								47.00		141.00					47.00		141.00													141.00						126.00				47.00				47.00			1.56	1.56				1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	031	0		29	10	S5820_031_0	3		Y	Non-Preferred Drug	4	11	1	1	4	1		110	01		100	1				30		90	2	2						90	30		31											79.00	45		45				67.00	40		40												45						40			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	031	0		29	10	S5820_031_0	3		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											477.00	33						485.00	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	032	0		29	10	S5820_032_0	3		Y	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	2	2						90	30		31								15.00		45.00					7.00		21.00													45.00						0.00				15.00				15.00			0.50	0.23				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	032	0		29	10	S5820_032_0	3		Y	Preferred Generic	4	01	1	2	1	3		110	01		100	1				30		90	2	2						90	30		31								15.00		45.00					7.00		21.00													45.00						0.00				15.00				15.00			0.50	0.23				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
S5820	032	0		29	10	S5820_032_0	3		Y	Generic	4	01	3	2	2	1		110	01		100	1				30		90	2	2						90	30		31								20.00		60.00					12.00		36.00													60.00						0.00				20.00				20.00			0.66	0.40				0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	032	0		29	10	S5820_032_0	3		Y	Generic	4	01	3	2	2	3		110	01		100	1				30		90	2	2						90	30		31								20.00		60.00					12.00		36.00													60.00						0.00				20.00				20.00			0.66	0.40				0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
S5820	032	0		29	10	S5820_032_0	3		Y	Preferred Brand	4	11	1	2	3	1		110	01		100	1				30		90	2	2						90	30		31								47.00		141.00					47.00		141.00													141.00						126.00				47.00				47.00			1.56	1.56				1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	032	0		29	10	S5820_032_0	3		Y	Non-Preferred Drug	4	11	1	1	4	1		110	01		100	1				30		90	2	2						90	30		31											72.00	45		45				69.00	40		40												45						40			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	032	0		29	10	S5820_032_0	3		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											580.00	33						312.00	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	033	0		29	10	S5820_033_0	3		Y	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	2	2						90	30		31								15.00		45.00					7.00		21.00													45.00						0.00				15.00				15.00			0.50	0.23				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	033	0		29	10	S5820_033_0	3		Y	Preferred Generic	4	01	1	2	1	3		110	01		100	1				30		90	2	2						90	30		31								15.00		45.00					7.00		21.00													45.00						0.00				15.00				15.00			0.50	0.23				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
S5820	033	0		29	10	S5820_033_0	3		Y	Generic	4	01	3	2	2	1		110	01		100	1				30		90	2	2						90	30		31								20.00		60.00					12.00		36.00													60.00						0.00				20.00				20.00			0.66	0.40				0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	033	0		29	10	S5820_033_0	3		Y	Generic	4	01	3	2	2	3		110	01		100	1				30		90	2	2						90	30		31								20.00		60.00					12.00		36.00													60.00						0.00				20.00				20.00			0.66	0.40				0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
S5820	033	0		29	10	S5820_033_0	3		Y	Preferred Brand	4	11	1	2	3	1		110	01		100	1				30		90	2	2						90	30		31								47.00		141.00					47.00		141.00													141.00						126.00				47.00				47.00			1.56	1.56				1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	033	0		29	10	S5820_033_0	3		Y	Non-Preferred Drug	4	11	1	1	4	1		110	01		100	1				30		90	2	2						90	30		31											82.00	45		45				70.00	40		40												45						40			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	033	0		29	10	S5820_033_0	3		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											248.00	33						571.00	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	034	0		29	10	S5820_034_0	2		N	Preferred Generic	2	01	1	2	1	1	110		01	100		1	30		90				2	2			90				30		31	17.00		51.00																					51.00																17.00				17.00		0.56						0.54	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	034	0		29	10	S5820_034_0	2		N	Generic	2	01	1	2	2	1	110		01	100		1	30		90				2	2			90				30		31	20.00		60.00																					60.00																20.00				20.00		0.66						0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	034	0		29	10	S5820_034_0	2		N	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	034	0		29	10	S5820_034_0	2		N	Non-Preferred Drug	2	11	1	1	4	1	110		01	100		1	30		90				2	2			90				30		31				80.00	50		50																				50															50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	034	0		29	10	S5820_034_0	2		N	Specialty Tier	2	11	1	1	5	1	010		01	010		1	30								30						30		31				426.00	25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	035	0		29	10	S5820_035_0	2		N	Preferred Generic	2	01	1	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						0.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	035	0		29	10	S5820_035_0	2		N	Generic	2	01	1	2	2	1	110		01	100		1	30		90				2	2			90				30		31	20.00		60.00																					60.00																20.00				20.00		0.66						0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	035	0		29	10	S5820_035_0	2		N	Preferred Brand	2	11	1	2	3	1	110		01	100		1	30		90				2	2			90				30		31	46.00		138.00																					138.00																46.00				46.00		1.53						1.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	035	0		29	10	S5820_035_0	2		N	Non-Preferred Drug	2	11	1	1	4	1	110		01	100		1	30		90				2	2			90				30		31				52.00	42		42																				42															42			42								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	035	0		29	10	S5820_035_0	2		N	Specialty Tier	2	11	1	1	5	1	010		01	010		1	30								30						30		31				398.00	25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	036	0		29	10	S5820_036_0	2		N	Preferred Generic	2	01	1	2	1	1	110		01	100		1	30		90				2	2			90				30		31	6.00		18.00																					18.00																6.00				6.00		0.20						0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	036	0		29	10	S5820_036_0	2		N	Generic	2	01	1	2	2	1	110		01	100		1	30		90				2	2			90				30		31	20.00		60.00																					60.00																20.00				20.00		0.66						0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	036	0		29	10	S5820_036_0	2		N	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	036	0		29	10	S5820_036_0	2		N	Non-Preferred Drug	2	11	1	1	4	1	110		01	100		1	30		90				2	2			90				30		31				73.00	50		50																				50															50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	036	0		29	10	S5820_036_0	2		N	Specialty Tier	2	11	1	1	5	1	010		01	010		1	30								30						30		31				437.00	25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	037	0		29	10	S5820_037_0	2		N	Preferred Generic	2	01	1	2	1	1		110	01		100	1				30		90	2	2						90	30		31								2.00		6.00					1.00		3.00													6.00						3.00				2.00				2.00			0.06	0.03				0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	037	0		29	10	S5820_037_0	2		N	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												
S5820	037	0		29	10	S5820_037_0	2		N	Preferred Brand	2	11	1	2	3	1		110	01		100	1				30		90	2	2						90	30		31								47.00		141.00					47.00		141.00													141.00						141.00				47.00				47.00			1.56	1.56				1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	037	0		29	10	S5820_037_0	2		N	Non-Preferred Drug	2	11	1	1	4	1		110	01		100	1				30		90	2	2						90	30		31											64.00	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		N	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31											307.00	25						265.00	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	038	0		29	10	S5820_038_0	2		N	Preferred Generic	2	01	1	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						0.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	038	0		29	10	S5820_038_0	2		N	Generic	2	01	1	2	2	1	110		01	100		1	30		90				2	2			90				30		31	20.00		60.00																					60.00																20.00				20.00		0.66						0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	038	0		29	10	S5820_038_0	2		N	Preferred Brand	2	11	1	2	3	1	110		01	100		1	30		90				2	2			90				30		31	46.00		138.00																					138.00																46.00				46.00		1.53						1.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	038	0		29	10	S5820_038_0	2		N	Non-Preferred Drug	2	11	1	1	4	1	110		01	100		1	30		90				2	2			90				30		31				75.00	50		50																				50															50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	038	0		29	10	S5820_038_0	2		N	Specialty Tier	2	11	1	1	5	1	010		01	010		1	30								30						30		31				507.00	25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	101	0		29	10	S5884_101_0	2			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	2			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	2			Preferred Brand	2	11	1	1	3	1		110	01		110	1				30		90	2	2				30		90	30		31											46.00	24		24				36.00	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	2			Non-Preferred Drug	2	11	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											82.00	41		41				70.00	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	2			Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	102	0		29	10	S5884_102_0	1			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	1			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	1			Preferred Brand	2	11	1	1	3	1		110	01		110	1				30		90	2	2				30		90	30		31											45.00	22		22				39.00	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	1			Non-Preferred Drug	2	11	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											91.00	42		42				87.00	40		40										42		42				40		30			42			42								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	102	0		29	10	S5884_102_0	1			Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	103	0		29	10	S5884_103_0	1			Preferred Generic	2	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								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	1			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	1			Preferred Brand	2	11	1	1	3	1		110	01		110	1				30		90	2	2				30		90	30		31											47.00	23		23				39.00	19		19										23		23				19		15			23			23								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	103	0		29	10	S5884_103_0	1			Non-Preferred Drug	2	11	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											89.00	40		40				84.00	38		38										40		40				38		30			40			40								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	103	0		29	10	S5884_103_0	1			Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	104	0		29	10	S5884_104_0	1			Preferred Generic	2	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								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	1			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	1			Preferred Brand	2	11	1	1	3	1		110	01		110	1				30		90	2	2				30		90	30		31											44.00	23		23				37.00	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	1			Non-Preferred Drug	2	11	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											90.00	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	1			Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	105	0		29	10	S5884_105_0	1			Preferred Generic	2	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								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	1			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	1			Preferred Brand	2	11	1	1	3	1		110	01		110	1				30		90	2	2				30		90	30		31											46.00	25		25				35.00	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	1			Non-Preferred Drug	2	11	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											92.00	50		50				74.00	40		40										50		50				40		30			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	105	0		29	10	S5884_105_0	1			Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	106	0		29	10	S5884_106_0	1			Preferred Generic	2	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								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	1			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	1			Preferred Brand	2	11	1	1	3	1		110	01		110	1				30		90	2	2				30		90	30		31											41.00	23		23				34.00	19		19										23		23				19		15			23			23								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	106	0		29	10	S5884_106_0	1			Non-Preferred Drug	2	11	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											92.00	45		45				80.00	39		39										45		45				39		30			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	106	0		29	10	S5884_106_0	1			Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	107	0		29	10	S5884_107_0	1			Preferred Generic	2	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								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	1			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	1			Preferred Brand	2	11	1	1	3	1		110	01		110	1				30		90	2	2				30		90	30		31											45.00	23		23				37.00	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	1			Non-Preferred Drug	2	11	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											92.00	49		49				75.00	40		40										49		49				40		30			49			49								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	107	0		29	10	S5884_107_0	1			Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	108	0		29	10	S5884_108_0	1			Preferred Generic	2	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								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	1			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	1			Preferred Brand	2	11	1	1	3	1		110	01		110	1				30		90	2	2				30		90	30		31											43.00	23		23				35.00	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	1			Non-Preferred Drug	2	11	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											99.00	42		42				90.00	38		38										42		42				38		30			42			42								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	108	0		29	10	S5884_108_0	1			Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	109	0		29	10	S5884_109_0	1			Preferred Generic	2	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								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	1			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	1			Preferred Brand	2	11	1	1	3	1		110	01		110	1				30		90	2	2				30		90	30		31											38.00	23		23				31.00	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	1			Non-Preferred Drug	2	11	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											83.00	44		44				72.00	38		38										44		44				38		30			44			44								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	109	0		29	10	S5884_109_0	1			Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	110	0		29	10	S5884_110_0	1			Preferred Generic	2	11	1	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	1			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	1			Preferred Brand	2	11	1	1	3	1		110	01		110	1				30		90	2	2				30		90	30		31											46.00	23		23				44.00	22		22										23		23				22		16			23			23								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	110	0		29	10	S5884_110_0	1			Non-Preferred Drug	2	11	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											99.00	43		43				99.00	43		43										43		43				43		30			43			43								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	110	0		29	10	S5884_110_0	1			Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	111	0		29	10	S5884_111_0	1			Preferred Generic	2	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								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	1			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	1			Preferred Brand	2	11	1	1	3	1		110	01		110	1				30		90	2	2				30		90	30		31											46.00	23		23				38.00	19		19										23		23				19		15			23			23								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	111	0		29	10	S5884_111_0	1			Non-Preferred Drug	2	11	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											92.00	41		41				90.00	40		40										41		41				40		30			41			41								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	111	0		29	10	S5884_111_0	1			Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	112	0		29	10	S5884_112_0	1			Preferred Generic	2	11	1	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	1			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	1			Preferred Brand	2	11	1	1	3	1		110	01		110	1				30		90	2	2				30		90	30		31											45.00	22		22				43.00	21		21										22		22				21		21			22			22								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	112	0		29	10	S5884_112_0	1			Non-Preferred Drug	2	11	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											98.00	40		40				95.00	39		39										40		40				39		39			40			40								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	112	0		29	10	S5884_112_0	1			Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	113	0		29	10	S5884_113_0	1			Preferred Generic	2	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								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	1			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	1			Preferred Brand	2	11	1	1	3	1		110	01		110	1				30		90	2	2				30		90	30		31											46.00	24		24				38.00	20		20										24		24				20		15			24			24								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	113	0		29	10	S5884_113_0	1			Non-Preferred Drug	2	11	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											98.00	49		49				84.00	42		42										49		49				42		30			49			49								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	113	0		29	10	S5884_113_0	1			Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	114	0		29	10	S5884_114_0	1			Preferred Generic	2	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								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	1			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	1			Preferred Brand	2	11	1	1	3	1		110	01		110	1				30		90	2	2				30		90	30		31											46.00	22		22				42.00	20		20										22		22				20		15			22			22								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	114	0		29	10	S5884_114_0	1			Non-Preferred Drug	2	11	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											99.00	44		44				88.00	39		39										44		44				39		30			44			44								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	114	0		29	10	S5884_114_0	1			Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	115	0		29	10	S5884_115_0	1			Preferred Generic	2	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								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	1			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	1			Preferred Brand	2	11	1	1	3	1		110	01		110	1				30		90	2	2				30		90	30		31											47.00	25		25				37.00	20		20										25		25				20		15			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	115	0		29	10	S5884_115_0	1			Non-Preferred Drug	2	11	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											80.00	49		49				80.00	49		49										49		49				49		30			49			49								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	115	0		29	10	S5884_115_0	1			Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	116	0		29	10	S5884_116_0	1			Preferred Generic	2	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								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	1			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	1			Preferred Brand	2	11	1	1	3	1		110	01		110	1				30		90	2	2				30		90	30		31											44.00	21		21				42.00	20		20										21		21				20		20			21			21								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	116	0		29	10	S5884_116_0	1			Non-Preferred Drug	2	11	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											100.00	48		48				98.00	47		47										48		48				47		47			48			48								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	116	0		29	10	S5884_116_0	1			Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	131	0		29	10	S5884_131_0	1			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	1			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	1			Preferred Brand	2	11	1	1	3	1		110	01		110	1				30		90	2	2				30		90	30		31											43.00	21		21				39.00	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	1			Non-Preferred Drug	2	11	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											98.00	45		45				87.00	40		40										45		45				40		30			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	131	0		29	10	S5884_131_0	1			Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	132	0		29	10	S5884_132_0	2			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	2			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	2			Preferred Brand	2	11	1	1	3	1		110	01		110	1				30		90	2	2				30		90	30		31											45.00	23		23				37.00	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	2			Non-Preferred Drug	2	11	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											97.00	46		46				85.00	40		40										46		46				40		30			46			46								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	132	0		29	10	S5884_132_0	2			Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	133	0		29	10	S5884_133_0	1			Preferred Generic	2	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								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	1			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	1			Preferred Brand	2	11	1	1	3	1		110	01		110	1				30		90	2	2				30		90	30		31											45.00	23		23				37.00	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	1			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				88.00	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	1			Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	134	0		29	10	S5884_134_0	1			Preferred Generic	2	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								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	1			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	1			Preferred Brand	2	11	1	1	3	1		110	01		110	1				30		90	2	2				30		90	30		31											42.00	25		25				40.00	24		24										25		25				24		17			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	134	0		29	10	S5884_134_0	1			Non-Preferred Drug	2	11	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											75.00	50		50				73.00	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	1			Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	135	0		29	10	S5884_135_0	1			Preferred Generic	2	11	1	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	1			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	1			Preferred Brand	2	11	1	1	3	1		110	01		110	1				30		90	2	2				30		90	30		31											43.00	23		23				38.00	20		20										23		23				20		15			23			23								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	135	0		29	10	S5884_135_0	1			Non-Preferred Drug	2	11	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											93.00	44		44				74.00	35		35										44		44				35		30			44			44								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	135	0		29	10	S5884_135_0	1			Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	136	0		29	10	S5884_136_0	1			Preferred Generic	2	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								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	1			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	1			Preferred Brand	2	11	1	1	3	1		110	01		110	1				30		90	2	2				30		90	30		31											43.00	23		23				35.00	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	1			Non-Preferred Drug	2	11	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											86.00	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	1			Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	137	0		29	10	S5884_137_0	1			Preferred Generic	2	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								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	1			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	1			Preferred Brand	2	11	1	1	3	1		110	01		110	1				30		90	2	2				30		90	30		31											42.00	25		25				37.00	22		22										25		25				22		15			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	137	0		29	10	S5884_137_0	1			Non-Preferred Drug	2	11	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											83.00	50		50				81.00	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	1			Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	138	0		29	10	S5884_138_0	1			Preferred Generic	2	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								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	1			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	1			Preferred Brand	2	11	1	1	3	1		110	01		110	1				30		90	2	2				30		90	30		31											43.00	23		23				36.00	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	1			Non-Preferred Drug	2	11	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											94.00	45		45				86.00	41		41										45		45				41		30			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	138	0		29	10	S5884_138_0	1			Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	139	0		29	10	S5884_139_0	1			Preferred Generic	2	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								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	1			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	1			Preferred Brand	2	11	1	1	3	1		110	01		110	1				30		90	2	2				30		90	30		31											40.00	21		21				36.00	19		19										21		21				19		15			21			21								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	139	0		29	10	S5884_139_0	1			Non-Preferred Drug	2	11	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											100.00	47		47				83.00	39		39										47		47				39		30			47			47								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	139	0		29	10	S5884_139_0	1			Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	140	0		29	10	S5884_140_0	1			Preferred Generic	2	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								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	1			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	1			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	140	0		29	10	S5884_140_0	1			Non-Preferred Drug	2	11	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											90.00	40		40				81.00	36		36										40		40				36		30			40			40								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	140	0		29	10	S5884_140_0	1			Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	141	0		29	10	S5884_141_0	1			Preferred Generic	2	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								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	1			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	1			Preferred Brand	2	11	1	1	3	1		110	01		110	1				30		90	2	2				30		90	30		31											38.00	24		24				30.00	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	1			Non-Preferred Drug	2	11	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											79.00	46		46				78.00	45		45										46		46				45		30			46			46								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	141	0		29	10	S5884_141_0	1			Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	142	0		29	10	S5884_142_0	1			Preferred Generic	2	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								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	1			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	1			Preferred Brand	2	11	1	1	3	1		110	01		110	1				30		90	2	2				30		90	30		31											44.00	23		23				36.00	19		19										23		23				19		15			23			23								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	142	0		29	10	S5884_142_0	1			Non-Preferred Drug	2	11	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											96.00	44		44				83.00	38		38										44		44				38		30			44			44								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	142	0		29	10	S5884_142_0	1			Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	143	0		29	10	S5884_143_0	1			Preferred Generic	2	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								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	1			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	1			Preferred Brand	2	11	1	1	3	1		110	01		110	1				30		90	2	2				30		90	30		31											44.00	23		23				37.00	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	1			Non-Preferred Drug	2	11	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											100.00	48		48				90.00	43		43										48		48				43		30			48			48								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	143	0		29	10	S5884_143_0	1			Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	144	0		29	10	S5884_144_0	1			Preferred Generic	2	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								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	1			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	1			Preferred Brand	2	11	1	1	3	1		110	01		110	1				30		90	2	2				30		90	30		31											46.00	24		24				37.00	19		19										24		24				19		15			24			24								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	144	0		29	10	S5884_144_0	1			Non-Preferred Drug	2	11	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											97.00	41		41				95.00	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	1			Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	145	0		29	10	S5884_145_0	2			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	2			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	2			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	145	0		29	10	S5884_145_0	2			Non-Preferred Drug	2	11	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											80.00	40		40				74.00	37		37										40		40				37		30			40			40								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	145	0		29	10	S5884_145_0	2			Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	146	0		29	10	S5884_146_0	2			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	2			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	2			Preferred Brand	2	11	1	1	3	1		110	01		110	1				30		90	2	2				30		90	30		31											47.00	22		22				44.00	21		21										22		22				21		21			22			22								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	146	0		29	10	S5884_146_0	2			Non-Preferred Drug	2	11	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											99.00	43		43				99.00	43		43										43		43				43		43			43			43								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	146	0		29	10	S5884_146_0	2			Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	147	0		29	10	S5884_147_0	1			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	1			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	1			Preferred Brand	2	11	1	1	3	1		110	01		110	1				30		90	2	2				30		90	30		31											41.00	24		24				33.00	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	1			Non-Preferred Drug	2	11	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											90.00	39		39				86.00	37		37										39		39				37		30			39			39								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	147	0		29	10	S5884_147_0	1			Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	148	0		29	10	S5884_148_0	3		Y	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								5.00		15.00					1.00		3.00											5.00		15.00				1.00		0.00				5.00				5.00			0.17	0.03		0.17	0.03	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	148	0		29	10	S5884_148_0	3		Y	Preferred Generic	4	11	1	2	1	3		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										1		
S5884	148	0		29	10	S5884_148_0	3		Y	Generic	4	11	3	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					4.00		12.00											10.00		30.00				4.00		0.00				10.00				10.00			0.33	0.13		0.33	0.13	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	148	0		29	10	S5884_148_0	3		Y	Generic	4	11	3	2	2	3		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										1		3
S5884	148	0		29	10	S5884_148_0	3		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					45.00		135.00											47.00		141.00				45.00		125.00				47.00				47.00			1.57	1.50		1.57	1.50	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	148	0		29	10	S5884_148_0	3		Y	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	148	0		29	10	S5884_148_0	3		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												28							28												28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	149	0		29	10	S5884_149_0	2		Y	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								5.00		15.00					1.00		3.00											5.00		15.00				1.00		0.00				5.00				5.00			0.17	0.03		0.17	0.03	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	149	0		29	10	S5884_149_0	2		Y	Preferred Generic	4	11	1	2	1	3		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										1		
S5884	149	0		29	10	S5884_149_0	2		Y	Generic	4	11	3	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					4.00		12.00											10.00		30.00				4.00		0.00				10.00				10.00			0.33	0.13		0.33	0.13	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	149	0		29	10	S5884_149_0	2		Y	Generic	4	11	3	2	2	3		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										1		3
S5884	149	0		29	10	S5884_149_0	2		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					45.00		135.00											47.00		141.00				45.00		125.00				47.00				47.00			1.57	1.50		1.57	1.50	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	149	0		29	10	S5884_149_0	2		Y	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											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	2		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												28							28												28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	150	0		29	10	S5884_150_0	2		Y	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								5.00		15.00					1.00		3.00											5.00		15.00				1.00		0.00				5.00				5.00			0.17	0.03		0.17	0.03	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	150	0		29	10	S5884_150_0	2		Y	Preferred Generic	4	11	1	2	1	3		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										1		
S5884	150	0		29	10	S5884_150_0	2		Y	Generic	4	11	3	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					4.00		12.00											10.00		30.00				4.00		0.00				10.00				10.00			0.33	0.13		0.33	0.13	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	150	0		29	10	S5884_150_0	2		Y	Generic	4	11	3	2	2	3		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										1		3
S5884	150	0		29	10	S5884_150_0	2		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					45.00		135.00											47.00		141.00				45.00		125.00				47.00				47.00			1.57	1.50		1.57	1.50	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	150	0		29	10	S5884_150_0	2		Y	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											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	150	0		29	10	S5884_150_0	2		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												28							28												28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	151	0		29	10	S5884_151_0	2		Y	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								5.00		15.00					1.00		3.00											5.00		15.00				1.00		0.00				5.00				5.00			0.17	0.03		0.17	0.03	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	151	0		29	10	S5884_151_0	2		Y	Preferred Generic	4	11	1	2	1	3		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										1		
S5884	151	0		29	10	S5884_151_0	2		Y	Generic	4	11	3	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					4.00		12.00											10.00		30.00				4.00		0.00				10.00				10.00			0.33	0.13		0.33	0.13	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	151	0		29	10	S5884_151_0	2		Y	Generic	4	11	3	2	2	3		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										1		3
S5884	151	0		29	10	S5884_151_0	2		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					45.00		135.00											47.00		141.00				45.00		125.00				47.00				47.00			1.57	1.50		1.57	1.50	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	151	0		29	10	S5884_151_0	2		Y	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											96.00	49		49				94.00	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	2		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												28							28												28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	152	0		29	10	S5884_152_0	2		Y	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								5.00		15.00					1.00		3.00											5.00		15.00				1.00		0.00				5.00				5.00			0.17	0.03		0.17	0.03	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	152	0		29	10	S5884_152_0	2		Y	Preferred Generic	4	11	1	2	1	3		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										1		
S5884	152	0		29	10	S5884_152_0	2		Y	Generic	4	11	3	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					4.00		12.00											10.00		30.00				4.00		0.00				10.00				10.00			0.33	0.13		0.33	0.13	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	152	0		29	10	S5884_152_0	2		Y	Generic	4	11	3	2	2	3		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										1		3
S5884	152	0		29	10	S5884_152_0	2		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					45.00		135.00											47.00		141.00				45.00		125.00				47.00				47.00			1.57	1.50		1.57	1.50	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	152	0		29	10	S5884_152_0	2		Y	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											79.00	50		50				77.00	49		49										50		50				49		49			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	152	0		29	10	S5884_152_0	2		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												29							29												29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	153	0		29	10	S5884_153_0	2		Y	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								5.00		15.00					1.00		3.00											5.00		15.00				1.00		0.00				5.00				5.00			0.17	0.03		0.17	0.03	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	153	0		29	10	S5884_153_0	2		Y	Preferred Generic	4	11	1	2	1	3		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										1		
S5884	153	0		29	10	S5884_153_0	2		Y	Generic	4	11	3	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					4.00		12.00											10.00		30.00				4.00		0.00				10.00				10.00			0.33	0.13		0.33	0.13	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	153	0		29	10	S5884_153_0	2		Y	Generic	4	11	3	2	2	3		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										1		3
S5884	153	0		29	10	S5884_153_0	2		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					45.00		135.00											47.00		141.00				45.00		125.00				47.00				47.00			1.57	1.50		1.57	1.50	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	153	0		29	10	S5884_153_0	2		Y	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											84.00	50		50				82.00	49		49										50		50				49		49			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	153	0		29	10	S5884_153_0	2		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												28							28												28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	154	0		29	10	S5884_154_0	2		Y	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								5.00		15.00					1.00		3.00											5.00		15.00				1.00		0.00				5.00				5.00			0.17	0.03		0.17	0.03	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	154	0		29	10	S5884_154_0	2		Y	Preferred Generic	4	11	1	2	1	3		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										1		
S5884	154	0		29	10	S5884_154_0	2		Y	Generic	4	11	3	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					4.00		12.00											10.00		30.00				4.00		0.00				10.00				10.00			0.33	0.13		0.33	0.13	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	154	0		29	10	S5884_154_0	2		Y	Generic	4	11	3	2	2	3		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										1		3
S5884	154	0		29	10	S5884_154_0	2		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					45.00		135.00											47.00		141.00				45.00		125.00				47.00				47.00			1.57	1.50		1.57	1.50	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	154	0		29	10	S5884_154_0	2		Y	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											83.00	50		50				82.00	49		49										50		50				49		49			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	154	0		29	10	S5884_154_0	2		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												28							28												28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	155	0		29	10	S5884_155_0	2		Y	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								5.00		15.00					1.00		3.00											5.00		15.00				1.00		0.00				5.00				5.00			0.17	0.03		0.17	0.03	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	155	0		29	10	S5884_155_0	2		Y	Preferred Generic	4	11	1	2	1	3		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										1		
S5884	155	0		29	10	S5884_155_0	2		Y	Generic	4	11	3	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					4.00		12.00											10.00		30.00				4.00		0.00				10.00				10.00			0.33	0.13		0.33	0.13	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	155	0		29	10	S5884_155_0	2		Y	Generic	4	11	3	2	2	3		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										1		3
S5884	155	0		29	10	S5884_155_0	2		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					45.00		135.00											47.00		141.00				45.00		125.00				47.00				47.00			1.57	1.50		1.57	1.50	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	155	0		29	10	S5884_155_0	2		Y	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											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	155	0		29	10	S5884_155_0	2		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												28							28												28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	156	0		29	10	S5884_156_0	2		Y	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								5.00		15.00					1.00		3.00											5.00		15.00				1.00		0.00				5.00				5.00			0.17	0.03		0.17	0.03	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	156	0		29	10	S5884_156_0	2		Y	Preferred Generic	4	11	1	2	1	3		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										1		
S5884	156	0		29	10	S5884_156_0	2		Y	Generic	4	11	3	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					4.00		12.00											10.00		30.00				4.00		0.00				10.00				10.00			0.33	0.13		0.33	0.13	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	156	0		29	10	S5884_156_0	2		Y	Generic	4	11	3	2	2	3		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										1		3
S5884	156	0		29	10	S5884_156_0	2		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					45.00		135.00											47.00		141.00				45.00		125.00				47.00				47.00			1.57	1.50		1.57	1.50	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	156	0		29	10	S5884_156_0	2		Y	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											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	156	0		29	10	S5884_156_0	2		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												28							28												28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	157	0		29	10	S5884_157_0	2		Y	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								5.00		15.00					1.00		3.00											5.00		15.00				1.00		0.00				5.00				5.00			0.17	0.03		0.17	0.03	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	157	0		29	10	S5884_157_0	2		Y	Preferred Generic	4	11	1	2	1	3		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										1		
S5884	157	0		29	10	S5884_157_0	2		Y	Generic	4	11	3	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					4.00		12.00											10.00		30.00				4.00		0.00				10.00				10.00			0.33	0.13		0.33	0.13	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	157	0		29	10	S5884_157_0	2		Y	Generic	4	11	3	2	2	3		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										1		3
S5884	157	0		29	10	S5884_157_0	2		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					45.00		135.00											47.00		141.00				45.00		125.00				47.00				47.00			1.57	1.50		1.57	1.50	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	157	0		29	10	S5884_157_0	2		Y	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											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	157	0		29	10	S5884_157_0	2		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												28							28												28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	158	0		29	10	S5884_158_0	2		Y	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								5.00		15.00					1.00		3.00											5.00		15.00				1.00		0.00				5.00				5.00			0.17	0.03		0.17	0.03	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	158	0		29	10	S5884_158_0	2		Y	Preferred Generic	4	11	1	2	1	3		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										1		
S5884	158	0		29	10	S5884_158_0	2		Y	Generic	4	11	3	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					4.00		12.00											10.00		30.00				4.00		0.00				10.00				10.00			0.33	0.13		0.33	0.13	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	158	0		29	10	S5884_158_0	2		Y	Generic	4	11	3	2	2	3		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										1		3
S5884	158	0		29	10	S5884_158_0	2		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					45.00		135.00											47.00		141.00				45.00		125.00				47.00				47.00			1.57	1.50		1.57	1.50	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	158	0		29	10	S5884_158_0	2		Y	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											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	158	0		29	10	S5884_158_0	2		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												28							28												28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	159	0		29	10	S5884_159_0	2		Y	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								5.00		15.00					1.00		3.00											5.00		15.00				1.00		0.00				5.00				5.00			0.17	0.03		0.17	0.03	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	159	0		29	10	S5884_159_0	2		Y	Preferred Generic	4	11	1	2	1	3		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										1		
S5884	159	0		29	10	S5884_159_0	2		Y	Generic	4	11	3	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					4.00		12.00											10.00		30.00				4.00		0.00				10.00				10.00			0.33	0.13		0.33	0.13	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	159	0		29	10	S5884_159_0	2		Y	Generic	4	11	3	2	2	3		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										1		3
S5884	159	0		29	10	S5884_159_0	2		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					45.00		135.00											47.00		141.00				45.00		125.00				47.00				47.00			1.57	1.50		1.57	1.50	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	159	0		29	10	S5884_159_0	2		Y	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											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	159	0		29	10	S5884_159_0	2		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												28							28												28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	160	0		29	10	S5884_160_0	2		Y	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								5.00		15.00					1.00		3.00											5.00		15.00				1.00		0.00				5.00				5.00			0.17	0.03		0.17	0.03	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	160	0		29	10	S5884_160_0	2		Y	Preferred Generic	4	11	1	2	1	3		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										1		
S5884	160	0		29	10	S5884_160_0	2		Y	Generic	4	11	3	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					4.00		12.00											10.00		30.00				4.00		0.00				10.00				10.00			0.33	0.13		0.33	0.13	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	160	0		29	10	S5884_160_0	2		Y	Generic	4	11	3	2	2	3		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										1		3
S5884	160	0		29	10	S5884_160_0	2		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					45.00		135.00											47.00		141.00				45.00		125.00				47.00				47.00			1.57	1.50		1.57	1.50	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	160	0		29	10	S5884_160_0	2		Y	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											100.00	37		37				100.00	37		37										37		37				37		37			37			37								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	160	0		29	10	S5884_160_0	2		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	161	0		29	10	S5884_161_0	2		Y	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								5.00		15.00					1.00		3.00											5.00		15.00				1.00		0.00				5.00				5.00			0.17	0.03		0.17	0.03	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	161	0		29	10	S5884_161_0	2		Y	Preferred Generic	4	11	1	2	1	3		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										1		
S5884	161	0		29	10	S5884_161_0	2		Y	Generic	4	11	3	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					4.00		12.00											10.00		30.00				4.00		0.00				10.00				10.00			0.33	0.13		0.33	0.13	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	161	0		29	10	S5884_161_0	2		Y	Generic	4	11	3	2	2	3		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										1		3
S5884	161	0		29	10	S5884_161_0	2		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					45.00		135.00											47.00		141.00				45.00		125.00				47.00				47.00			1.57	1.50		1.57	1.50	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	161	0		29	10	S5884_161_0	2		Y	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											85.00	50		50				84.00	49		49										50		50				49		49			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	161	0		29	10	S5884_161_0	2		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												28							28												28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	162	0		29	10	S5884_162_0	2		Y	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								5.00		15.00					1.00		3.00											5.00		15.00				1.00		0.00				5.00				5.00			0.17	0.03		0.17	0.03	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	162	0		29	10	S5884_162_0	2		Y	Preferred Generic	4	11	1	2	1	3		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										1		
S5884	162	0		29	10	S5884_162_0	2		Y	Generic	4	11	3	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					4.00		12.00											10.00		30.00				4.00		0.00				10.00				10.00			0.33	0.13		0.33	0.13	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	162	0		29	10	S5884_162_0	2		Y	Generic	4	11	3	2	2	3		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										1		3
S5884	162	0		29	10	S5884_162_0	2		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					45.00		135.00											47.00		141.00				45.00		125.00				47.00				47.00			1.57	1.50		1.57	1.50	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	162	0		29	10	S5884_162_0	2		Y	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											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	162	0		29	10	S5884_162_0	2		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												28							28												28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	163	0		29	10	S5884_163_0	2		Y	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								5.00		15.00					1.00		3.00											5.00		15.00				1.00		0.00				5.00				5.00			0.17	0.03		0.17	0.03	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	163	0		29	10	S5884_163_0	2		Y	Preferred Generic	4	11	1	2	1	3		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										1		
S5884	163	0		29	10	S5884_163_0	2		Y	Generic	4	11	3	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					4.00		12.00											10.00		30.00				4.00		0.00				10.00				10.00			0.33	0.13		0.33	0.13	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	163	0		29	10	S5884_163_0	2		Y	Generic	4	11	3	2	2	3		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										1		3
S5884	163	0		29	10	S5884_163_0	2		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					45.00		135.00											47.00		141.00				45.00		125.00				47.00				47.00			1.57	1.50		1.57	1.50	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	163	0		29	10	S5884_163_0	2		Y	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											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	163	0		29	10	S5884_163_0	2		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												28							28												28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	164	0		29	10	S5884_164_0	2		Y	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								5.00		15.00					1.00		3.00											5.00		15.00				1.00		0.00				5.00				5.00			0.17	0.03		0.17	0.03	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	164	0		29	10	S5884_164_0	2		Y	Preferred Generic	4	11	1	2	1	3		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										1		
S5884	164	0		29	10	S5884_164_0	2		Y	Generic	4	11	3	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					4.00		12.00											10.00		30.00				4.00		0.00				10.00				10.00			0.33	0.13		0.33	0.13	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	164	0		29	10	S5884_164_0	2		Y	Generic	4	11	3	2	2	3		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										1		3
S5884	164	0		29	10	S5884_164_0	2		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					45.00		135.00											47.00		141.00				45.00		125.00				47.00				47.00			1.57	1.50		1.57	1.50	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	164	0		29	10	S5884_164_0	2		Y	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											80.00	50		50				78.00	49		49										50		50				49		49			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	164	0		29	10	S5884_164_0	2		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												29							29												29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	165	0		29	10	S5884_165_0	2		Y	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								5.00		15.00					1.00		3.00											5.00		15.00				1.00		0.00				5.00				5.00			0.17	0.03		0.17	0.03	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	165	0		29	10	S5884_165_0	2		Y	Preferred Generic	4	11	1	2	1	3		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										1		
S5884	165	0		29	10	S5884_165_0	2		Y	Generic	4	11	3	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					4.00		12.00											10.00		30.00				4.00		0.00				10.00				10.00			0.33	0.13		0.33	0.13	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	165	0		29	10	S5884_165_0	2		Y	Generic	4	11	3	2	2	3		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										1		3
S5884	165	0		29	10	S5884_165_0	2		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					45.00		135.00											47.00		141.00				45.00		125.00				47.00				47.00			1.57	1.50		1.57	1.50	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	165	0		29	10	S5884_165_0	2		Y	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											78.00	50		50				77.00	49		49										50		50				49		49			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	165	0		29	10	S5884_165_0	2		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												29							29												29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	166	0		29	10	S5884_166_0	2		Y	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								5.00		15.00					1.00		3.00											5.00		15.00				1.00		0.00				5.00				5.00			0.17	0.03		0.17	0.03	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	166	0		29	10	S5884_166_0	2		Y	Preferred Generic	4	11	1	2	1	3		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										1		
S5884	166	0		29	10	S5884_166_0	2		Y	Generic	4	11	3	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					4.00		12.00											10.00		30.00				4.00		0.00				10.00				10.00			0.33	0.13		0.33	0.13	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	166	0		29	10	S5884_166_0	2		Y	Generic	4	11	3	2	2	3		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										1		3
S5884	166	0		29	10	S5884_166_0	2		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					45.00		135.00											47.00		141.00				45.00		125.00				47.00				47.00			1.57	1.50		1.57	1.50	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	166	0		29	10	S5884_166_0	2		Y	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											83.00	50		50				82.00	49		49										50		50				49		49			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	166	0		29	10	S5884_166_0	2		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												28							28												28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	167	0		29	10	S5884_167_0	2		Y	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								5.00		15.00					1.00		3.00											5.00		15.00				1.00		0.00				5.00				5.00			0.17	0.03		0.17	0.03	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	167	0		29	10	S5884_167_0	2		Y	Preferred Generic	4	11	1	2	1	3		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										1		
S5884	167	0		29	10	S5884_167_0	2		Y	Generic	4	11	3	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					4.00		12.00											10.00		30.00				4.00		0.00				10.00				10.00			0.33	0.13		0.33	0.13	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	167	0		29	10	S5884_167_0	2		Y	Generic	4	11	3	2	2	3		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										1		3
S5884	167	0		29	10	S5884_167_0	2		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					45.00		135.00											47.00		141.00				45.00		125.00				47.00				47.00			1.57	1.50		1.57	1.50	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	167	0		29	10	S5884_167_0	2		Y	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											90.00	50		50				89.00	49		49										50		50				49		49			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	167	0		29	10	S5884_167_0	2		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												28							28												28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	168	0		29	10	S5884_168_0	2		Y	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								5.00		15.00					1.00		3.00											5.00		15.00				1.00		0.00				5.00				5.00			0.17	0.03		0.17	0.03	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	168	0		29	10	S5884_168_0	2		Y	Preferred Generic	4	11	1	2	1	3		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										1		
S5884	168	0		29	10	S5884_168_0	2		Y	Generic	4	11	3	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					4.00		12.00											10.00		30.00				4.00		0.00				10.00				10.00			0.33	0.13		0.33	0.13	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	168	0		29	10	S5884_168_0	2		Y	Generic	4	11	3	2	2	3		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										1		3
S5884	168	0		29	10	S5884_168_0	2		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					45.00		135.00											47.00		141.00				45.00		125.00				47.00				47.00			1.57	1.50		1.57	1.50	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	168	0		29	10	S5884_168_0	2		Y	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											88.00	50		50				87.00	49		49										50		50				49		49			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	168	0		29	10	S5884_168_0	2		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												28							28												28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	169	0		29	10	S5884_169_0	2		Y	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								5.00		15.00					1.00		3.00											5.00		15.00				1.00		0.00				5.00				5.00			0.17	0.03		0.17	0.03	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	169	0		29	10	S5884_169_0	2		Y	Preferred Generic	4	11	1	2	1	3		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										1		
S5884	169	0		29	10	S5884_169_0	2		Y	Generic	4	11	3	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					4.00		12.00											10.00		30.00				4.00		0.00				10.00				10.00			0.33	0.13		0.33	0.13	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	169	0		29	10	S5884_169_0	2		Y	Generic	4	11	3	2	2	3		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										1		3
S5884	169	0		29	10	S5884_169_0	2		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					45.00		135.00											47.00		141.00				45.00		125.00				47.00				47.00			1.57	1.50		1.57	1.50	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	169	0		29	10	S5884_169_0	2		Y	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											95.00	50		50				93.00	49		49										50		50				49		49			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	169	0		29	10	S5884_169_0	2		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												28							28												28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	170	0		29	10	S5884_170_0	2		Y	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								5.00		15.00					1.00		3.00											5.00		15.00				1.00		0.00				5.00				5.00			0.17	0.03		0.17	0.03	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	170	0		29	10	S5884_170_0	2		Y	Preferred Generic	4	11	1	2	1	3		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										1		
S5884	170	0		29	10	S5884_170_0	2		Y	Generic	4	11	3	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					4.00		12.00											10.00		30.00				4.00		0.00				10.00				10.00			0.33	0.13		0.33	0.13	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	170	0		29	10	S5884_170_0	2		Y	Generic	4	11	3	2	2	3		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										1		3
S5884	170	0		29	10	S5884_170_0	2		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					45.00		135.00											47.00		141.00				45.00		125.00				47.00				47.00			1.57	1.50		1.57	1.50	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	170	0		29	10	S5884_170_0	2		Y	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											86.00	50		50				84.00	49		49										50		50				49		49			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	170	0		29	10	S5884_170_0	2		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												28							28												28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	171	0		29	10	S5884_171_0	2		Y	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								5.00		15.00					1.00		3.00											5.00		15.00				1.00		0.00				5.00				5.00			0.17	0.03		0.17	0.03	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	171	0		29	10	S5884_171_0	2		Y	Preferred Generic	4	11	1	2	1	3		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										1		
S5884	171	0		29	10	S5884_171_0	2		Y	Generic	4	11	3	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					4.00		12.00											10.00		30.00				4.00		0.00				10.00				10.00			0.33	0.13		0.33	0.13	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	171	0		29	10	S5884_171_0	2		Y	Generic	4	11	3	2	2	3		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										1		3
S5884	171	0		29	10	S5884_171_0	2		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					45.00		135.00											47.00		141.00				45.00		125.00				47.00				47.00			1.57	1.50		1.57	1.50	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	171	0		29	10	S5884_171_0	2		Y	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											80.00	50		50				78.00	49		49										50		50				49		49			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	171	0		29	10	S5884_171_0	2		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												28							28												28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	172	0		29	10	S5884_172_0	2		Y	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								5.00		15.00					1.00		3.00											5.00		15.00				1.00		0.00				5.00				5.00			0.17	0.03		0.17	0.03	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	172	0		29	10	S5884_172_0	2		Y	Preferred Generic	4	11	1	2	1	3		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										1		
S5884	172	0		29	10	S5884_172_0	2		Y	Generic	4	11	3	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					4.00		12.00											10.00		30.00				4.00		0.00				10.00				10.00			0.33	0.13		0.33	0.13	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	172	0		29	10	S5884_172_0	2		Y	Generic	4	11	3	2	2	3		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										1		3
S5884	172	0		29	10	S5884_172_0	2		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					45.00		135.00											47.00		141.00				45.00		125.00				47.00				47.00			1.57	1.50		1.57	1.50	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	172	0		29	10	S5884_172_0	2		Y	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											100.00	44		44				100.00	44		44										44		44				44		44			44			44								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	172	0		29	10	S5884_172_0	2		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	173	0		29	10	S5884_173_0	2		Y	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								5.00		15.00					1.00		3.00											5.00		15.00				1.00		0.00				5.00				5.00			0.17	0.03		0.17	0.03	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	173	0		29	10	S5884_173_0	2		Y	Preferred Generic	4	11	1	2	1	3		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										1		
S5884	173	0		29	10	S5884_173_0	2		Y	Generic	4	11	3	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					4.00		12.00											10.00		30.00				4.00		0.00				10.00				10.00			0.33	0.13		0.33	0.13	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	173	0		29	10	S5884_173_0	2		Y	Generic	4	11	3	2	2	3		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										1		3
S5884	173	0		29	10	S5884_173_0	2		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					45.00		135.00											47.00		141.00				45.00		125.00				47.00				47.00			1.57	1.50		1.57	1.50	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	173	0		29	10	S5884_173_0	2		Y	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											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	173	0		29	10	S5884_173_0	2		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												28							28												28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	174	0		29	10	S5884_174_0	2		Y	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								5.00		15.00					1.00		3.00											5.00		15.00				1.00		0.00				5.00				5.00			0.17	0.03		0.17	0.03	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	174	0		29	10	S5884_174_0	2		Y	Preferred Generic	4	11	1	2	1	3		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										1		
S5884	174	0		29	10	S5884_174_0	2		Y	Generic	4	11	3	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					4.00		12.00											10.00		30.00				4.00		0.00				10.00				10.00			0.33	0.13		0.33	0.13	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	174	0		29	10	S5884_174_0	2		Y	Generic	4	11	3	2	2	3		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										1		3
S5884	174	0		29	10	S5884_174_0	2		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					45.00		135.00											47.00		141.00				45.00		125.00				47.00				47.00			1.57	1.50		1.57	1.50	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	174	0		29	10	S5884_174_0	2		Y	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											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	174	0		29	10	S5884_174_0	2		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												28							28												28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	175	0		29	10	S5884_175_0	2		Y	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								5.00		15.00					1.00		3.00											5.00		15.00				1.00		0.00				5.00				5.00			0.17	0.03		0.17	0.03	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	175	0		29	10	S5884_175_0	2		Y	Preferred Generic	4	11	1	2	1	3		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										1		
S5884	175	0		29	10	S5884_175_0	2		Y	Generic	4	11	3	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					4.00		12.00											10.00		30.00				4.00		0.00				10.00				10.00			0.33	0.13		0.33	0.13	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	175	0		29	10	S5884_175_0	2		Y	Generic	4	11	3	2	2	3		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										1		3
S5884	175	0		29	10	S5884_175_0	2		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					45.00		135.00											47.00		141.00				45.00		125.00				47.00				47.00			1.57	1.50		1.57	1.50	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	175	0		29	10	S5884_175_0	2		Y	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											93.00	46		46				91.00	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	2		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												28							28												28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	176	0		29	10	S5884_176_0	2		Y	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								5.00		15.00					1.00		3.00											5.00		15.00				1.00		0.00				5.00				5.00			0.17	0.03		0.17	0.03	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	176	0		29	10	S5884_176_0	2		Y	Preferred Generic	4	11	1	2	1	3		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										1		
S5884	176	0		29	10	S5884_176_0	2		Y	Generic	4	11	3	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					4.00		12.00											10.00		30.00				4.00		0.00				10.00				10.00			0.33	0.13		0.33	0.13	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	176	0		29	10	S5884_176_0	2		Y	Generic	4	11	3	2	2	3		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										1		3
S5884	176	0		29	10	S5884_176_0	2		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					45.00		135.00											47.00		141.00				45.00		125.00				47.00				47.00			1.57	1.50		1.57	1.50	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	176	0		29	10	S5884_176_0	2		Y	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											80.00	50		50				78.00	49		49										50		50				49		49			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	176	0		29	10	S5884_176_0	2		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												28							28												28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	177	0		29	10	S5884_177_0	2		Y	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								5.00		15.00					1.00		3.00											5.00		15.00				1.00		0.00				5.00				5.00			0.17	0.03		0.17	0.03	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	177	0		29	10	S5884_177_0	2		Y	Preferred Generic	4	11	1	2	1	3		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										1		
S5884	177	0		29	10	S5884_177_0	2		Y	Generic	4	11	3	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					4.00		12.00											10.00		30.00				4.00		0.00				10.00				10.00			0.33	0.13		0.33	0.13	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	177	0		29	10	S5884_177_0	2		Y	Generic	4	11	3	2	2	3		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										1		3
S5884	177	0		29	10	S5884_177_0	2		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					45.00		135.00											47.00		141.00				45.00		125.00				47.00				47.00			1.57	1.50		1.57	1.50	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	177	0		29	10	S5884_177_0	2		Y	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											100.00	35		35				100.00	35		35										35		35				35		35			35			35								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	177	0		29	10	S5884_177_0	2		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	178	0		29	10	S5884_178_0	2		Y	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								5.00		15.00					1.00		3.00											5.00		15.00				1.00		0.00				5.00				5.00			0.17	0.03		0.17	0.03	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	178	0		29	10	S5884_178_0	2		Y	Preferred Generic	4	11	1	2	1	3		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										1		
S5884	178	0		29	10	S5884_178_0	2		Y	Generic	4	11	3	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					4.00		12.00											10.00		30.00				4.00		0.00				10.00				10.00			0.33	0.13		0.33	0.13	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	178	0		29	10	S5884_178_0	2		Y	Generic	4	11	3	2	2	3		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										1		3
S5884	178	0		29	10	S5884_178_0	2		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					45.00		135.00											47.00		141.00				45.00		125.00				47.00				47.00			1.57	1.50		1.57	1.50	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	178	0		29	10	S5884_178_0	2		Y	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											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	178	0		29	10	S5884_178_0	2		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												28							28												28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	179	0		29	10	S5884_179_0	2		Y	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								5.00		15.00					1.00		3.00											5.00		15.00				1.00		0.00				5.00				5.00			0.17	0.03		0.17	0.03	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	179	0		29	10	S5884_179_0	2		Y	Preferred Generic	4	11	1	2	1	3		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										1		
S5884	179	0		29	10	S5884_179_0	2		Y	Generic	4	11	3	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					4.00		12.00											10.00		30.00				4.00		0.00				10.00				10.00			0.33	0.13		0.33	0.13	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	179	0		29	10	S5884_179_0	2		Y	Generic	4	11	3	2	2	3		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										1		3
S5884	179	0		29	10	S5884_179_0	2		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					45.00		135.00											47.00		141.00				45.00		125.00				47.00				47.00			1.57	1.50		1.57	1.50	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	179	0		29	10	S5884_179_0	2		Y	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											93.00	41		41				91.00	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	2		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												28							28												28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	180	0		29	10	S5884_180_0	2		Y	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								5.00		15.00					1.00		3.00											5.00		15.00				1.00		0.00				5.00				5.00			0.17	0.03		0.17	0.03	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	180	0		29	10	S5884_180_0	2		Y	Preferred Generic	4	11	1	2	1	3		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										1		
S5884	180	0		29	10	S5884_180_0	2		Y	Generic	4	11	3	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					4.00		12.00											10.00		30.00				4.00		0.00				10.00				10.00			0.33	0.13		0.33	0.13	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	180	0		29	10	S5884_180_0	2		Y	Generic	4	11	3	2	2	3		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										1		3
S5884	180	0		29	10	S5884_180_0	2		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					45.00		135.00											47.00		141.00				45.00		125.00				47.00				47.00			1.57	1.50		1.57	1.50	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	180	0		29	10	S5884_180_0	2		Y	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											99.00	45		45				99.00	45		45										45		45				45		45			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	180	0		29	10	S5884_180_0	2		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												28							28												28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	181	0		29	10	S5884_181_0	2			Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					1.00		3.00											10.00		30.00				1.00		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	2			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	181	0		29	10	S5884_181_0	2			Preferred Brand	4	11	1	1	3	1		110	01		110	1				30		90	2	2				30		90	30		31											43.00	20		20				32.00	15		15										20		20				15		15			20			20								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	181	0		29	10	S5884_181_0	2			Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											93.00	50		50				93.00	50		50										50		50				50		50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	181	0		29	10	S5884_181_0	2			Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	182	0		29	10	S5884_182_0	1			Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		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	1			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	182	0		29	10	S5884_182_0	1			Preferred Brand	4	11	1	1	3	1		110	01		110	1				30		90	2	2				30		90	30		31											34.00	18		18				31.00	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	1			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				88.00	50		50										50		50				50		50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	182	0		29	10	S5884_182_0	1			Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	183	0		29	10	S5884_183_0	1			Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					1.00		3.00											10.00		30.00				1.00		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	1			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	183	0		29	10	S5884_183_0	1			Preferred Brand	4	11	1	1	3	1		110	01		110	1				30		90	2	2				30		90	30		31											35.00	19		19				26.00	14		14										19		19				14		14			19			19								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	183	0		29	10	S5884_183_0	1			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				96.00	50		50										50		50				50		50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	183	0		29	10	S5884_183_0	1			Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	184	0		29	10	S5884_184_0	1			Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					1.00		3.00											10.00		30.00				1.00		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	1			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	184	0		29	10	S5884_184_0	1			Preferred Brand	4	11	1	1	3	1		110	01		110	1				30		90	2	2				30		90	30		31											37.00	20		20				28.00	15		15										20		20				15		15			20			20								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	184	0		29	10	S5884_184_0	1			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				92.00	50		50										50		50				50		50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	184	0		29	10	S5884_184_0	1			Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	185	0		29	10	S5884_185_0	1			Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		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	1			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	185	0		29	10	S5884_185_0	1			Preferred Brand	4	11	1	1	3	1		110	01		110	1				30		90	2	2				30		90	30		31											38.00	21		21				29.00	16		16										21		21				16		16			21			21								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	185	0		29	10	S5884_185_0	1			Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											90.00	50		50				90.00	50		50										50		50				50		50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	185	0		29	10	S5884_185_0	1			Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	186	0		29	10	S5884_186_0	2			Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.33	0		0.33	0	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	186	0		29	10	S5884_186_0	2			Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					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	186	0		29	10	S5884_186_0	2			Preferred Brand	4	11	1	1	3	1		110	01		110	1				30		90	2	2				30		90	30		31											37.00	19		19				35.00	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	2			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				84.00	50		50										50		50				50		50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	186	0		29	10	S5884_186_0	2			Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	187	0		29	10	S5884_187_0	1			Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					1.00		3.00											10.00		30.00				1.00		0.00				10.00				10.00			0.33	0.03		0.33	0.03	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	187	0		29	10	S5884_187_0	1			Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					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	187	0		29	10	S5884_187_0	1			Preferred Brand	4	11	1	1	3	1		110	01		110	1				30		90	2	2				30		90	30		31											39.00	22		22				27.00	15		15										22		22				15		15			22			22								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	187	0		29	10	S5884_187_0	1			Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											81.00	49		49				81.00	49		49										49		49				49		49			49			49								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	187	0		29	10	S5884_187_0	1			Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	188	0		29	10	S5884_188_0	1			Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					1.00		3.00											10.00		30.00				1.00		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	1			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	188	0		29	10	S5884_188_0	1			Preferred Brand	4	11	1	1	3	1		110	01		110	1				30		90	2	2				30		90	30		31											36.00	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	1			Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											88.00	46		46				88.00	46		46										46		46				46		46			46			46								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	188	0		29	10	S5884_188_0	1			Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	189	0		29	10	S5884_189_0	1			Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					1.00		3.00											10.00		30.00				1.00		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	1			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	189	0		29	10	S5884_189_0	1			Preferred Brand	4	11	1	1	3	1		110	01		110	1				30		90	2	2				30		90	30		31											35.00	20		20				28.00	16		16										20		20				16		16			20			20								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	189	0		29	10	S5884_189_0	1			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	189	0		29	10	S5884_189_0	1			Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	190	0		29	10	S5884_190_0	1			Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					1.00		3.00											10.00		30.00				1.00		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	1			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	190	0		29	10	S5884_190_0	1			Preferred Brand	4	11	1	1	3	1		110	01		110	1				30		90	2	2				30		90	30		31											38.00	22		22				26.00	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	1			Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											89.00	50		50				89.00	50		50										50		50				50		50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	190	0		29	10	S5884_190_0	1			Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	191	0		29	10	S5884_191_0	1			Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					1.00		3.00											10.00		30.00				1.00		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	1			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	191	0		29	10	S5884_191_0	1			Preferred Brand	4	11	1	1	3	1		110	01		110	1				30		90	2	2				30		90	30		31											38.00	21		21				29.00	16		16										21		21				16		16			21			21								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	191	0		29	10	S5884_191_0	1			Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											88.00	48		48				74.00	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	1			Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	192	0		29	10	S5884_192_0	1			Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					1.00		3.00											10.00		30.00				1.00		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	1			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	192	0		29	10	S5884_192_0	1			Preferred Brand	4	11	1	1	3	1		110	01		110	1				30		90	2	2				30		90	30		31											44.00	22		22				32.00	16		16										22		22				16		16			22			22								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	192	0		29	10	S5884_192_0	1			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				88.00	50		50										50		50				50		50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	192	0		29	10	S5884_192_0	1			Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	193	0		29	10	S5884_193_0	1			Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					1.00		3.00											10.00		30.00				1.00		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	1			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	193	0		29	10	S5884_193_0	1			Preferred Brand	4	11	1	1	3	1		110	01		110	1				30		90	2	2				30		90	30		31											37.00	19		19				35.00	18		18										19		19				18		18			19			19								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	193	0		29	10	S5884_193_0	1			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				75.00	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	1			Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	194	0		29	10	S5884_194_0	1			Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					1.00		3.00											10.00		30.00				1.00		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	1			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	194	0		29	10	S5884_194_0	1			Preferred Brand	4	11	1	1	3	1		110	01		110	1				30		90	2	2				30		90	30		31											39.00	20		20				35.00	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	1			Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											86.00	49		49				66.00	38		38										49		49				38		38			49			49								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	194	0		29	10	S5884_194_0	1			Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	195	0		29	10	S5884_195_0	2			Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.33	0		0.33	0	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	195	0		29	10	S5884_195_0	2			Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					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	195	0		29	10	S5884_195_0	2			Preferred Brand	4	11	1	1	3	1		110	01		110	1				30		90	2	2				30		90	30		31											46.00	21		21				39.00	18		18										21		21				18		18			21			21								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	195	0		29	10	S5884_195_0	2			Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											82.00	50		50				82.00	50		50										50		50				50		50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	195	0		29	10	S5884_195_0	2			Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	196	0		29	10	S5884_196_0	1			Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					1.00		3.00											10.00		30.00				1.00		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	1			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	196	0		29	10	S5884_196_0	1			Preferred Brand	4	11	1	1	3	1		110	01		110	1				30		90	2	2				30		90	30		31											47.00	22		22				34.00	16		16										22		22				16		16			22			22								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	196	0		29	10	S5884_196_0	1			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				88.00	50		50										50		50				50		50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	196	0		29	10	S5884_196_0	1			Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	197	0		29	10	S5884_197_0	2			Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					1.00		3.00											10.00		30.00				1.00		3.00				10.00				10.00			0.33	0.03		0.33	0.03	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	197	0		29	10	S5884_197_0	2			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	197	0		29	10	S5884_197_0	2			Preferred Brand	4	11	1	1	3	1		110	01		110	1				30		90	2	2				30		90	30		31											43.00	22		22				30.00	15		15										22		22				15		15			22			22								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	197	0		29	10	S5884_197_0	2			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				85.00	50		50										50		50				50		50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	197	0		29	10	S5884_197_0	2			Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	198	0		29	10	S5884_198_0	1			Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		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	1			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	198	0		29	10	S5884_198_0	1			Preferred Brand	4	11	1	1	3	1		110	01		110	1				30		90	2	2				30		90	30		31											34.00	19		19				31.00	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	1			Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											78.00	50		50				78.00	50		50										50		50				50		50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	198	0		29	10	S5884_198_0	1			Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	199	0		29	10	S5884_199_0	1			Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					1.00		3.00											10.00		30.00				1.00		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	1			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	199	0		29	10	S5884_199_0	1			Preferred Brand	4	11	1	1	3	1		110	01		110	1				30		90	2	2				30		90	30		31											38.00	20		20				30.00	16		16										20		20				16		16			20			20								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	199	0		29	10	S5884_199_0	1			Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											76.00	43		43				65.00	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	1			Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	200	0		29	10	S5884_200_0	1			Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		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	1			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	1			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	1			Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											89.00	50		50				89.00	50		50										50		50				50		50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	200	0		29	10	S5884_200_0	1			Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	201	0		29	10	S5884_201_0	1			Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					1.00		3.00											10.00		30.00				1.00		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	1			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	201	0		29	10	S5884_201_0	1			Preferred Brand	4	11	1	1	3	1		110	01		110	1				30		90	2	2				30		90	30		31											39.00	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	1			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				96.00	50		50										50		50				50		50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	201	0		29	10	S5884_201_0	1			Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	202	0		29	10	S5884_202_0	1			Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					1.00		3.00											10.00		30.00				1.00		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	1			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	202	0		29	10	S5884_202_0	1			Preferred Brand	4	11	1	1	3	1		110	01		110	1				30		90	2	2				30		90	30		31											32.00	17		17				28.00	15		15										17		17				15		15			17			17								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	202	0		29	10	S5884_202_0	1			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				93.00	50		50										50		50				50		50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	202	0		29	10	S5884_202_0	1			Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	203	0		29	10	S5884_203_0	1			Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		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	1			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	1			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	203	0		29	10	S5884_203_0	1			Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											82.00	50		50				82.00	50		50										50		50				50		50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	203	0		29	10	S5884_203_0	1			Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	204	0		29	10	S5884_204_0	1			Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		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	1			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	204	0		29	10	S5884_204_0	1			Preferred Brand	4	11	1	1	3	1		110	01		110	1				30		90	2	2				30		90	30		31											47.00	22		22				34.00	16		16										22		22				16		16			22			22								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	204	0		29	10	S5884_204_0	1			Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											80.00	50		50				80.00	50		50										50		50				50		50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	204	0		29	10	S5884_204_0	1			Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	205	0		29	10	S5884_205_0	1			Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					1.00		3.00											10.00		30.00				1.00		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	1			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	205	0		29	10	S5884_205_0	1			Preferred Brand	4	11	1	1	3	1		110	01		110	1				30		90	2	2				30		90	30		31											34.00	18		18				32.00	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	1			Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											89.00	50		50				89.00	50		50										50		50				50		50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	205	0		29	10	S5884_205_0	1			Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	206	0		29	10	S5884_206_0	1			Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					1.00		3.00											10.00		30.00				1.00		0.00				10.00				10.00			0.33	0.03		0.33	0.03	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	206	0		29	10	S5884_206_0	1			Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					2.00		6.00											20.00		60.00				2.00		5.00				20.00				20.00			0.67	0.07		0.67	0.07	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	206	0		29	10	S5884_206_0	1			Preferred Brand	4	11	1	1	3	1		110	01		110	1				30		90	2	2				30		90	30		31											46.00	23		23				32.00	16		16										23		23				16		16			23			23								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	206	0		29	10	S5884_206_0	1			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				85.00	50		50										50		50				50		50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	206	0		29	10	S5884_206_0	1			Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	207	0		29	10	S5884_207_0	1			Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					1.00		3.00											10.00		30.00				1.00		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	1			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	207	0		29	10	S5884_207_0	1			Preferred Brand	4	11	1	1	3	1		110	01		110	1				30		90	2	2				30		90	30		31											44.00	21		21				37.00	18		18										21		21				18		18			21			21								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	207	0		29	10	S5884_207_0	1			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				96.00	50		50										50		50				50		50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	207	0		29	10	S5884_207_0	1			Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	208	0		29	10	S5884_208_0	1			Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					1.00		3.00											10.00		30.00				1.00		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	1			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	208	0		29	10	S5884_208_0	1			Preferred Brand	4	11	1	1	3	1		110	01		110	1				30		90	2	2				30		90	30		31											42.00	21		21				30.00	15		15										21		21				15		15			21			21								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	208	0		29	10	S5884_208_0	1			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				98.00	50		50										50		50				50		50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	208	0		29	10	S5884_208_0	1			Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	209	0		29	10	S5884_209_0	2			Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					1.00		3.00											10.00		30.00				1.00		0.00				10.00				10.00			0.33	0.03		0.33	0.03	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	209	0		29	10	S5884_209_0	2			Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					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	209	0		29	10	S5884_209_0	2			Preferred Brand	4	11	1	1	3	1		110	01		110	1				30		90	2	2				30		90	30		31											42.00	22		22				32.00	17		17										22		22				17		17			22			22								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	209	0		29	10	S5884_209_0	2			Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											75.00	50		50				75.00	50		50										50		50				50		50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	209	0		29	10	S5884_209_0	2			Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	210	0		29	10	S5884_210_0	2			Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					1.00		3.00											10.00		30.00				1.00		3.00				10.00				10.00			0.33	0.03		0.33	0.03	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	210	0		29	10	S5884_210_0	2			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	210	0		29	10	S5884_210_0	2			Preferred Brand	4	11	1	1	3	1		110	01		110	1				30		90	2	2				30		90	30		31											40.00	21		21				28.00	15		15										21		21				15		15			21			21								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	210	0		29	10	S5884_210_0	2			Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											82.00	50		50				82.00	50		50										50		50				50		50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	210	0		29	10	S5884_210_0	2			Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	211	0		29	10	S5884_211_0	1			Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		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	1			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	1			Preferred Brand	4	11	1	1	3	1		110	01		110	1				30		90	2	2				30		90	30		31											32.00	18		18				26.00	15		15										18		18				15		15			18			18								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	211	0		29	10	S5884_211_0	1			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				93.00	50		50										50		50				50		50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	211	0		29	10	S5884_211_0	1			Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	212	0		29	10	S5884_212_0	1			Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					1.00		3.00											10.00		30.00				1.00		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	1			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	212	0		29	10	S5884_212_0	1			Preferred Brand	4	11	1	1	3	1		110	01		110	1				30		90	2	2				30		90	30		31											37.00	18		18				33.00	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	1			Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											99.00	48		48				99.00	48		48										48		48				48		48			48			48								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	212	0		29	10	S5884_212_0	1			Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	213	0		29	10	S5884_213_0	1			Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					1.00		3.00											10.00		30.00				1.00		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	1			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	213	0		29	10	S5884_213_0	1			Preferred Brand	4	11	1	1	3	1		110	01		110	1				30		90	2	2				30		90	30		31											47.00	22		22				34.00	16		16										22		22				16		16			22			22								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	213	0		29	10	S5884_213_0	1			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				95.00	50		50										50		50				50		50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	213	0		29	10	S5884_213_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												
S5904	001	0		29	10	S5904_001_0	7		N	Preferred Generic	3	01	1	2	1	1	110		01	110		1	31		90				1	2	31		90				31		31	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	7		N	Generic	3	01	1	2	2	1	110		01	110		1	31		90				1	2	31		90				31		31	14.00		42.00																			14.00		42.00																14.00				14.00		0.45			0.45			0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5904	001	0		29	10	S5904_001_0	7		N	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	7		N	Non-Preferred Drug	3	10	1	1	4	1	110		01	110		1	31		90				1	2	31		90				31		31				99.95	50		50																		50		50															50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5904	001	0		29	10	S5904_001_0	7		N	Specialty Tier	3	10	1	1	5	1	010		01	010		1	31								31						31		31				1232.67	25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5904	002	0		29	10	S5904_002_0	5		Y	Preferred Generic	4	01	1	2	1	1	110		01	110		1	31		90				1	1	31		90				31		31	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	002	0		29	10	S5904_002_0	5		Y	Preferred Generic	4	01	1	2	1	3	110		01	110		1	31		90				1	1	31		90				31		31	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		
S5904	002	0		29	10	S5904_002_0	5		Y	Generic	4	01	1	2	2	1	110		01	110		1	31		90				1	1	31		90				31		31	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												
S5904	002	0		29	10	S5904_002_0	5		Y	Generic	4	01	1	2	2	3	110		01	110		1	31		90				1	1	31		90				31		31	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										1		
S5904	002	0		29	10	S5904_002_0	5		Y	Preferred Brand	4	11	1	2	3	1	110		01	110		1	31		90				1	1	31		90				31		31	40.00		120.00																			40.00		120.00																40.00				40.00		1.29			1.29			1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5904	002	0		29	10	S5904_002_0	5		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01	110		1	31		90				1	1	31		90				31		31	93.00		279.00																			93.00		279.00																93.00				93.00		3.00			3.00			3.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5904	002	0		29	10	S5904_002_0	5		Y	Specialty Tier	4	11	1	1	5	1	010		01	010		1	31								31						31		31				1162.12	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5916	001	0		29	10	S5916_001_0	5			Preferred Generic	3	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								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												
S5916	001	0		29	10	S5916_001_0	5			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	51.00					10.00	20.00	30.00					10.00	20.00	30.00																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	5			Preferred Brand	3	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					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												
S5916	001	0		29	10	S5916_001_0	5			Non-Preferred Drug	3	11	1	1	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											74.21	45	45	45				65.97	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	5			Specialty Tier	3	11	1	1	5	1		010	01	010		1				30					30						30		31											897.35	26						897.35	26						26																	26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5916	002	0		29	10	S5916_002_0	5			Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	3.00	6.00	6.00																			3.00	6.00	6.00																3.00				3.00		0.10			0.10			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5916	002	0		29	10	S5916_002_0	5			Preferred Generic	4	01	1	2	1	3	111		01	111		1	30	60	90				1	2	30	60	90				30		31	3.00	6.00	6.00																			3.00	6.00	6.00																3.00				3.00		0.10			0.10			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
S5916	002	0		29	10	S5916_002_0	5			Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	10.00	20.00	20.00																			10.00	20.00	20.00																10.00				10.00		0.33			0.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5916	002	0		29	10	S5916_002_0	5			Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	47.00	94.00	117.50																			47.00	94.00	117.50																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5916	002	0		29	10	S5916_002_0	5			Non-Preferred Drug	4	11	1	1	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31				65.97	40	40	40																		40	40	40															40			40								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5916	002	0		29	10	S5916_002_0	5			Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				1138.94	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	348	0		29	10	S5921_348_0	2			Preferred Generic	2	01	1	2	1	1		110	01		100	1				30		90	2	2						90	30		31								6.00		18.00					1.00		3.00													18.00						3.00				6.00				6.00			0.20	0.03				0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	348	0		29	10	S5921_348_0	2			Generic	2	01	1	2	2	1		110	01		100	1				30		90	2	2						90	30		31								10.00		30.00					5.00		15.00													30.00						15.00				10.00				10.00			0.33	0.16				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	348	0		29	10	S5921_348_0	2			Preferred Brand	2	11	1	1	3	1		110	01		100	1				30		90	2	2						90	30		31											33.00	17		17				36.00	17		17												17						17			17			17								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	348	0		29	10	S5921_348_0	2			Non-Preferred Drug	2	11	1	1	4	1		110	01		100	1				30		90	2	2						90	30		31											69.00	42		42				72.00	42		42												42						42			42			42								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	348	0		29	10	S5921_348_0	2			Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31											187.00	25						160.00	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	349	0		29	10	S5921_349_0	2			Preferred Generic	2	01	1	2	1	1		110	01		100	1				30		90	2	2						90	30		31								6.00		18.00					1.00		3.00													18.00						3.00				6.00				6.00			0.20	0.03				0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	349	0		29	10	S5921_349_0	2			Generic	2	01	1	2	2	1		110	01		100	1				30		90	2	2						90	30		31								11.00		33.00					6.00		18.00													33.00						18.00				11.00				11.00			0.36	0.20				0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	349	0		29	10	S5921_349_0	2			Preferred Brand	2	11	1	1	3	1		110	01		100	1				30		90	2	2						90	30		31											32.00	17		17				37.00	17		17												17						17			17			17								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	349	0		29	10	S5921_349_0	2			Non-Preferred Drug	2	11	1	1	4	1		110	01		100	1				30		90	2	2						90	30		31											77.00	42		42				72.00	42		42												42						42			42			42								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	349	0		29	10	S5921_349_0	2			Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31											197.00	25						174.00	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	350	0		29	10	S5921_350_0	2			Preferred Generic	2	01	1	2	1	1		110	01		100	1				30		90	2	2						90	30		31								6.00		18.00					1.00		3.00													18.00						3.00				6.00				6.00			0.20	0.03				0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	350	0		29	10	S5921_350_0	2			Generic	2	01	1	2	2	1		110	01		100	1				30		90	2	2						90	30		31								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	350	0		29	10	S5921_350_0	2			Preferred Brand	2	11	1	1	3	1		110	01		100	1				30		90	2	2						90	30		31											36.00	18		18				39.00	18		18												18						18			18			18								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	350	0		29	10	S5921_350_0	2			Non-Preferred Drug	2	11	1	1	4	1		110	01		100	1				30		90	2	2						90	30		31											71.00	42		42				63.00	42		42												42						42			42			42								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	350	0		29	10	S5921_350_0	2			Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31											203.00	25						208.00	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	351	0		29	10	S5921_351_0	2			Preferred Generic	2	01	1	2	1	1		110	01		100	1				30		90	2	2						90	30		31								6.00		18.00					1.00		3.00													18.00						3.00				6.00				6.00			0.20	0.03				0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	351	0		29	10	S5921_351_0	2			Generic	2	01	1	2	2	1		110	01		100	1				30		90	2	2						90	30		31								10.00		30.00					5.00		15.00													30.00						15.00				10.00				10.00			0.33	0.16				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	351	0		29	10	S5921_351_0	2			Preferred Brand	2	11	1	1	3	1		110	01		100	1				30		90	2	2						90	30		31											35.00	18		18				40.00	18		18												18						18			18			18								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	351	0		29	10	S5921_351_0	2			Non-Preferred Drug	2	11	1	1	4	1		110	01		100	1				30		90	2	2						90	30		31											70.00	42		42				71.00	42		42												42						42			42			42								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	351	0		29	10	S5921_351_0	2			Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31											187.00	25						206.00	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	352	0		29	10	S5921_352_0	3			Preferred Generic	2	01	1	2	1	1		110	01		100	1				30		90	2	2						90	30		31								6.00		18.00					1.00		3.00													18.00						3.00				6.00				6.00			0.20	0.03				0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	352	0		29	10	S5921_352_0	3			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	352	0		29	10	S5921_352_0	3			Preferred Brand	2	11	1	1	3	1		110	01		100	1				30		90	2	2						90	30		31											34.00	18		18				39.00	18		18												18						18			18			18								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	352	0		29	10	S5921_352_0	3			Non-Preferred Drug	2	11	1	1	4	1		110	01		100	1				30		90	2	2						90	30		31											72.00	42		42				68.00	42		42												42						42			42			42								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	352	0		29	10	S5921_352_0	3			Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31											191.00	25						204.00	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	353	0		29	10	S5921_353_0	2			Preferred Generic	2	01	1	2	1	1		110	01		100	1				30		90	2	2						90	30		31								6.00		18.00					1.00		3.00													18.00						3.00				6.00				6.00			0.20	0.03				0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	353	0		29	10	S5921_353_0	2			Generic	2	01	1	2	2	1		110	01		100	1				30		90	2	2						90	30		31								20.00		60.00					17.00		51.00													60.00						51.00				20.00				20.00			0.66	0.56				0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	353	0		29	10	S5921_353_0	2			Preferred Brand	2	11	1	1	3	1		110	01		100	1				30		90	2	2						90	30		31											35.00	17		17				38.00	17		17												17						17			17			17								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	353	0		29	10	S5921_353_0	2			Non-Preferred Drug	2	11	1	1	4	1		110	01		100	1				30		90	2	2						90	30		31											77.00	42		42				64.00	42		42												42						42			42			42								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	353	0		29	10	S5921_353_0	2			Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31											262.00	25						292.00	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	354	0		29	10	S5921_354_0	2			Preferred Generic	2	01	1	2	1	1		110	01		100	1				30		90	2	2						90	30		31								6.00		18.00					1.00		3.00													18.00						3.00				6.00				6.00			0.20	0.03				0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	354	0		29	10	S5921_354_0	2			Generic	2	01	1	2	2	1		110	01		100	1				30		90	2	2						90	30		31								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	354	0		29	10	S5921_354_0	2			Preferred Brand	2	11	1	1	3	1		110	01		100	1				30		90	2	2						90	30		31											36.00	18		18				40.00	18		18												18						18			18			18								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	354	0		29	10	S5921_354_0	2			Non-Preferred Drug	2	11	1	1	4	1		110	01		100	1				30		90	2	2						90	30		31											75.00	42		42				64.00	42		42												42						42			42			42								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	354	0		29	10	S5921_354_0	2			Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31											246.00	25						187.00	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	355	0		29	10	S5921_355_0	2			Preferred Generic	2	01	1	2	1	1		110	01		100	1				30		90	2	2						90	30		31								6.00		18.00					1.00		3.00													18.00						3.00				6.00				6.00			0.20	0.03				0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	355	0		29	10	S5921_355_0	2			Generic	2	01	1	2	2	1		110	01		100	1				30		90	2	2						90	30		31								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	2			Preferred Brand	2	11	1	1	3	1		110	01		100	1				30		90	2	2						90	30		31											34.00	18		18				38.00	18		18												18						18			18			18								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	355	0		29	10	S5921_355_0	2			Non-Preferred Drug	2	11	1	1	4	1		110	01		100	1				30		90	2	2						90	30		31											73.00	42		42				70.00	42		42												42						42			42			42								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	355	0		29	10	S5921_355_0	2			Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31											299.00	25						280.00	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								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	356	0		29	10	S5921_356_0	3			Preferred Brand	2	11	1	1	3	1		110	01		100	1				30		90	2	2						90	30		31											33.00	18		18				38.00	18		18												18						18			18			18								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											74.00	42		42				71.00	42		42												42						42			42			42								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											296.00	25						237.00	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	357	0		29	10	S5921_357_0	2			Preferred Generic	2	01	1	2	1	1		110	01		100	1				30		90	2	2						90	30		31								6.00		18.00					1.00		3.00													18.00						3.00				6.00				6.00			0.20	0.03				0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	357	0		29	10	S5921_357_0	2			Generic	2	01	1	2	2	1		110	01		100	1				30		90	2	2						90	30		31								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	357	0		29	10	S5921_357_0	2			Preferred Brand	2	11	1	1	3	1		110	01		100	1				30		90	2	2						90	30		31											28.00	17		17				33.00	17		17												17						17			17			17								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	357	0		29	10	S5921_357_0	2			Non-Preferred Drug	2	11	1	1	4	1		110	01		100	1				30		90	2	2						90	30		31											75.00	42		42				73.00	42		42												42						42			42			42								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	357	0		29	10	S5921_357_0	2			Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31											207.00	25						205.00	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	358	0		29	10	S5921_358_0	2			Preferred Generic	2	01	1	2	1	1		110	01		100	1				30		90	2	2						90	30		31								6.00		18.00					1.00		3.00													18.00						3.00				6.00				6.00			0.20	0.03				0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	358	0		29	10	S5921_358_0	2			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	358	0		29	10	S5921_358_0	2			Preferred Brand	2	11	1	1	3	1		110	01		100	1				30		90	2	2						90	30		31											28.00	17		17				35.00	17		17												17						17			17			17								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	358	0		29	10	S5921_358_0	2			Non-Preferred Drug	2	11	1	1	4	1		110	01		100	1				30		90	2	2						90	30		31											77.00	42		42				72.00	42		42												42						42			42			42								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	358	0		29	10	S5921_358_0	2			Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31											172.00	25						126.00	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	359	0		29	10	S5921_359_0	2			Preferred Generic	2	01	1	2	1	1		110	01		100	1				30		90	2	2						90	30		31								6.00		18.00					1.00		3.00													18.00						3.00				6.00				6.00			0.20	0.03				0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	359	0		29	10	S5921_359_0	2			Generic	2	01	1	2	2	1		110	01		100	1				30		90	2	2						90	30		31								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	2			Preferred Brand	2	11	1	1	3	1		110	01		100	1				30		90	2	2						90	30		31											35.00	17		17				38.00	17		17												17						17			17			17								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	359	0		29	10	S5921_359_0	2			Non-Preferred Drug	2	11	1	1	4	1		110	01		100	1				30		90	2	2						90	30		31											73.00	42		42				66.00	42		42												42						42			42			42								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	359	0		29	10	S5921_359_0	2			Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31											195.00	25						174.00	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	360	0		29	10	S5921_360_0	2			Preferred Generic	2	01	1	2	1	1		110	01		100	1				30		90	2	2						90	30		31								6.00		18.00					1.00		3.00													18.00						3.00				6.00				6.00			0.20	0.03				0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	360	0		29	10	S5921_360_0	2			Generic	2	01	1	2	2	1		110	01		100	1				30		90	2	2						90	30		31								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	360	0		29	10	S5921_360_0	2			Preferred Brand	2	11	1	1	3	1		110	01		100	1				30		90	2	2						90	30		31											33.00	18		18				38.00	18		18												18						18			18			18								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	360	0		29	10	S5921_360_0	2			Non-Preferred Drug	2	11	1	1	4	1		110	01		100	1				30		90	2	2						90	30		31											72.00	42		42				67.00	42		42												42						42			42			42								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	360	0		29	10	S5921_360_0	2			Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31											195.00	25						170.00	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	361	0		29	10	S5921_361_0	2			Preferred Generic	2	01	1	2	1	1		110	01		100	1				30		90	2	2						90	30		31								6.00		18.00					1.00		3.00													18.00						3.00				6.00				6.00			0.20	0.03				0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	361	0		29	10	S5921_361_0	2			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	361	0		29	10	S5921_361_0	2			Preferred Brand	2	11	1	1	3	1		110	01		100	1				30		90	2	2						90	30		31											30.00	17		17				33.00	17		17												17						17			17			17								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	361	0		29	10	S5921_361_0	2			Non-Preferred Drug	2	11	1	1	4	1		110	01		100	1				30		90	2	2						90	30		31											73.00	42		42				65.00	42		42												42						42			42			42								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	361	0		29	10	S5921_361_0	2			Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31											185.00	25						128.00	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	362	0		29	10	S5921_362_0	2			Preferred Generic	2	01	1	2	1	1		110	01		100	1				30		90	2	2						90	30		31								6.00		18.00					1.00		3.00													18.00						3.00				6.00				6.00			0.20	0.03				0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	362	0		29	10	S5921_362_0	2			Generic	2	01	1	2	2	1		110	01		100	1				30		90	2	2						90	30		31								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	362	0		29	10	S5921_362_0	2			Preferred Brand	2	11	1	1	3	1		110	01		100	1				30		90	2	2						90	30		31											31.00	17		17				37.00	17		17												17						17			17			17								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	362	0		29	10	S5921_362_0	2			Non-Preferred Drug	2	11	1	1	4	1		110	01		100	1				30		90	2	2						90	30		31											71.00	42		42				76.00	42		42												42						42			42			42								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	362	0		29	10	S5921_362_0	2			Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31											203.00	25						187.00	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	363	0		29	10	S5921_363_0	2			Preferred Generic	2	01	1	2	1	1		110	01		100	1				30		90	2	2						90	30		31								6.00		18.00					1.00		3.00													18.00						3.00				6.00				6.00			0.20	0.03				0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	363	0		29	10	S5921_363_0	2			Generic	2	01	1	2	2	1		110	01		100	1				30		90	2	2						90	30		31								13.00		39.00					8.00		24.00													39.00						24.00				13.00				13.00			0.43	0.26				0.41	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	363	0		29	10	S5921_363_0	2			Preferred Brand	2	11	1	1	3	1		110	01		100	1				30		90	2	2						90	30		31											35.00	18		18				37.00	18		18												18						18			18			18								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	363	0		29	10	S5921_363_0	2			Non-Preferred Drug	2	11	1	1	4	1		110	01		100	1				30		90	2	2						90	30		31											72.00	42		42				67.00	42		42												42						42			42			42								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	363	0		29	10	S5921_363_0	2			Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31											235.00	25						182.00	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	364	0		29	10	S5921_364_0	2			Preferred Generic	2	01	1	2	1	1		110	01		100	1				30		90	2	2						90	30		31								6.00		18.00					1.00		3.00													18.00						3.00				6.00				6.00			0.20	0.03				0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	364	0		29	10	S5921_364_0	2			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	364	0		29	10	S5921_364_0	2			Preferred Brand	2	11	1	1	3	1		110	01		100	1				30		90	2	2						90	30		31											34.00	17		17				35.00	17		17												17						17			17			17								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	364	0		29	10	S5921_364_0	2			Non-Preferred Drug	2	11	1	1	4	1		110	01		100	1				30		90	2	2						90	30		31											70.00	42		42				56.00	42		42												42						42			42			42								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	364	0		29	10	S5921_364_0	2			Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31											247.00	25						207.00	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	365	0		29	10	S5921_365_0	2			Preferred Generic	2	01	1	2	1	1		110	01		100	1				30		90	2	2						90	30		31								6.00		18.00					1.00		3.00													18.00						3.00				6.00				6.00			0.20	0.03				0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	365	0		29	10	S5921_365_0	2			Generic	2	01	1	2	2	1		110	01		100	1				30		90	2	2						90	30		31								12.00		36.00					7.00		21.00													36.00						21.00				12.00				12.00			0.40	0.23				0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	365	0		29	10	S5921_365_0	2			Preferred Brand	2	11	1	1	3	1		110	01		100	1				30		90	2	2						90	30		31											35.00	18		18				38.00	18		18												18						18			18			18								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	365	0		29	10	S5921_365_0	2			Non-Preferred Drug	2	11	1	1	4	1		110	01		100	1				30		90	2	2						90	30		31											69.00	42		42				69.00	42		42												42						42			42			42								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	365	0		29	10	S5921_365_0	2			Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31											217.00	25						230.00	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	366	0		29	10	S5921_366_0	3			Preferred Generic	2	01	1	2	1	1		110	01		100	1				30		90	2	2						90	30		31								6.00		18.00					1.00		3.00													18.00						3.00				6.00				6.00			0.20	0.03				0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	366	0		29	10	S5921_366_0	3			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	366	0		29	10	S5921_366_0	3			Preferred Brand	2	11	1	1	3	1		110	01		100	1				30		90	2	2						90	30		31											32.00	17		17				35.00	17		17												17						17			17			17								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	366	0		29	10	S5921_366_0	3			Non-Preferred Drug	2	11	1	1	4	1		110	01		100	1				30		90	2	2						90	30		31											80.00	42		42				73.00	42		42												42						42			42			42								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	366	0		29	10	S5921_366_0	3			Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31											231.00	25						181.00	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	367	0		29	10	S5921_367_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	367	0		29	10	S5921_367_0	4			Generic	2	01	1	2	2	1		110	01		100	1				30		90	2	2						90	30		31								17.00		51.00					12.00		36.00													51.00						36.00				17.00				17.00			0.56	0.40				0.54	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	367	0		29	10	S5921_367_0	4			Preferred Brand	2	11	1	1	3	1		110	01		100	1				30		90	2	2						90	30		31											33.00	17		17				36.00	17		17												17						17			17			17								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	367	0		29	10	S5921_367_0	4			Non-Preferred Drug	2	11	1	1	4	1		110	01		100	1				30		90	2	2						90	30		31											77.00	42		42				70.00	42		42												42						42			42			42								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	367	0		29	10	S5921_367_0	4			Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31											235.00	25						237.00	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	368	0		29	10	S5921_368_0	2			Preferred Generic	2	01	1	2	1	1		110	01		100	1				30		90	2	2						90	30		31								6.00		18.00					1.00		3.00													18.00						3.00				6.00				6.00			0.20	0.03				0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	368	0		29	10	S5921_368_0	2			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	368	0		29	10	S5921_368_0	2			Preferred Brand	2	11	1	1	3	1		110	01		100	1				30		90	2	2						90	30		31											33.00	18		18				37.00	18		18												18						18			18			18								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	368	0		29	10	S5921_368_0	2			Non-Preferred Drug	2	11	1	1	4	1		110	01		100	1				30		90	2	2						90	30		31											78.00	42		42				74.00	42		42												42						42			42			42								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	368	0		29	10	S5921_368_0	2			Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31											205.00	25						284.00	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	369	0		29	10	S5921_369_0	2			Preferred Generic	2	01	1	2	1	1		110	01		100	1				30		90	2	2						90	30		31								6.00		18.00					1.00		3.00													18.00						3.00				6.00				6.00			0.20	0.03				0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	369	0		29	10	S5921_369_0	2			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	369	0		29	10	S5921_369_0	2			Preferred Brand	2	11	1	1	3	1		110	01		100	1				30		90	2	2						90	30		31											36.00	18		18				38.00	18		18												18						18			18			18								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	369	0		29	10	S5921_369_0	2			Non-Preferred Drug	2	11	1	1	4	1		110	01		100	1				30		90	2	2						90	30		31											71.00	42		42				67.00	42		42												42						42			42			42								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	369	0		29	10	S5921_369_0	2			Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31											155.00	25						326.00	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	370	0		29	10	S5921_370_0	3			Preferred Generic	2	01	1	2	1	1		110	01		100	1				30		90	2	2						90	30		31								6.00		18.00					1.00		3.00													18.00						3.00				6.00				6.00			0.20	0.03				0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	370	0		29	10	S5921_370_0	3			Generic	2	01	1	2	2	1		110	01		100	1				30		90	2	2						90	30		31								11.00		33.00					6.00		18.00													33.00						18.00				11.00				11.00			0.36	0.20				0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	370	0		29	10	S5921_370_0	3			Preferred Brand	2	11	1	1	3	1		110	01		100	1				30		90	2	2						90	30		31											31.00	17		17				34.00	17		17												17						17			17			17								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	370	0		29	10	S5921_370_0	3			Non-Preferred Drug	2	11	1	1	4	1		110	01		100	1				30		90	2	2						90	30		31											68.00	42		42				69.00	42		42												42						42			42			42								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	370	0		29	10	S5921_370_0	3			Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31											174.00	25						146.00	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	371	0		29	10	S5921_371_0	2			Preferred Generic	2	01	1	2	1	1		110	01		100	1				30		90	2	2						90	30		31								6.00		18.00					1.00		3.00													18.00						3.00				6.00				6.00			0.20	0.03				0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	371	0		29	10	S5921_371_0	2			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	371	0		29	10	S5921_371_0	2			Preferred Brand	2	11	1	1	3	1		110	01		100	1				30		90	2	2						90	30		31											31.00	17		17				33.00	17		17												17						17			17			17								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	371	0		29	10	S5921_371_0	2			Non-Preferred Drug	2	11	1	1	4	1		110	01		100	1				30		90	2	2						90	30		31											73.00	42		42				73.00	42		42												42						42			42			42								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	371	0		29	10	S5921_371_0	2			Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31											174.00	25						158.00	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	372	0		29	10	S5921_372_0	2			Preferred Generic	2	01	1	2	1	1		110	01		100	1				30		90	2	2						90	30		31								6.00		18.00					1.00		3.00													18.00						3.00				6.00				6.00			0.20	0.03				0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	372	0		29	10	S5921_372_0	2			Generic	2	01	1	2	2	1		110	01		100	1				30		90	2	2						90	30		31								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	2			Preferred Brand	2	11	1	1	3	1		110	01		100	1				30		90	2	2						90	30		31											35.00	18		18				40.00	18		18												18						18			18			18								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	372	0		29	10	S5921_372_0	2			Non-Preferred Drug	2	11	1	1	4	1		110	01		100	1				30		90	2	2						90	30		31											73.00	42		42				69.00	42		42												42						42			42			42								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	372	0		29	10	S5921_372_0	2			Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31											208.00	25						236.00	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	373	0		29	10	S5921_373_0	2			Preferred Generic	2	01	1	2	1	1		110	01		100	1				30		90	2	2						90	30		31								6.00		18.00					1.00		3.00													18.00						3.00				6.00				6.00			0.20	0.03				0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	373	0		29	10	S5921_373_0	2			Generic	2	01	1	2	2	1		110	01		100	1				30		90	2	2						90	30		31								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	373	0		29	10	S5921_373_0	2			Preferred Brand	2	11	1	1	3	1		110	01		100	1				30		90	2	2						90	30		31											32.00	18		18				37.00	18		18												18						18			18			18								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	373	0		29	10	S5921_373_0	2			Non-Preferred Drug	2	11	1	1	4	1		110	01		100	1				30		90	2	2						90	30		31											74.00	42		42				77.00	42		42												42						42			42			42								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	373	0		29	10	S5921_373_0	2			Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31											197.00	25						229.00	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	374	0		29	10	S5921_374_0	2			Preferred Generic	2	01	1	2	1	1		110	01		100	1				30		90	2	2						90	30		31								6.00		18.00					1.00		3.00													18.00						3.00				6.00				6.00			0.20	0.03				0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	374	0		29	10	S5921_374_0	2			Generic	2	01	1	2	2	1		110	01		100	1				30		90	2	2						90	30		31								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	374	0		29	10	S5921_374_0	2			Preferred Brand	2	11	1	1	3	1		110	01		100	1				30		90	2	2						90	30		31											31.00	17		17				35.00	17		17												17						17			17			17								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	374	0		29	10	S5921_374_0	2			Non-Preferred Drug	2	11	1	1	4	1		110	01		100	1				30		90	2	2						90	30		31											72.00	42		42				65.00	42		42												42						42			42			42								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	374	0		29	10	S5921_374_0	2			Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31											178.00	25						161.00	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	375	0		29	10	S5921_375_0	2			Preferred Generic	2	01	1	2	1	1		110	01		100	1				30		90	2	2						90	30		31								6.00		18.00					1.00		3.00													18.00						3.00				6.00				6.00			0.20	0.03				0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	375	0		29	10	S5921_375_0	2			Generic	2	01	1	2	2	1		110	01		100	1				30		90	2	2						90	30		31								11.00		33.00					6.00		18.00													33.00						18.00				11.00				11.00			0.36	0.20				0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	375	0		29	10	S5921_375_0	2			Preferred Brand	2	11	1	1	3	1		110	01		100	1				30		90	2	2						90	30		31											32.00	18		18				38.00	18		18												18						18			18			18								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	375	0		29	10	S5921_375_0	2			Non-Preferred Drug	2	11	1	1	4	1		110	01		100	1				30		90	2	2						90	30		31											74.00	42		42				65.00	42		42												42						42			42			42								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	375	0		29	10	S5921_375_0	2			Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31											220.00	25						163.00	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	376	0		29	10	S5921_376_0	2			Preferred Generic	2	01	1	2	1	1		110	01		100	1				30		90	2	2						90	30		31								6.00		18.00					1.00		3.00													18.00						3.00				6.00				6.00			0.20	0.03				0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	376	0		29	10	S5921_376_0	2			Generic	2	01	1	2	2	1		110	01		100	1				30		90	2	2						90	30		31								9.00		27.00					4.00		12.00													27.00						12.00				9.00				9.00			0.30	0.13				0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	376	0		29	10	S5921_376_0	2			Preferred Brand	2	11	1	1	3	1		110	01		100	1				30		90	2	2						90	30		31											35.00	18		18				39.00	18		18												18						18			18			18								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	376	0		29	10	S5921_376_0	2			Non-Preferred Drug	2	11	1	1	4	1		110	01		100	1				30		90	2	2						90	30		31											79.00	42		42				71.00	42		42												42						42			42			42								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	376	0		29	10	S5921_376_0	2			Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31											232.00	25						313.00	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	377	0		29	10	S5921_377_0	2			Preferred Generic	2	01	1	2	1	1		110	01		100	1				30		90	2	2						90	30		31								6.00		18.00					1.00		3.00													18.00						3.00				6.00				6.00			0.20	0.03				0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	377	0		29	10	S5921_377_0	2			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	2			Preferred Brand	2	11	1	1	3	1		110	01		100	1				30		90	2	2						90	30		31											30.00	17		17				39.00	17		17												17						17			17			17								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	377	0		29	10	S5921_377_0	2			Non-Preferred Drug	2	11	1	1	4	1		110	01		100	1				30		90	2	2						90	30		31											72.00	42		42				75.00	42		42												42						42			42			42								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	377	0		29	10	S5921_377_0	2			Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31											114.00	25						265.00	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	378	0		29	10	S5921_378_0	2			Preferred Generic	2	01	1	2	1	1		110	01		100	1				30		90	2	2						90	30		31								6.00		18.00					1.00		3.00													18.00						3.00				6.00				6.00			0.20	0.03				0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	378	0		29	10	S5921_378_0	2			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	2			Preferred Brand	2	11	1	1	3	1		110	01		100	1				30		90	2	2						90	30		31											33.00	18		18				39.00	18		18												18						18			18			18								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	378	0		29	10	S5921_378_0	2			Non-Preferred Drug	2	11	1	1	4	1		110	01		100	1				30		90	2	2						90	30		31											69.00	42		42				65.00	42		42												42						42			42			42								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	378	0		29	10	S5921_378_0	2			Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31											203.00	25						186.00	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	379	0		29	10	S5921_379_0	2			Preferred Generic	2	01	1	2	1	1		110	01		100	1				30		90	2	2						90	30		31								6.00		18.00					1.00		3.00													18.00						3.00				6.00				6.00			0.20	0.03				0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	379	0		29	10	S5921_379_0	2			Generic	2	01	1	2	2	1		110	01		100	1				30		90	2	2						90	30		31								13.00		39.00					8.00		24.00													39.00						24.00				13.00				13.00			0.43	0.26				0.41	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	379	0		29	10	S5921_379_0	2			Preferred Brand	2	11	1	1	3	1		110	01		100	1				30		90	2	2						90	30		31											36.00	17		17				38.00	17		17												17						17			17			17								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	379	0		29	10	S5921_379_0	2			Non-Preferred Drug	2	11	1	1	4	1		110	01		100	1				30		90	2	2						90	30		31											76.00	42		42				69.00	42		42												42						42			42			42								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	379	0		29	10	S5921_379_0	2			Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31											284.00	25						302.00	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	380	0		29	10	S5921_380_0	2			Preferred Generic	2	01	1	2	1	1		110	01		100	1				30		90	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	2			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	380	0		29	10	S5921_380_0	2			Preferred Brand	2	11	1	1	3	1		110	01		100	1				30		90	2	2						90	30		31											31.00	17		17				37.00	17		17												17						17			17			17								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	380	0		29	10	S5921_380_0	2			Non-Preferred Drug	2	11	1	1	4	1		110	01		100	1				30		90	2	2						90	30		31											72.00	42		42				74.00	42		42												42						42			42			42								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	380	0		29	10	S5921_380_0	2			Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31											286.00	25						220.00	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	381	0		29	10	S5921_381_0	2			Preferred Generic	2	01	1	2	1	1		110	01		100	1				30		90	2	2						90	30		31								6.00		18.00					1.00		3.00													18.00						3.00				6.00				6.00			0.20	0.03				0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	381	0		29	10	S5921_381_0	2			Generic	2	01	1	2	2	1		110	01		100	1				30		90	2	2						90	30		31								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	381	0		29	10	S5921_381_0	2			Preferred Brand	2	11	1	1	3	1		110	01		100	1				30		90	2	2						90	30		31											30.00	16		16				37.00	16		16												16						16			16			16								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	381	0		29	10	S5921_381_0	2			Non-Preferred Drug	2	11	1	1	4	1		110	01		100	1				30		90	2	2						90	30		31											85.00	42		42				98.00	42		42												42						42			42			42								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	381	0		29	10	S5921_381_0	2			Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31											178.00	25						384.00	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								16.00		48.00					1.00		3.00													48.00						3.00				16.00				16.00			0.53	0.03				0.51	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											99.00	50		50				83.00	45		45												50						45			50			50								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											352.00	27						201.00	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								16.00		48.00					1.00		3.00													48.00						3.00				16.00				16.00			0.53	0.03				0.51	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											92.00	50		50				80.00	45		45												50						45			50			50								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											325.00	27						311.00	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								16.00		48.00					1.00		3.00													48.00						3.00				16.00				16.00			0.53	0.03				0.51	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											89.00	50		50				73.00	45		45												50						45			50			50								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											185.00	27						259.00	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								16.00		48.00					1.00		3.00													48.00						3.00				16.00				16.00			0.53	0.03				0.51	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											97.00	50		50				74.00	45		45												50						45			50			50								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											249.00	27						202.00	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								16.00		48.00					1.00		3.00													48.00						3.00				16.00				16.00			0.53	0.03				0.51	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											100.00	50		50				79.00	45		45												50						45			50			50								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											365.00	27						265.00	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								16.00		48.00					1.00		3.00													48.00						3.00				16.00				16.00			0.53	0.03				0.51	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											92.00	50		50				72.00	45		45												50						45			50			50								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											275.00	27						295.00	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								16.00		48.00					1.00		3.00													48.00						3.00				16.00				16.00			0.53	0.03				0.51	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											88.00	50		50				74.00	45		45												50						45			50			50								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											309.00	27						174.00	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								16.00		48.00					1.00		3.00													48.00						3.00				16.00				16.00			0.53	0.03				0.51	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											97.00	50		50				80.00	45		45												50						45			50			50								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											352.00	27						221.00	27												27						27					27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	390	0		29	10	S5921_390_0	5			Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	2	2						90	30		31								16.00		48.00					1.00		3.00													48.00						3.00				16.00				16.00			0.53	0.03				0.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	390	0		29	10	S5921_390_0	5			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	5			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	5			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	5			Non-Preferred Drug	4	11	1	1	4	1		110	01		100	1				30		90	2	2						90	30		31											100.00	50		50				81.00	45		45												50						45			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	390	0		29	10	S5921_390_0	5			Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											454.00	27						380.00	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								16.00		48.00					1.00		3.00													48.00						3.00				16.00				16.00			0.53	0.03				0.51	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											98.00	50		50				80.00	45		45												50						45			50			50								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											217.00	27						334.00	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								16.00		48.00					1.00		3.00													48.00						3.00				16.00				16.00			0.53	0.03				0.51	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											98.00	50		50				80.00	45		45												50						45			50			50								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											359.00	27						249.00	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								16.00		48.00					1.00		3.00													48.00						3.00				16.00				16.00			0.53	0.03				0.51	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											100.00	50		50				81.00	45		45												50						45			50			50								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											199.00	27						248.00	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								16.00		48.00					1.00		3.00													48.00						3.00				16.00				16.00			0.53	0.03				0.51	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											92.00	50		50				75.00	45		45												50						45			50			50								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											381.00	27						220.00	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								16.00		48.00					1.00		3.00													48.00						3.00				16.00				16.00			0.53	0.03				0.51	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											96.00	50		50				79.00	45		45												50						45			50			50								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											286.00	27						199.00	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								16.00		48.00					1.00		3.00													48.00						3.00				16.00				16.00			0.53	0.03				0.51	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											90.00	50		50				77.00	45		45												50						45			50			50								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											258.00	27						177.00	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								16.00		48.00					1.00		3.00													48.00						3.00				16.00				16.00			0.53	0.03				0.51	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											85.00	50		50				74.00	45		45												50						45			50			50								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											323.00	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								16.00		48.00					1.00		3.00													48.00						3.00				16.00				16.00			0.53	0.03				0.51	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											84.00	50		50				77.00	45		45												50						45			50			50								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											384.00	27						259.00	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								16.00		48.00					1.00		3.00													48.00						3.00				16.00				16.00			0.53	0.03				0.51	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											91.00	50		50				78.00	45		45												50						45			50			50								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											156.00	27						192.00	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								16.00		48.00					1.00		3.00													48.00						3.00				16.00				16.00			0.53	0.03				0.51	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											96.00	50		50				74.00	45		45												50						45			50			50								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											300.00	27						292.00	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								16.00		48.00					1.00		3.00													48.00						3.00				16.00				16.00			0.53	0.03				0.51	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											94.00	50		50				84.00	45		45												50						45			50			50								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											391.00	27						344.00	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								16.00		48.00					1.00		3.00													48.00						3.00				16.00				16.00			0.53	0.03				0.51	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											99.00	50		50				82.00	45		45												50						45			50			50								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											369.00	27						280.00	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								16.00		48.00					1.00		3.00													48.00						3.00				16.00				16.00			0.53	0.03				0.51	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											100.00	50		50				84.00	45		45												50						45			50			50								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											251.00	27						251.00	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								16.00		48.00					1.00		3.00													48.00						3.00				16.00				16.00			0.53	0.03				0.51	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											98.00	50		50				96.00	45		45												50						45			50			50								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											300.00	27						315.00	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								16.00		48.00					1.00		3.00													48.00						3.00				16.00				16.00			0.53	0.03				0.51	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											98.00	50		50				88.00	45		45												50						45			50			50								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											238.00	27						169.00	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								16.00		48.00					1.00		3.00													48.00						3.00				16.00				16.00			0.53	0.03				0.51	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											92.00	50		50				75.00	45		45												50						45			50			50								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											193.00	27						218.00	27												27						27					27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	407	0		29	10	S5921_407_0	3			Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	2	2						90	30		31								16.00		48.00					1.00		3.00													48.00						3.00				16.00				16.00			0.53	0.03				0.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	407	0		29	10	S5921_407_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	407	0		29	10	S5921_407_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	407	0		29	10	S5921_407_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	407	0		29	10	S5921_407_0	3			Non-Preferred Drug	4	11	1	1	4	1		110	01		100	1				30		90	2	2						90	30		31											100.00	50		50				88.00	45		45												50						45			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	407	0		29	10	S5921_407_0	3			Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											281.00	27						355.00	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								16.00		48.00					1.00		3.00													48.00						3.00				16.00				16.00			0.53	0.03				0.51	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											96.00	50		50				79.00	45		45												50						45			50			50								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											411.00	27						221.00	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								16.00		48.00					1.00		3.00													48.00						3.00				16.00				16.00			0.53	0.03				0.51	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											100.00	50		50				88.00	45		45												50						45			50			50								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											250.00	27						293.00	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								16.00		48.00					1.00		3.00													48.00						3.00				16.00				16.00			0.53	0.03				0.51	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											100.00	50		50				87.00	45		45												50						45			50			50								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											463.00	27						364.00	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								16.00		48.00					1.00		3.00													48.00						3.00				16.00				16.00			0.53	0.03				0.51	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											95.00	50		50				73.00	45		45												50						45			50			50								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											257.00	27						292.00	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								16.00		48.00					1.00		3.00													48.00						3.00				16.00				16.00			0.53	0.03				0.51	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											84.00	50		50				79.00	45		45												50						45			50			50								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											348.00	27						238.00	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								16.00		48.00					1.00		3.00													48.00						3.00				16.00				16.00			0.53	0.03				0.51	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											93.00	50		50				76.00	45		45												50						45			50			50								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											259.00	27						331.00	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								16.00		48.00					1.00		3.00													48.00						3.00				16.00				16.00			0.53	0.03				0.51	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											91.00	50		50				97.00	45		45												50						45			50			50								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											601.00	27						346.00	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								16.00		48.00					1.00		3.00													48.00						3.00				16.00				16.00			0.53	0.03				0.51	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	50		50				81.00	45		45												50						45			50			50								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											299.00	27						319.00	27												27						27					27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5953	001	0		29	10	S5953_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								10.00	20.00	30.00					7.00	14.00	21.00					7.00	14.00	17.50																10.00				7.00			0.33	0.23	0.23			0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5953	001	0		29	10	S5953_001_0	3			Generic	3	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		31								20.00	40.00	60.00					15.00	30.00	45.00					15.00	30.00	37.50																20.00				15.00			0.67	0.50	0.50			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5953	001	0		29	10	S5953_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								47.00	94.00	141.00					40.00	80.00	120.00					40.00	80.00	100.00																47.00				40.00			1.57	1.33	1.33			1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5953	001	0		29	10	S5953_001_0	3			Non-Preferred Drug	3	11	1	1	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		31											76.28	50	50	50				68.92	45	45	45				45	45	45															50			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5953	001	0		29	10	S5953_001_0	3			Specialty Tier	3	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	25															25			25								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					0.00	0.00	0.00																5.00				0.00			0.17	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5953	002	0		29	10	S5953_002_0	3			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					0.00	0.00	0.00																5.00				0.00			0.17	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
S5953	002	0		29	10	S5953_002_0	3			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					3.00	6.00	7.50																8.00				3.00			0.27	0.10	0.10			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5953	002	0		29	10	S5953_002_0	3			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					3.00	6.00	7.50																8.00				3.00			0.27	0.10	0.10			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
S5953	002	0		29	10	S5953_002_0	3			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					20.00	40.00	50.00																27.00				20.00			0.90	0.67	0.67			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5953	002	0		29	10	S5953_002_0	3			Non-Preferred Drug	4	11	1	1	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		31											43.77	45	45	45				39.20	40	40	40				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								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5953	004	0		29	10	S5953_004_0	2			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					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												
S5953	004	0		29	10	S5953_004_0	2			Generic	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					5.00	10.00	12.50																20.00				5.00			0.67	0.17	0.17			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5953	004	0		29	10	S5953_004_0	2			Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		31								47.00	94.00	141.00					40.00	80.00	120.00					40.00	80.00	100.00																47.00				40.00			1.57	1.33	1.33			1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5953	004	0		29	10	S5953_004_0	2			Non-Preferred Drug	4	11	1	1	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		31											46.30	50	50	50				51.32	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	2			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	25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5993	001	0		29	10	S5993_001_0	4			Preferred Generic	2	01	1	2	1	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5993	001	0		29	10	S5993_001_0	4			Generic	2	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				7.00	14.00	21.00				14.00				14.00		0.47				0.47	0.23	0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5993	001	0		29	10	S5993_001_0	4			Preferred Brand	2	11	1	2	3	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	34.00	68.00	102.00																									34.00	68.00	102.00				34.00	68.00	102.00				34.00				34.00		1.13				1.13	1.13	1.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5993	001	0		29	10	S5993_001_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				84.70	40	40	40																								40	40	40				40	40	40			40			40								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5993	001	0		29	10	S5993_001_0	4			Specialty Tier	2	11	1	1	5	1	010		01			1	30														30		31				377.90	25																																					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5993	003	0		29	10	S5993_003_0	4			Preferred Generic	4	01	1	2	1	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	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	4			Preferred Generic	4	01	1	2	1	3	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		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	4			Generic	4	01	1	2	2	1	111		01		111	1	30	60	90				1	1				30	60	90	30		31	8.00	16.00	24.00																									8.00	16.00	24.00				4.00	8.00	12.00				8.00				8.00		0.27				0.27	0.13	0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5993	003	0		29	10	S5993_003_0	4			Generic	4	01	1	2	2	3	111		01		111	1	30	60	90				1	1				30	60	90	30		31	8.00	16.00	24.00																									8.00	16.00	24.00				4.00	8.00	12.00				8.00				8.00		0.27				0.27	0.13	0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
S5993	003	0		29	10	S5993_003_0	4			Preferred Brand	4	11	1	2	3	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	40.00	80.00	120.00																									40.00	80.00	120.00				40.00	80.00	120.00				40.00				40.00		1.33				1.33	1.33	1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5993	003	0		29	10	S5993_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				89.23	45	45	45																								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	4			Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31				539.02	33																																					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5993	007	0		29	10	S5993_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								14.00	28.00	42.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			.47	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	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					4.00	8.00	12.00											4.00	8.00	12.00				2.00	4.00	6.00				4.00				4.00			0.67	0.13		0.13	0.07	0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5993	007	0		29	10	S5993_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					35.00	70.00	105.00											35.00	70.00	105.00				35.00	70.00	105.00				35.00				35.00			1.57	1.17		1.17	1.17	1.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5993	007	0		29	10	S5993_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											50.42	46	46	46				49.30	44	44	44										44	44	44				44	44	44			44			44								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5993	007	0		29	10	S5993_007_0	5			Specialty Tier	4	11	1	1	5	1		010	01			1				30											30		31											368.19	25						368.19	25																							25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6506	001	0		29	10	S6506_001_0	3			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												
S6506	001	0		29	10	S6506_001_0	3			Generic	2	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	5.00	10.00	15.00																			5.00	10.00	15.00																5.00				5.00		0.17			0.17			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6506	001	0		29	10	S6506_001_0	3			Preferred Brand	2	11	1	1	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31				58.20	25	25	25																		25	25	25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6506	001	0		29	10	S6506_001_0	3			Non-Preferred Drug	2	11	1	1	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31				69.13	46	46	46																		46	46	46															46			46								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6506	001	0		29	10	S6506_001_0	3			Specialty Tier	2	11	1	1	5	1	010		01	010		1	30								30						30		31					25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6506	002	0		29	10	S6506_002_0	3			Preferred Generic	4	01	1	2	1	1	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6506	002	0		29	10	S6506_002_0	3			Generic	4	01	1	2	2	1	110		01	100		1	30		90				1	2			90				30		31	3.00		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	3			Preferred Brand	4	11	1	1	3	1	110		01	100		1	30		90				1	2			90				30		31				30.00	20		20																				20															20			20								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6506	002	0		29	10	S6506_002_0	3			Non-Preferred Drug	4	11	1	1	4	1	110		01	100		1	30		90				1	2			90				30		31				54.86	45		45																				45															45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6506	002	0		29	10	S6506_002_0	3			Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31					33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	001	0		29	10	S6946_001_0	6			Preferred Generic	2	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								6.00	12.00	18.00					1.00	2.00	3.00											6.00	12.00	18.00				1.00	2.00	3.00				6.00				6.00			0.20	0.03		0.20	0.03	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	001	0		29	10	S6946_001_0	6			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	6			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	6			Non-Preferred Drug	2	10	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											58.00	34	34	34				55.00	34	34	34										34	34	34				34	34	34			34			34								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	001	0		29	10	S6946_001_0	6			Specialty Tier	2	11	1	1	5	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											1036.00	25	25	25				1036.00	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	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	002	0		29	10	S6946_002_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	002	0		29	10	S6946_002_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					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				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	5			Non-Preferred Drug	2	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											58.00	35	35	35				55.00	35	35	35										35	35	35				35	35	35			35			35								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	002	0		29	10	S6946_002_0	5			Specialty Tier	2	11	1	1	5	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											1036.00	25	25	25				1036.00	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	11	1	2	3	1		111	01		111	1				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	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											58.00	38	38	38				55.00	38	38	38										38	38	38				38	38	38			38			38								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											1036.00	25	25	25				1036.00	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	11	1	2	3	1		111	01		111	1				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	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											58.00	35	35	35				55.00	35	35	35										35	35	35				35	35	35			35			35								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											1036.00	25	25	25				1036.00	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	11	1	2	3	1		111	01		111	1				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	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											58.00	35	35	35				55.00	35	35	35										35	35	35				35	35	35			35			35								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											1036.00	25	25	25				1036.00	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	11	1	2	3	1		111	01		111	1				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	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											58.00	35	35	35				55.00	35	35	35										35	35	35				35	35	35			35			35								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											1036.00	25	25	25				1036.00	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	11	1	2	3	1		111	01		111	1				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	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											58.00	34	34	34				55.00	34	34	34										34	34	34				34	34	34			34			34								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											1036.00	25	25	25				1036.00	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	11	1	2	3	1		111	01		111	1				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	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											58.00	34	34	34				55.00	34	34	34										34	34	34				34	34	34			34			34								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											1036.00	25	25	25				1036.00	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	11	1	2	3	1		111	01		111	1				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	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											58.00	32	32	32				55.00	32	32	32										32	32	32				32	32	32			32			32								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											1036.00	25	25	25				1036.00	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	11	1	2	3	1		111	01		111	1				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	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											58.00	32	32	32				55.00	32	32	32										32	32	32				32	32	32			32			32								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											1036.00	25	25	25				1036.00	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	11	1	2	3	1		111	01		111	1				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	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											58.00	35	35	35				55.00	35	35	35										35	35	35				35	35	35			35			35								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											1036.00	25	25	25				1036.00	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	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	012	0		29	10	S6946_012_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	012	0		29	10	S6946_012_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					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				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	5			Non-Preferred Drug	2	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											58.00	35	35	35				55.00	35	35	35										35	35	35				35	35	35			35			35								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	012	0		29	10	S6946_012_0	5			Specialty Tier	2	11	1	1	5	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											1036.00	25	25	25				1036.00	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	11	1	2	3	1		111	01		111	1				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	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											58.00	33	33	33				55.00	33	33	33										33	33	33				33	33	33			33			33								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											1036.00	25	25	25				1036.00	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	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	014	0		29	10	S6946_014_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	014	0		29	10	S6946_014_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					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				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	5			Non-Preferred Drug	2	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											58.00	35	35	35				55.00	35	35	35										35	35	35				35	35	35			35			35								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	014	0		29	10	S6946_014_0	5			Specialty Tier	2	11	1	1	5	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											1036.00	25	25	25				1036.00	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	11	1	2	3	1		111	01		111	1				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	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											58.00	32	32	32				55.00	32	32	32										32	32	32				32	32	32			32			32								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	015	0		29	10	S6946_015_0	4			Specialty Tier	2	11	1	1	5	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											1036.00	25	25	25				1036.00	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	11	1	2	3	1		111	01		111	1				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	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											58.00	32	32	32				55.00	32	32	32										32	32	32				32	32	32			32			32								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											1036.00	25	25	25				1036.00	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	11	1	2	3	1		111	01		111	1				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	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											58.00	36	36	36				55.00	36	36	36										36	36	36				36	36	36			36			36								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											1036.00	25	25	25				1036.00	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	6			Preferred Generic	2	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								6.00	12.00	18.00					1.00	2.00	3.00											6.00	12.00	18.00				1.00	2.00	3.00				6.00				6.00			0.20	0.03		0.20	0.03	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	018	0		29	10	S6946_018_0	6			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	6			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					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				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	6			Non-Preferred Drug	2	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											58.00	36	36	36				55.00	36	36	36										36	36	36				36	36	36			36			36								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	018	0		29	10	S6946_018_0	6			Specialty Tier	2	11	1	1	5	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											1036.00	25	25	25				1036.00	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	6			Preferred Generic	2	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								6.00	12.00	18.00					1.00	2.00	3.00											6.00	12.00	18.00				1.00	2.00	3.00				6.00				6.00			0.20	0.03		0.20	0.03	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	019	0		29	10	S6946_019_0	6			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	6			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					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				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	6			Non-Preferred Drug	2	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											58.00	33	33	33				55.00	33	33	33										33	33	33				33	33	33			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	019	0		29	10	S6946_019_0	6			Specialty Tier	2	11	1	1	5	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											1036.00	25	25	25				1036.00	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	11	1	2	3	1		111	01		111	1				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	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											58.00	32	32	32				55.00	32	32	32										32	32	32				32	32	32			32			32								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											1036.00	25	25	25				1036.00	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	11	1	2	3	1		111	01		111	1				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	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											58.00	31	31	31				55.00	31	31	31										31	31	31				31	31	31			31			31								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											1036.00	25	25	25				1036.00	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	11	1	2	3	1		111	01		111	1				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	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											58.00	32	32	32				55.00	32	32	32										32	32	32				32	32	32			32			32								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											1036.00	25	25	25				1036.00	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	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	023	0		29	10	S6946_023_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	023	0		29	10	S6946_023_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					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				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	5			Non-Preferred Drug	2	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											58.00	37	37	37				55.00	37	37	37										37	37	37				37	37	37			37			37								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	023	0		29	10	S6946_023_0	5			Specialty Tier	2	11	1	1	5	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											1036.00	25	25	25				1036.00	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	6			Preferred Generic	2	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								6.00	12.00	18.00					1.00	2.00	3.00											6.00	12.00	18.00				1.00	2.00	3.00				6.00				6.00			0.20	0.03		0.20	0.03	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	024	0		29	10	S6946_024_0	6			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	6			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					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				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	6			Non-Preferred Drug	2	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											58.00	36	36	36				55.00	36	36	36										36	36	36				36	36	36			36			36								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	024	0		29	10	S6946_024_0	6			Specialty Tier	2	11	1	1	5	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											1036.00	25	25	25				1036.00	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	11	1	2	3	1		111	01		111	1				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	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											58.00	35	35	35				55.00	35	35	35										35	35	35				35	35	35			35			35								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											1036.00	25	25	25				1036.00	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	11	1	2	3	1		111	01		111	1				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	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											58.00	34	34	34				55.00	34	34	34										34	34	34				34	34	34			34			34								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	026	0		29	10	S6946_026_0	4			Specialty Tier	2	11	1	1	5	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											1036.00	25	25	25				1036.00	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	11	1	2	3	1		111	01		111	1				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	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											58.00	35	35	35				55.00	35	35	35										35	35	35				35	35	35			35			35								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	027	0		29	10	S6946_027_0	4			Specialty Tier	2	11	1	1	5	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											1036.00	25	25	25				1036.00	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	11	1	2	3	1		111	01		111	1				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	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											58.00	40	40	40				55.00	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											1036.00	25	25	25				1036.00	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	11	1	2	3	1		111	01		111	1				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	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											58.00	38	38	38				55.00	38	38	38										38	38	38				38	38	38			38			38								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											1036.00	25	25	25				1036.00	25	25	25										25	25	25				25	25	25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	030	0		29	10	S6946_030_0	4		Y	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					1.00	2.00	3.00											15.00	30.00	45.00				1.00	2.00	3.00				15.00				15.00			0.50	0.03		0.50	0.03	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	030	0		29	10	S6946_030_0	4		Y	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					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	4		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				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	4		Y	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											75.00	50	50	50				66.00	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	4		Y	Specialty Tier	4	11	1	1	5	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											1110.00	25	25	25				1110.00	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	3		Y	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					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	3		Y	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					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	3		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				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	3		Y	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											75.00	50	50	50				66.00	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	3		Y	Specialty Tier	4	11	1	1	5	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											1110.00	25	25	25				1110.00	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	3		Y	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					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	3		Y	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					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	3		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				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	3		Y	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											75.00	50	50	50				66.00	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	3		Y	Specialty Tier	4	11	1	1	5	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											1110.00	25	25	25				1110.00	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	3		Y	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					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	3		Y	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					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	3		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				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	3		Y	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											75.00	50	50	50				66.00	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	3		Y	Specialty Tier	4	11	1	1	5	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											1110.00	25	25	25				1110.00	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	3		Y	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					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	3		Y	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					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	3		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				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	3		Y	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											75.00	50	50	50				66.00	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	3		Y	Specialty Tier	4	11	1	1	5	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											1110.00	25	25	25				1110.00	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	3		Y	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					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	3		Y	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					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	3		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				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	3		Y	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											75.00	50	50	50				66.00	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	3		Y	Specialty Tier	4	11	1	1	5	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											1110.00	25	25	25				1110.00	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	3		Y	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					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	3		Y	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					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	3		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				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	3		Y	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											75.00	50	50	50				66.00	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	3		Y	Specialty Tier	4	11	1	1	5	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											1110.00	25	25	25				1110.00	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	3		Y	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					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	3		Y	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					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	3		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				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	3		Y	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											75.00	50	50	50				66.00	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	3		Y	Specialty Tier	4	11	1	1	5	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											1110.00	25	25	25				1110.00	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	3		Y	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					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	3		Y	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					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	3		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				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	3		Y	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											75.00	50	50	50				66.00	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	3		Y	Specialty Tier	4	11	1	1	5	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											1110.00	25	25	25				1110.00	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	3		Y	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					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	3		Y	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					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	3		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				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	3		Y	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											75.00	50	50	50				66.00	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	3		Y	Specialty Tier	4	11	1	1	5	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											1110.00	25	25	25				1110.00	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	3		Y	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					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	3		Y	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					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	3		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				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	3		Y	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											75.00	50	50	50				66.00	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	3		Y	Specialty Tier	4	11	1	1	5	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											1110.00	25	25	25				1110.00	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	3		Y	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					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	3		Y	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					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	3		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				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	3		Y	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											75.00	50	50	50				66.00	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	3		Y	Specialty Tier	4	11	1	1	5	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											1110.00	25	25	25				1110.00	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	3		Y	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					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	3		Y	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					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	3		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				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	3		Y	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											75.00	50	50	50				66.00	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	3		Y	Specialty Tier	4	11	1	1	5	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											1110.00	25	25	25				1110.00	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	3		Y	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					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	3		Y	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					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	3		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				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	3		Y	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											75.00	50	50	50				66.00	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	3		Y	Specialty Tier	4	11	1	1	5	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											1110.00	25	25	25				1110.00	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	3		Y	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					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	3		Y	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					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	3		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				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	3		Y	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											75.00	50	50	50				66.00	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	3		Y	Specialty Tier	4	11	1	1	5	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											1110.00	25	25	25				1110.00	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	3		Y	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					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	3		Y	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					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	3		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				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	3		Y	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											75.00	50	50	50				66.00	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	3		Y	Specialty Tier	4	11	1	1	5	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											1110.00	25	25	25				1110.00	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	3		Y	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					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	3		Y	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					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	3		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				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	3		Y	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											75.00	50	50	50				66.00	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	3		Y	Specialty Tier	4	11	1	1	5	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											1110.00	25	25	25				1110.00	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	3		Y	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					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	3		Y	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					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	3		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				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	3		Y	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											75.00	50	50	50				66.00	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	3		Y	Specialty Tier	4	11	1	1	5	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											1110.00	25	25	25				1110.00	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	3		Y	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					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	3		Y	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					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	3		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				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	3		Y	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											75.00	50	50	50				66.00	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	3		Y	Specialty Tier	4	11	1	1	5	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											1110.00	25	25	25				1110.00	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	3		Y	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					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	3		Y	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					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	3		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				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	3		Y	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											75.00	50	50	50				66.00	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	3		Y	Specialty Tier	4	11	1	1	5	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											1110.00	25	25	25				1110.00	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	3		Y	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					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	3		Y	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					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	3		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				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	3		Y	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											75.00	50	50	50				66.00	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	3		Y	Specialty Tier	4	11	1	1	5	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											1110.00	25	25	25				1110.00	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	3		Y	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					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	3		Y	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					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	3		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				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	3		Y	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											75.00	50	50	50				66.00	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	3		Y	Specialty Tier	4	11	1	1	5	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											1110.00	25	25	25				1110.00	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	3		Y	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					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	3		Y	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					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	3		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				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	3		Y	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											75.00	50	50	50				66.00	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	3		Y	Specialty Tier	4	11	1	1	5	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											1110.00	25	25	25				1110.00	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	3		Y	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					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	3		Y	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					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	3		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				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	3		Y	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											75.00	50	50	50				66.00	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	3		Y	Specialty Tier	4	11	1	1	5	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											1110.00	25	25	25				1110.00	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	3		Y	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					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	3		Y	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					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	3		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				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	3		Y	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											75.00	50	50	50				66.00	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	3		Y	Specialty Tier	4	11	1	1	5	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											1110.00	25	25	25				1110.00	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	3		Y	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					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	3		Y	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					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	3		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				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	3		Y	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											75.00	50	50	50				66.00	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	3		Y	Specialty Tier	4	11	1	1	5	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											1110.00	25	25	25				1110.00	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	3		Y	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					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	3		Y	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					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	3		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				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	3		Y	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											75.00	50	50	50				66.00	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	3		Y	Specialty Tier	4	11	1	1	5	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											1110.00	25	25	25				1110.00	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	3		Y	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					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	3		Y	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					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	3		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				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	3		Y	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											75.00	50	50	50				66.00	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	3		Y	Specialty Tier	4	11	1	1	5	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											1110.00	25	25	25				1110.00	25	25	25										25	25	25				25	25	25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	059	0		29	10	S6946_059_0	5		N	Preferred Generic	2	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								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	059	0		29	10	S6946_059_0	5		N	Generic	2	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								8.00	16.00	24.00					3.00	6.00	9.00											8.00	16.00	24.00				3.00	6.00	9.00				8.00				8.00			0.27	0.10		0.27	0.10	0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	059	0		29	10	S6946_059_0	5		N	Preferred Brand	2	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				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	059	0		29	10	S6946_059_0	5		N	Non-Preferred Drug	2	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											58.00	36	36	36				55.00	36	36	36										36	36	36				36	36	36			36			36								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	059	0		29	10	S6946_059_0	5		N	Specialty Tier	2	11	1	1	5	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											1036.00	25	25	25				1036.00	25	25	25										25	25	25				25	25	25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	060	0		29	10	S6946_060_0	5		N	Preferred Generic	2	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								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	060	0		29	10	S6946_060_0	5		N	Generic	2	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								8.00	16.00	24.00					3.00	6.00	9.00											8.00	16.00	24.00				3.00	6.00	9.00				8.00				8.00			0.27	0.10		0.27	0.10	0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	060	0		29	10	S6946_060_0	5		N	Preferred Brand	2	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				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	060	0		29	10	S6946_060_0	5		N	Non-Preferred Drug	2	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											58.00	36	36	36				55.00	36	36	36										36	36	36				36	36	36			36			36								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	060	0		29	10	S6946_060_0	5		N	Specialty Tier	2	11	1	1	5	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											1036.00	25	25	25				1036.00	25	25	25										25	25	25				25	25	25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	061	0		29	10	S6946_061_0	5		N	Preferred Generic	2	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								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	061	0		29	10	S6946_061_0	5		N	Generic	2	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								8.00	16.00	24.00					3.00	6.00	9.00											8.00	16.00	24.00				3.00	6.00	9.00				8.00				8.00			0.27	0.10		0.27	0.10	0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	061	0		29	10	S6946_061_0	5		N	Preferred Brand	2	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				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	061	0		29	10	S6946_061_0	5		N	Non-Preferred Drug	2	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											58.00	36	36	36				55.00	36	36	36										36	36	36				36	36	36			36			36								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	061	0		29	10	S6946_061_0	5		N	Specialty Tier	2	11	1	1	5	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											1036.00	25	25	25				1036.00	25	25	25										25	25	25				25	25	25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	062	0		29	10	S6946_062_0	5		N	Preferred Generic	2	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								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	062	0		29	10	S6946_062_0	5		N	Generic	2	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								8.00	16.00	24.00					3.00	6.00	9.00											8.00	16.00	24.00				3.00	6.00	9.00				8.00				8.00			0.27	0.10		0.27	0.10	0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	062	0		29	10	S6946_062_0	5		N	Preferred Brand	2	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				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	062	0		29	10	S6946_062_0	5		N	Non-Preferred Drug	2	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											58.00	36	36	36				55.00	36	36	36										36	36	36				36	36	36			36			36								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	062	0		29	10	S6946_062_0	5		N	Specialty Tier	2	11	1	1	5	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											1036.00	25	25	25				1036.00	25	25	25										25	25	25				25	25	25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	063	0		29	10	S6946_063_0	3		Y	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					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	063	0		29	10	S6946_063_0	3		Y	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					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	063	0		29	10	S6946_063_0	3		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				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	063	0		29	10	S6946_063_0	3		Y	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											75.00	50	50	50				66.00	45	45	45										50	50	50				45	45	45			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	063	0		29	10	S6946_063_0	3		Y	Specialty Tier	4	11	1	1	5	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											1110.00	25	25	25				1110.00	25	25	25										25	25	25				25	25	25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	064	0		29	10	S6946_064_0	3		Y	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					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	064	0		29	10	S6946_064_0	3		Y	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					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	064	0		29	10	S6946_064_0	3		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				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	064	0		29	10	S6946_064_0	3		Y	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											75.00	50	50	50				66.00	45	45	45										50	50	50				45	45	45			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	064	0		29	10	S6946_064_0	3		Y	Specialty Tier	4	11	1	1	5	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											1110.00	25	25	25				1110.00	25	25	25										25	25	25				25	25	25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	065	0		29	10	S6946_065_0	3		Y	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					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	065	0		29	10	S6946_065_0	3		Y	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					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	065	0		29	10	S6946_065_0	3		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				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	065	0		29	10	S6946_065_0	3		Y	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											75.00	50	50	50				66.00	45	45	45										50	50	50				45	45	45			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	065	0		29	10	S6946_065_0	3		Y	Specialty Tier	4	11	1	1	5	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											1110.00	25	25	25				1110.00	25	25	25										25	25	25				25	25	25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	066	0		29	10	S6946_066_0	3		Y	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					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	066	0		29	10	S6946_066_0	3		Y	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					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	066	0		29	10	S6946_066_0	3		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				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	066	0		29	10	S6946_066_0	3		Y	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											75.00	50	50	50				66.00	45	45	45										50	50	50				45	45	45			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	066	0		29	10	S6946_066_0	3		Y	Specialty Tier	4	11	1	1	5	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											1110.00	25	25	25				1110.00	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	6		N	Preferred Generic	2	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								8.00		24.00					1.00		3.00													2.50						2.50				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	6		N	Generic	2	01	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								12.00		36.00					5.00		15.00													12.50						12.50				12.00				12.00			0.40	0.17				0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	001	0		29	10	S7126_001_0	6		N	Preferred Brand	2	11	1	1	3	1		110	01		100	1				30		90	1	2						90	30		31											44.90	22		22				40.07	20		20												20						20			22			22								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	001	0		29	10	S7126_001_0	6		N	Non-Preferred Drug	2	11	1	1	4	1		010	01		010	1				30								30			30		31											92.38	42						89.09	40												42						40					42			42								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	001	0		29	10	S7126_001_0	6		N	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	002	0		29	10	S7126_002_0	2		N	Preferred Generic	2	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								8.00		24.00					1.00		3.00													2.50						2.50				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	2		N	Generic	2	01	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								12.00		36.00					5.00		15.00													12.50						12.50				12.00				12.00			0.40	0.17				0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	002	0		29	10	S7126_002_0	2		N	Preferred Brand	2	11	1	1	3	1		110	01		100	1				30		90	1	2						90	30		31											45.31	22		22				41.36	20		20												20						20			22			22								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	002	0		29	10	S7126_002_0	2		N	Non-Preferred Drug	2	11	1	1	4	1		010	01		010	1				30								30			30		31											97.72	40						92.71	38												40						38					40			40								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	002	0		29	10	S7126_002_0	2		N	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	003	0		29	10	S7126_003_0	2		N	Preferred Generic	2	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								8.00		24.00					1.00		3.00													2.50						2.50				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	2		N	Generic	2	01	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								12.00		36.00					5.00		15.00													12.50						12.50				12.00				12.00			0.40	0.17				0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	003	0		29	10	S7126_003_0	2		N	Preferred Brand	2	11	1	1	3	1		110	01		100	1				30		90	1	2						90	30		31											47.60	22		22				43.24	20		20												20						20			22			22								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	003	0		29	10	S7126_003_0	2		N	Non-Preferred Drug	2	11	1	1	4	1		010	01		010	1				30								30			30		31											90.82	40						84.95	38												40						38					40			40								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	003	0		29	10	S7126_003_0	2		N	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	004	0		29	10	S7126_004_0	2		N	Preferred Generic	2	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								8.00		24.00					1.00		3.00													2.50						2.50				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	2		N	Generic	2	01	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								12.00		36.00					5.00		15.00													12.50						12.50				12.00				12.00			0.40	0.17				0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	004	0		29	10	S7126_004_0	2		N	Preferred Brand	2	11	1	1	3	1		110	01		100	1				30		90	1	2						90	30		31											47.79	22		22				43.19	20		20												20						20			22			22								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	004	0		29	10	S7126_004_0	2		N	Non-Preferred Drug	2	11	1	1	4	1		010	01		010	1				30								30			30		31											90.81	40						85.59	38												40						38					40			40								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	004	0		29	10	S7126_004_0	2		N	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	005	0		29	10	S7126_005_0	2		N	Preferred Generic	2	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								8.00		24.00					1.00		3.00													2.50						2.50				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	2		N	Generic	2	01	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								12.00		36.00					5.00		15.00													12.50						12.50				12.00				12.00			0.40	0.17				0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	005	0		29	10	S7126_005_0	2		N	Preferred Brand	2	11	1	1	3	1		110	01		100	1				30		90	1	2						90	30		31											47.56	23		23				43.43	21		21												21						21			23			23								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	005	0		29	10	S7126_005_0	2		N	Non-Preferred Drug	2	11	1	1	4	1		010	01		010	1				30								30			30		31											98.86	42						91.59	40												42						40					42			42								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	005	0		29	10	S7126_005_0	2		N	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	006	0		29	10	S7126_006_0	2		N	Preferred Generic	2	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								8.00		24.00					1.00		3.00													2.50						2.50				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	2		N	Generic	2	01	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								12.00		36.00					5.00		15.00													12.50						12.50				12.00				12.00			0.40	0.17				0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	006	0		29	10	S7126_006_0	2		N	Preferred Brand	2	11	1	1	3	1		110	01		100	1				30		90	1	2						90	30		31											48.49	23		23				43.89	21		21												21						21			23			23								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	006	0		29	10	S7126_006_0	2		N	Non-Preferred Drug	2	11	1	1	4	1		010	01		010	1				30								30			30		31											96.18	41						89.85	39												41						39					41			41								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	006	0		29	10	S7126_006_0	2		N	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	007	0		29	10	S7126_007_0	2		N	Preferred Generic	2	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								8.00		24.00					1.00		3.00													2.50						2.50				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	2		N	Generic	2	01	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								12.00		36.00					5.00		15.00													12.50						12.50				12.00				12.00			0.40	0.17				0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	007	0		29	10	S7126_007_0	2		N	Preferred Brand	2	11	1	1	3	1		110	01		100	1				30		90	1	2						90	30		31											47.84	22		22				43.05	20		20												20						20			22			22								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	007	0		29	10	S7126_007_0	2		N	Non-Preferred Drug	2	11	1	1	4	1		010	01		010	1				30								30			30		31											94.93	44						87.48	42												44						42					44			44								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	007	0		29	10	S7126_007_0	2		N	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	008	0		29	10	S7126_008_0	2		N	Preferred Generic	2	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								8.00		24.00					1.00		3.00													2.50						2.50				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	2		N	Generic	2	01	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								12.00		36.00					5.00		15.00													12.50						12.50				12.00				12.00			0.40	0.17				0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	008	0		29	10	S7126_008_0	2		N	Preferred Brand	2	11	1	1	3	1		110	01		100	1				30		90	1	2						90	30		31											44.84	22		22				40.68	20		20												20						20			22			22								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	008	0		29	10	S7126_008_0	2		N	Non-Preferred Drug	2	11	1	1	4	1		010	01		010	1				30								30			30		31											88.00	39						83.21	37												39						37					39			39								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	008	0		29	10	S7126_008_0	2		N	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	009	0		29	10	S7126_009_0	2		N	Preferred Generic	2	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								8.00		24.00					1.00		3.00													2.50						2.50				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	2		N	Generic	2	01	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								12.00		36.00					5.00		15.00													12.50						12.50				12.00				12.00			0.40	0.17				0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	009	0		29	10	S7126_009_0	2		N	Preferred Brand	2	11	1	1	3	1		110	01		100	1				30		90	1	2						90	30		31											41.58	21		21				37.68	19		19												19						19			21			21								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	009	0		29	10	S7126_009_0	2		N	Non-Preferred Drug	2	11	1	1	4	1		010	01		010	1				30								30			30		31											91.85	39						87.47	37												39						37					39			39								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	009	0		29	10	S7126_009_0	2		N	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	010	0		29	10	S7126_010_0	2		N	Preferred Generic	2	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								8.00		24.00					1.00		3.00													2.50						2.50				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	2		N	Generic	2	01	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								12.00		36.00					5.00		15.00													12.50						12.50				12.00				12.00			0.40	0.17				0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	010	0		29	10	S7126_010_0	2		N	Preferred Brand	2	11	1	1	3	1		110	01		100	1				30		90	1	2						90	30		31											43.51	21		21				40.00	19		19												19						19			21			21								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	010	0		29	10	S7126_010_0	2		N	Non-Preferred Drug	2	11	1	1	4	1		010	01		010	1				30								30			30		31											90.65	38						82.37	36												38						36					38			38								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	010	0		29	10	S7126_010_0	2		N	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	011	0		29	10	S7126_011_0	2		N	Preferred Generic	2	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								8.00		24.00					1.00		3.00													2.50						2.50				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	2		N	Generic	2	01	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								12.00		36.00					5.00		15.00													12.50						12.50				12.00				12.00			0.40	0.17				0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	011	0		29	10	S7126_011_0	2		N	Preferred Brand	2	11	1	1	3	1		110	01		100	1				30		90	1	2						90	30		31											39.26	20		20				35.22	18		18												18						18			20			20								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	011	0		29	10	S7126_011_0	2		N	Non-Preferred Drug	2	11	1	1	4	1		010	01		010	1				30								30			30		31											91.99	40						86.24	38												40						38					40			40								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	011	0		29	10	S7126_011_0	2		N	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	012	0		29	10	S7126_012_0	2		N	Preferred Generic	2	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								8.00		24.00					1.00		3.00													2.50						2.50				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	2		N	Generic	2	01	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								12.00		36.00					5.00		15.00													12.50						12.50				12.00				12.00			0.40	0.17				0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	012	0		29	10	S7126_012_0	2		N	Preferred Brand	2	11	1	1	3	1		110	01		100	1				30		90	1	2						90	30		31											45.16	21		21				41.91	19		19												19						19			21			21								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	012	0		29	10	S7126_012_0	2		N	Non-Preferred Drug	2	11	1	1	4	1		010	01		010	1				30								30			30		31											91.44	38						80.72	36												38						36					38			38								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	012	0		29	10	S7126_012_0	2		N	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	013	0		29	10	S7126_013_0	2		N	Preferred Generic	2	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								8.00		24.00					1.00		3.00													2.50						2.50				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	2		N	Generic	2	01	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								12.00		36.00					5.00		15.00													12.50						12.50				12.00				12.00			0.40	0.17				0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	013	0		29	10	S7126_013_0	2		N	Preferred Brand	2	11	1	1	3	1		110	01		100	1				30		90	1	2						90	30		31											47.23	22		22				43.07	20		20												20						20			22			22								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	013	0		29	10	S7126_013_0	2		N	Non-Preferred Drug	2	11	1	1	4	1		010	01		010	1				30								30			30		31											90.59	41						83.86	39												41						39					41			41								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	013	0		29	10	S7126_013_0	2		N	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	014	0		29	10	S7126_014_0	2		N	Preferred Generic	2	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								8.00		24.00					1.00		3.00													2.50						2.50				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	2		N	Generic	2	01	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								12.00		36.00					5.00		15.00													12.50						12.50				12.00				12.00			0.40	0.17				0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	014	0		29	10	S7126_014_0	2		N	Preferred Brand	2	11	1	1	3	1		110	01		100	1				30		90	1	2						90	30		31											44.88	22		22				40.98	20		20												20						20			22			22								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	014	0		29	10	S7126_014_0	2		N	Non-Preferred Drug	2	11	1	1	4	1		010	01		010	1				30								30			30		31											87.33	40						81.35	38												40						38					40			40								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	014	0		29	10	S7126_014_0	2		N	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	015	0		29	10	S7126_015_0	2		N	Preferred Generic	2	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								8.00		24.00					1.00		3.00													2.50						2.50				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	2		N	Generic	2	01	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								12.00		36.00					5.00		15.00													12.50						12.50				12.00				12.00			0.40	0.17				0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	015	0		29	10	S7126_015_0	2		N	Preferred Brand	2	11	1	1	3	1		110	01		100	1				30		90	1	2						90	30		31											41.23	20		20				38.02	18		18												18						18			20			20								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	015	0		29	10	S7126_015_0	2		N	Non-Preferred Drug	2	11	1	1	4	1		010	01		010	1				30								30			30		31											91.80	38						85.75	36												38						36					38			38								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	015	0		29	10	S7126_015_0	2		N	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	016	0		29	10	S7126_016_0	2		N	Preferred Generic	2	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								8.00		24.00					1.00		3.00													2.50						2.50				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	2		N	Generic	2	01	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								12.00		36.00					5.00		15.00													12.50						12.50				12.00				12.00			0.40	0.17				0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	016	0		29	10	S7126_016_0	2		N	Preferred Brand	2	11	1	1	3	1		110	01		100	1				30		90	1	2						90	30		31											47.71	22		22				43.94	20		20												20						20			22			22								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	016	0		29	10	S7126_016_0	2		N	Non-Preferred Drug	2	11	1	1	4	1		010	01		010	1				30								30			30		31											88.37	39						82.21	37												39						37					39			39								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	016	0		29	10	S7126_016_0	2		N	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	017	0		29	10	S7126_017_0	2		N	Preferred Generic	2	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								8.00		24.00					1.00		3.00													2.50						2.50				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	2		N	Generic	2	01	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								12.00		36.00					5.00		15.00													12.50						12.50				12.00				12.00			0.40	0.17				0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	017	0		29	10	S7126_017_0	2		N	Preferred Brand	2	11	1	1	3	1		110	01		100	1				30		90	1	2						90	30		31											39.23	20		20				35.56	18		18												18						18			20			20								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	017	0		29	10	S7126_017_0	2		N	Non-Preferred Drug	2	11	1	1	4	1		010	01		010	1				30								30			30		31											86.76	40						80.26	38												40						38					40			40								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	017	0		29	10	S7126_017_0	2		N	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	018	0		29	10	S7126_018_0	2		N	Preferred Generic	2	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								8.00		24.00					1.00		3.00													2.50						2.50				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	2		N	Generic	2	01	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								12.00		36.00					5.00		15.00													12.50						12.50				12.00				12.00			0.40	0.17				0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	018	0		29	10	S7126_018_0	2		N	Preferred Brand	2	11	1	1	3	1		110	01		100	1				30		90	1	2						90	30		31											40.90	21		21				37.02	19		19												19						19			21			21								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	018	0		29	10	S7126_018_0	2		N	Non-Preferred Drug	2	11	1	1	4	1		010	01		010	1				30								30			30		31											89.51	39						83.45	37												39						37					39			39								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	018	0		29	10	S7126_018_0	2		N	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	019	0		29	10	S7126_019_0	2		N	Preferred Generic	2	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								8.00		24.00					1.00		3.00													2.50						2.50				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	2		N	Generic	2	01	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								12.00		36.00					5.00		15.00													12.50						12.50				12.00				12.00			0.40	0.17				0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	019	0		29	10	S7126_019_0	2		N	Preferred Brand	2	11	1	1	3	1		110	01		100	1				30		90	1	2						90	30		31											43.17	20		20				38.86	18		18												18						18			20			20								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	019	0		29	10	S7126_019_0	2		N	Non-Preferred Drug	2	11	1	1	4	1		010	01		010	1				30								30			30		31											92.29	40						84.06	38												40						38					40			40								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	019	0		29	10	S7126_019_0	2		N	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	020	0		29	10	S7126_020_0	2		N	Preferred Generic	2	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								8.00		24.00					1.00		3.00													2.50						2.50				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	2		N	Generic	2	01	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								12.00		36.00					5.00		15.00													12.50						12.50				12.00				12.00			0.40	0.17				0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	020	0		29	10	S7126_020_0	2		N	Preferred Brand	2	11	1	1	3	1		110	01		100	1				30		90	1	2						90	30		31											39.97	20		20				36.44	18		18												18						18			20			20								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	020	0		29	10	S7126_020_0	2		N	Non-Preferred Drug	2	11	1	1	4	1		010	01		010	1				30								30			30		31											86.31	39						79.70	37												39						37					39			39								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	020	0		29	10	S7126_020_0	2		N	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	021	0		29	10	S7126_021_0	2		N	Preferred Generic	2	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								8.00		24.00					1.00		3.00													2.50						2.50				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	2		N	Generic	2	01	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								12.00		36.00					5.00		15.00													12.50						12.50				12.00				12.00			0.40	0.17				0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	021	0		29	10	S7126_021_0	2		N	Preferred Brand	2	11	1	1	3	1		110	01		100	1				30		90	1	2						90	30		31											46.23	22		22				42.16	20		20												20						20			22			22								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	021	0		29	10	S7126_021_0	2		N	Non-Preferred Drug	2	11	1	1	4	1		010	01		010	1				30								30			30		31											93.82	41						86.47	39												41						39					41			41								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	021	0		29	10	S7126_021_0	2		N	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	022	0		29	10	S7126_022_0	2		N	Preferred Generic	2	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								8.00		24.00					1.00		3.00													2.50						2.50				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	2		N	Generic	2	01	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								12.00		36.00					5.00		15.00													12.50						12.50				12.00				12.00			0.40	0.17				0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	022	0		29	10	S7126_022_0	2		N	Preferred Brand	2	11	1	1	3	1		110	01		100	1				30		90	1	2						90	30		31											40.04	20		20				36.43	18		18												18						18			20			20								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	022	0		29	10	S7126_022_0	2		N	Non-Preferred Drug	2	11	1	1	4	1		010	01		010	1				30								30			30		31											91.21	40						82.72	38												40						38					40			40								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	022	0		29	10	S7126_022_0	2		N	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	023	0		29	10	S7126_023_0	2		N	Preferred Generic	2	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								8.00		24.00					1.00		3.00													2.50						2.50				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	2		N	Generic	2	01	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								12.00		36.00					5.00		15.00													12.50						12.50				12.00				12.00			0.40	0.17				0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	023	0		29	10	S7126_023_0	2		N	Preferred Brand	2	11	1	1	3	1		110	01		100	1				30		90	1	2						90	30		31											40.53	20		20				36.94	18		18												18						18			20			20								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	023	0		29	10	S7126_023_0	2		N	Non-Preferred Drug	2	11	1	1	4	1		010	01		010	1				30								30			30		31											87.05	39						79.77	37												39						37					39			39								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	023	0		29	10	S7126_023_0	2		N	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	024	0		29	10	S7126_024_0	2		N	Preferred Generic	2	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								8.00		24.00					1.00		3.00													2.50						2.50				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	2		N	Generic	2	01	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								12.00		36.00					5.00		15.00													12.50						12.50				12.00				12.00			0.40	0.17				0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	024	0		29	10	S7126_024_0	2		N	Preferred Brand	2	11	1	1	3	1		110	01		100	1				30		90	1	2						90	30		31											42.03	20		20				38.06	18		18												18						18			20			20								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	024	0		29	10	S7126_024_0	2		N	Non-Preferred Drug	2	11	1	1	4	1		010	01		010	1				30								30			30		31											81.40	39						75.60	37												39						37					39			39								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	024	0		29	10	S7126_024_0	2		N	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	025	0		29	10	S7126_025_0	2		N	Preferred Generic	2	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								8.00		24.00					1.00		3.00													2.50						2.50				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	2		N	Generic	2	01	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								12.00		36.00					5.00		15.00													12.50						12.50				12.00				12.00			0.40	0.17				0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	025	0		29	10	S7126_025_0	2		N	Preferred Brand	2	11	1	1	3	1		110	01		100	1				30		90	1	2						90	30		31											48.26	21		21				43.09	19		19												19						19			21			21								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	025	0		29	10	S7126_025_0	2		N	Non-Preferred Drug	2	11	1	1	4	1		010	01		010	1				30								30			30		31											93.53	38						89.58	36												38						36					38			38								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	025	0		29	10	S7126_025_0	2		N	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	026	0		29	10	S7126_026_0	2		N	Preferred Generic	2	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								8.00		24.00					1.00		3.00													2.50						2.50				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	2		N	Generic	2	01	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								12.00		36.00					5.00		15.00													12.50						12.50				12.00				12.00			0.40	0.17				0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	026	0		29	10	S7126_026_0	2		N	Preferred Brand	2	11	1	1	3	1		110	01		100	1				30		90	1	2						90	30		31											45.68	21		21				41.45	19		19												19						19			21			21								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	026	0		29	10	S7126_026_0	2		N	Non-Preferred Drug	2	11	1	1	4	1		010	01		010	1				30								30			30		31											92.10	39						85.35	37												39						37					39			39								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	026	0		29	10	S7126_026_0	2		N	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	027	0		29	10	S7126_027_0	2		N	Preferred Generic	2	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								8.00		24.00					1.00		3.00													2.50						2.50				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	2		N	Generic	2	01	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								12.00		36.00					5.00		15.00													12.50						12.50				12.00				12.00			0.40	0.17				0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	027	0		29	10	S7126_027_0	2		N	Preferred Brand	2	11	1	1	3	1		110	01		100	1				30		90	1	2						90	30		31											47.25	22		22				42.40	20		20												20						20			22			22								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	027	0		29	10	S7126_027_0	2		N	Non-Preferred Drug	2	11	1	1	4	1		010	01		010	1				30								30			30		31											97.87	40						91.80	38												40						38					40			40								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	027	0		29	10	S7126_027_0	2		N	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	028	0		29	10	S7126_028_0	2		N	Preferred Generic	2	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								8.00		24.00					1.00		3.00													2.50						2.50				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	2		N	Generic	2	01	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								12.00		36.00					5.00		15.00													12.50						12.50				12.00				12.00			0.40	0.17				0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	028	0		29	10	S7126_028_0	2		N	Preferred Brand	2	11	1	1	3	1		110	01		100	1				30		90	1	2						90	30		31											45.97	22		22				42.62	20		20												20						20			22			22								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	028	0		29	10	S7126_028_0	2		N	Non-Preferred Drug	2	11	1	1	4	1		010	01		010	1				30								30			30		31											98.61	41						89.87	39												41						39					41			41								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	028	0		29	10	S7126_028_0	2		N	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	029	0		29	10	S7126_029_0	2		N	Preferred Generic	2	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								8.00		24.00					1.00		3.00													2.50						2.50				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	2		N	Generic	2	01	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								12.00		36.00					5.00		15.00													12.50						12.50				12.00				12.00			0.40	0.17				0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	029	0		29	10	S7126_029_0	2		N	Preferred Brand	2	11	1	1	3	1		110	01		100	1				30		90	1	2						90	30		31											43.30	21		21				39.38	19		19												19						19			21			21								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	029	0		29	10	S7126_029_0	2		N	Non-Preferred Drug	2	11	1	1	4	1		010	01		010	1				30								30			30		31											94.10	39						85.99	37												39						37					39			39								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	029	0		29	10	S7126_029_0	2		N	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	030	0		29	10	S7126_030_0	2		N	Preferred Generic	2	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								8.00		24.00					1.00		3.00													2.50						2.50				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	2		N	Generic	2	01	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								12.00		36.00					5.00		15.00													12.50						12.50				12.00				12.00			0.40	0.17				0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	030	0		29	10	S7126_030_0	2		N	Preferred Brand	2	11	1	1	3	1		110	01		100	1				30		90	1	2						90	30		31											44.85	21		21				40.50	19		19												19						19			21			21								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	030	0		29	10	S7126_030_0	2		N	Non-Preferred Drug	2	11	1	1	4	1		010	01		010	1				30								30			30		31											91.82	40						87.42	38												40						38					40			40								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	030	0		29	10	S7126_030_0	2		N	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	031	0		29	10	S7126_031_0	2		N	Preferred Generic	2	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								8.00		24.00					1.00		3.00													2.50						2.50				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	2		N	Generic	2	01	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								12.00		36.00					5.00		15.00													12.50						12.50				12.00				12.00			0.40	0.17				0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	031	0		29	10	S7126_031_0	2		N	Preferred Brand	2	11	1	1	3	1		110	01		100	1				30		90	1	2						90	30		31											46.66	22		22				42.37	20		20												20						20			22			22								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	031	0		29	10	S7126_031_0	2		N	Non-Preferred Drug	2	11	1	1	4	1		010	01		010	1				30								30			30		31											98.69	38						89.06	36												38						36					38			38								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	031	0		29	10	S7126_031_0	2		N	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	032	0		29	10	S7126_032_0	2		N	Preferred Generic	2	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								8.00		24.00					1.00		3.00													2.50						2.50				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	2		N	Generic	2	01	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								12.00		36.00					5.00		15.00													12.50						12.50				12.00				12.00			0.40	0.17				0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	032	0		29	10	S7126_032_0	2		N	Preferred Brand	2	11	1	1	3	1		110	01		100	1				30		90	1	2						90	30		31											50.13	22		22				44.94	20		20												20						20			22			22								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	032	0		29	10	S7126_032_0	2		N	Non-Preferred Drug	2	11	1	1	4	1		010	01		010	1				30								30			30		31											97.54	41						95.96	39												41						39					41			41								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	032	0		29	10	S7126_032_0	2		N	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	033	0		29	10	S7126_033_0	2		N	Preferred Generic	2	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								8.00		24.00					1.00		3.00													2.50						2.50				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	2		N	Generic	2	01	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								12.00		36.00					5.00		15.00													12.50						12.50				12.00				12.00			0.40	0.17				0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	033	0		29	10	S7126_033_0	2		N	Preferred Brand	2	11	1	1	3	1		110	01		100	1				30		90	1	2						90	30		31											48.89	22		22				44.53	20		20												20						20			22			22								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	033	0		29	10	S7126_033_0	2		N	Non-Preferred Drug	2	11	1	1	4	1		010	01		010	1				30								30			30		31											94.63	39						88.96	37												39						37					39			39								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	033	0		29	10	S7126_033_0	2		N	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	071	0		29	10	S7126_071_0	3		Y	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								8.00		24.00					1.00		3.00													2.50						2.50				8.00				8.00			0.27	0.03				0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	071	0		29	10	S7126_071_0	3		Y	Generic	4	01	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								17.00		51.00					10.00		30.00													25.00						25.00				17.00				17.00			0.57	0.33				0.55	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	071	0		29	10	S7126_071_0	3		Y	Preferred Brand	4	11	1	2	3	1		110	01		100	1				30		90	1	2						90	30		31								47.00		141.00					45.00		135.00													112.50						112.50				47.00				47.00			1.57	1.50				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	071	0		29	10	S7126_071_0	3		Y	Non-Preferred Drug	4	11	1	1	4	1		010	01		010	1				30								30			30		31											85.12	47						80.48	45												47						45					47			47								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	071	0		29	10	S7126_071_0	3		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	072	0		29	10	S7126_072_0	2		Y	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								8.00		24.00					1.00		3.00													2.50						2.50				8.00				8.00			0.27	0.03				0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	072	0		29	10	S7126_072_0	2		Y	Generic	4	01	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								17.00		51.00					10.00		30.00													25.00						25.00				17.00				17.00			0.57	0.33				0.55	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	072	0		29	10	S7126_072_0	2		Y	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						112.50				47.00				47.00			1.57	1.50				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	072	0		29	10	S7126_072_0	2		Y	Non-Preferred Drug	4	11	1	1	4	1		010	01		010	1				30								30			30		31											78.95	47						73.93	45												47						45					47			47								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	072	0		29	10	S7126_072_0	2		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	073	0		29	10	S7126_073_0	2		Y	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								8.00		24.00					1.00		3.00													2.50						2.50				8.00				8.00			0.27	0.03				0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	073	0		29	10	S7126_073_0	2		Y	Generic	4	01	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								17.00		51.00					10.00		30.00													25.00						25.00				17.00				17.00			0.57	0.33				0.55	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	073	0		29	10	S7126_073_0	2		Y	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						112.50				47.00				47.00			1.57	1.50				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	073	0		29	10	S7126_073_0	2		Y	Non-Preferred Drug	4	11	1	1	4	1		010	01		010	1				30								30			30		31											83.71	47						78.73	45												47						45					47			47								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	073	0		29	10	S7126_073_0	2		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	074	0		29	10	S7126_074_0	2		Y	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								8.00		24.00					1.00		3.00													2.50						2.50				8.00				8.00			0.27	0.03				0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	074	0		29	10	S7126_074_0	2		Y	Generic	4	01	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								17.00		51.00					10.00		30.00													25.00						25.00				17.00				17.00			0.57	0.33				0.55	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	074	0		29	10	S7126_074_0	2		Y	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						112.50				47.00				47.00			1.57	1.50				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	074	0		29	10	S7126_074_0	2		Y	Non-Preferred Drug	4	11	1	1	4	1		010	01		010	1				30								30			30		31											99.37	47						92.23	45												47						45					47			47								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	074	0		29	10	S7126_074_0	2		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	075	0		29	10	S7126_075_0	2		Y	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								8.00		24.00					1.00		3.00													2.50						2.50				8.00				8.00			0.27	0.03				0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	075	0		29	10	S7126_075_0	2		Y	Generic	4	01	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								17.00		51.00					10.00		30.00													25.00						25.00				17.00				17.00			0.57	0.33				0.55	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	075	0		29	10	S7126_075_0	2		Y	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						112.50				47.00				47.00			1.57	1.50				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	075	0		29	10	S7126_075_0	2		Y	Non-Preferred Drug	4	11	1	1	4	1		010	01		010	1				30								30			30		31											86.69	47						84.19	45												47						45					47			47								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	075	0		29	10	S7126_075_0	2		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	076	0		29	10	S7126_076_0	2		Y	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								8.00		24.00					1.00		3.00													2.50						2.50				8.00				8.00			0.27	0.03				0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	076	0		29	10	S7126_076_0	2		Y	Generic	4	01	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								17.00		51.00					10.00		30.00													25.00						25.00				17.00				17.00			0.57	0.33				0.55	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	076	0		29	10	S7126_076_0	2		Y	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						112.50				47.00				47.00			1.57	1.50				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	076	0		29	10	S7126_076_0	2		Y	Non-Preferred Drug	4	11	1	1	4	1		010	01		010	1				30								30			30		31											75.77	47						70.85	45												47						45					47			47								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	076	0		29	10	S7126_076_0	2		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	077	0		29	10	S7126_077_0	2		Y	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								8.00		24.00					1.00		3.00													2.50						2.50				8.00				8.00			0.27	0.03				0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	077	0		29	10	S7126_077_0	2		Y	Generic	4	01	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								17.00		51.00					10.00		30.00													25.00						25.00				17.00				17.00			0.57	0.33				0.55	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	077	0		29	10	S7126_077_0	2		Y	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						112.50				47.00				47.00			1.57	1.50				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	077	0		29	10	S7126_077_0	2		Y	Non-Preferred Drug	4	11	1	1	4	1		010	01		010	1				30								30			30		31											71.44	47						66.42	45												47						45					47			47								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	077	0		29	10	S7126_077_0	2		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	078	0		29	10	S7126_078_0	2		Y	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								8.00		24.00					1.00		3.00													2.50						2.50				8.00				8.00			0.27	0.03				0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	078	0		29	10	S7126_078_0	2		Y	Generic	4	01	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								17.00		51.00					10.00		30.00													25.00						25.00				17.00				17.00			0.57	0.33				0.55	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	078	0		29	10	S7126_078_0	2		Y	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						112.50				47.00				47.00			1.57	1.50				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	078	0		29	10	S7126_078_0	2		Y	Non-Preferred Drug	4	11	1	1	4	1		010	01		010	1				30								30			30		31											80.42	47						75.32	45												47						45					47			47								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	078	0		29	10	S7126_078_0	2		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	079	0		29	10	S7126_079_0	2		Y	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								8.00		24.00					1.00		3.00													2.50						2.50				8.00				8.00			0.27	0.03				0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	079	0		29	10	S7126_079_0	2		Y	Generic	4	01	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								17.00		51.00					10.00		30.00													25.00						25.00				17.00				17.00			0.57	0.33				0.55	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	079	0		29	10	S7126_079_0	2		Y	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						112.50				47.00				47.00			1.57	1.50				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	079	0		29	10	S7126_079_0	2		Y	Non-Preferred Drug	4	11	1	1	4	1		010	01		010	1				30								30			30		31											86.74	47						83.60	45												47						45					47			47								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	079	0		29	10	S7126_079_0	2		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	080	0		29	10	S7126_080_0	2		Y	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								8.00		24.00					1.00		3.00													2.50						2.50				8.00				8.00			0.27	0.03				0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	080	0		29	10	S7126_080_0	2		Y	Generic	4	01	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								17.00		51.00					10.00		30.00													25.00						25.00				17.00				17.00			0.57	0.33				0.55	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	080	0		29	10	S7126_080_0	2		Y	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						112.50				47.00				47.00			1.57	1.50				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	080	0		29	10	S7126_080_0	2		Y	Non-Preferred Drug	4	11	1	1	4	1		010	01		010	1				30								30			30		31											86.69	47						82.24	45												47						45					47			47								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	080	0		29	10	S7126_080_0	2		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	081	0		29	10	S7126_081_0	2		Y	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								8.00		24.00					1.00		3.00													2.50						2.50				8.00				8.00			0.27	0.03				0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	081	0		29	10	S7126_081_0	2		Y	Generic	4	01	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								17.00		51.00					10.00		30.00													25.00						25.00				17.00				17.00			0.57	0.33				0.55	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	081	0		29	10	S7126_081_0	2		Y	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						112.50				47.00				47.00			1.57	1.50				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	081	0		29	10	S7126_081_0	2		Y	Non-Preferred Drug	4	11	1	1	4	1		010	01		010	1				30								30			30		31											77.81	47						74.43	45												47						45					47			47								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	081	0		29	10	S7126_081_0	2		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	082	0		29	10	S7126_082_0	2		Y	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								8.00		24.00					1.00		3.00													2.50						2.50				8.00				8.00			0.27	0.03				0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	082	0		29	10	S7126_082_0	2		Y	Generic	4	01	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								17.00		51.00					10.00		30.00													25.00						25.00				17.00				17.00			0.57	0.33				0.55	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	082	0		29	10	S7126_082_0	2		Y	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						112.50				47.00				47.00			1.57	1.50				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	082	0		29	10	S7126_082_0	2		Y	Non-Preferred Drug	4	11	1	1	4	1		010	01		010	1				30								30			30		31											80.02	47						73.32	45												47						45					47			47								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	082	0		29	10	S7126_082_0	2		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	083	0		29	10	S7126_083_0	2		Y	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								8.00		24.00					1.00		3.00													2.50						2.50				8.00				8.00			0.27	0.03				0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	083	0		29	10	S7126_083_0	2		Y	Generic	4	01	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								17.00		51.00					10.00		30.00													25.00						25.00				17.00				17.00			0.57	0.33				0.55	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	083	0		29	10	S7126_083_0	2		Y	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						112.50				47.00				47.00			1.57	1.50				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	083	0		29	10	S7126_083_0	2		Y	Non-Preferred Drug	4	11	1	1	4	1		010	01		010	1				30								30			30		31											81.90	47						76.76	45												47						45					47			47								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	083	0		29	10	S7126_083_0	2		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	084	0		29	10	S7126_084_0	2		Y	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								8.00		24.00					1.00		3.00													2.50						2.50				8.00				8.00			0.27	0.03				0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	084	0		29	10	S7126_084_0	2		Y	Generic	4	01	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								17.00		51.00					10.00		30.00													25.00						25.00				17.00				17.00			0.57	0.33				0.55	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	084	0		29	10	S7126_084_0	2		Y	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						112.50				47.00				47.00			1.57	1.50				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	084	0		29	10	S7126_084_0	2		Y	Non-Preferred Drug	4	11	1	1	4	1		010	01		010	1				30								30			30		31											79.20	47						74.62	45												47						45					47			47								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	084	0		29	10	S7126_084_0	2		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	085	0		29	10	S7126_085_0	2		Y	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								8.00		24.00					1.00		3.00													2.50						2.50				8.00				8.00			0.27	0.03				0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	085	0		29	10	S7126_085_0	2		Y	Generic	4	01	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								17.00		51.00					10.00		30.00													25.00						25.00				17.00				17.00			0.57	0.33				0.55	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	085	0		29	10	S7126_085_0	2		Y	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						112.50				47.00				47.00			1.57	1.50				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	085	0		29	10	S7126_085_0	2		Y	Non-Preferred Drug	4	11	1	1	4	1		010	01		010	1				30								30			30		31											94.39	47						90.74	45												47						45					47			47								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	085	0		29	10	S7126_085_0	2		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	086	0		29	10	S7126_086_0	2		Y	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								8.00		24.00					1.00		3.00													2.50						2.50				8.00				8.00			0.27	0.03				0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	086	0		29	10	S7126_086_0	2		Y	Generic	4	01	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								17.00		51.00					10.00		30.00													25.00						25.00				17.00				17.00			0.57	0.33				0.55	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	086	0		29	10	S7126_086_0	2		Y	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						112.50				47.00				47.00			1.57	1.50				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	086	0		29	10	S7126_086_0	2		Y	Non-Preferred Drug	4	11	1	1	4	1		010	01		010	1				30								30			30		31											84.94	47						79.40	45												47						45					47			47								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	086	0		29	10	S7126_086_0	2		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	087	0		29	10	S7126_087_0	2		Y	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								8.00		24.00					1.00		3.00													2.50						2.50				8.00				8.00			0.27	0.03				0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	087	0		29	10	S7126_087_0	2		Y	Generic	4	01	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								17.00		51.00					10.00		30.00													25.00						25.00				17.00				17.00			0.57	0.33				0.55	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	087	0		29	10	S7126_087_0	2		Y	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						112.50				47.00				47.00			1.57	1.50				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	087	0		29	10	S7126_087_0	2		Y	Non-Preferred Drug	4	11	1	1	4	1		010	01		010	1				30								30			30		31											74.11	47						70.86	45												47						45					47			47								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	087	0		29	10	S7126_087_0	2		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	088	0		29	10	S7126_088_0	2		Y	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								8.00		24.00					1.00		3.00													2.50						2.50				8.00				8.00			0.27	0.03				0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	088	0		29	10	S7126_088_0	2		Y	Generic	4	01	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								17.00		51.00					10.00		30.00													25.00						25.00				17.00				17.00			0.57	0.33				0.55	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	088	0		29	10	S7126_088_0	2		Y	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						112.50				47.00				47.00			1.57	1.50				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	088	0		29	10	S7126_088_0	2		Y	Non-Preferred Drug	4	11	1	1	4	1		010	01		010	1				30								30			30		31											89.78	47						87.34	45												47						45					47			47								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	088	0		29	10	S7126_088_0	2		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	089	0		29	10	S7126_089_0	2		Y	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								8.00		24.00					1.00		3.00													2.50						2.50				8.00				8.00			0.27	0.03				0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	089	0		29	10	S7126_089_0	2		Y	Generic	4	01	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								17.00		51.00					10.00		30.00													25.00						25.00				17.00				17.00			0.57	0.33				0.55	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	089	0		29	10	S7126_089_0	2		Y	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						112.50				47.00				47.00			1.57	1.50				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	089	0		29	10	S7126_089_0	2		Y	Non-Preferred Drug	4	11	1	1	4	1		010	01		010	1				30								30			30		31											87.00	47						85.18	45												47						45					47			47								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	089	0		29	10	S7126_089_0	2		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	090	0		29	10	S7126_090_0	2		Y	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								8.00		24.00					1.00		3.00													2.50						2.50				8.00				8.00			0.27	0.03				0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	090	0		29	10	S7126_090_0	2		Y	Generic	4	01	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								17.00		51.00					10.00		30.00													25.00						25.00				17.00				17.00			0.57	0.33				0.55	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	090	0		29	10	S7126_090_0	2		Y	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						112.50				47.00				47.00			1.57	1.50				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	090	0		29	10	S7126_090_0	2		Y	Non-Preferred Drug	4	11	1	1	4	1		010	01		010	1				30								30			30		31											76.13	47						69.97	45												47						45					47			47								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	090	0		29	10	S7126_090_0	2		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	091	0		29	10	S7126_091_0	2		Y	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								8.00		24.00					1.00		3.00													2.50						2.50				8.00				8.00			0.27	0.03				0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	091	0		29	10	S7126_091_0	2		Y	Generic	4	01	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								17.00		51.00					10.00		30.00													25.00						25.00				17.00				17.00			0.57	0.33				0.55	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	091	0		29	10	S7126_091_0	2		Y	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						112.50				47.00				47.00			1.57	1.50				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	091	0		29	10	S7126_091_0	2		Y	Non-Preferred Drug	4	11	1	1	4	1		010	01		010	1				30								30			30		31											85.27	47						80.43	45												47						45					47			47								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	091	0		29	10	S7126_091_0	2		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	092	0		29	10	S7126_092_0	2		Y	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								8.00		24.00					1.00		3.00													2.50						2.50				8.00				8.00			0.27	0.03				0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	092	0		29	10	S7126_092_0	2		Y	Generic	4	01	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								17.00		51.00					10.00		30.00													25.00						25.00				17.00				17.00			0.57	0.33				0.55	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	092	0		29	10	S7126_092_0	2		Y	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						112.50				47.00				47.00			1.57	1.50				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	092	0		29	10	S7126_092_0	2		Y	Non-Preferred Drug	4	11	1	1	4	1		010	01		010	1				30								30			30		31											78.23	47						74.22	45												47						45					47			47								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	092	0		29	10	S7126_092_0	2		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	093	0		29	10	S7126_093_0	2		Y	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								8.00		24.00					1.00		3.00													2.50						2.50				8.00				8.00			0.27	0.03				0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	093	0		29	10	S7126_093_0	2		Y	Generic	4	01	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								17.00		51.00					10.00		30.00													25.00						25.00				17.00				17.00			0.57	0.33				0.55	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	093	0		29	10	S7126_093_0	2		Y	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						112.50				47.00				47.00			1.57	1.50				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	093	0		29	10	S7126_093_0	2		Y	Non-Preferred Drug	4	11	1	1	4	1		010	01		010	1				30								30			30		31											84.49	47						81.41	45												47						45					47			47								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	093	0		29	10	S7126_093_0	2		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	094	0		29	10	S7126_094_0	2		Y	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								8.00		24.00					1.00		3.00													2.50						2.50				8.00				8.00			0.27	0.03				0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	094	0		29	10	S7126_094_0	2		Y	Generic	4	01	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								17.00		51.00					10.00		30.00													25.00						25.00				17.00				17.00			0.57	0.33				0.55	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	094	0		29	10	S7126_094_0	2		Y	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						112.50				47.00				47.00			1.57	1.50				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	094	0		29	10	S7126_094_0	2		Y	Non-Preferred Drug	4	11	1	1	4	1		010	01		010	1				30								30			30		31											79.35	47						76.10	45												47						45					47			47								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	094	0		29	10	S7126_094_0	2		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	095	0		29	10	S7126_095_0	2		Y	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								8.00		24.00					1.00		3.00													2.50						2.50				8.00				8.00			0.27	0.03				0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	095	0		29	10	S7126_095_0	2		Y	Generic	4	01	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								17.00		51.00					10.00		30.00													25.00						25.00				17.00				17.00			0.57	0.33				0.55	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	095	0		29	10	S7126_095_0	2		Y	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						112.50				47.00				47.00			1.57	1.50				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	095	0		29	10	S7126_095_0	2		Y	Non-Preferred Drug	4	11	1	1	4	1		010	01		010	1				30								30			30		31											84.89	47						80.94	45												47						45					47			47								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	095	0		29	10	S7126_095_0	2		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	096	0		29	10	S7126_096_0	2		Y	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								8.00		24.00					1.00		3.00													2.50						2.50				8.00				8.00			0.27	0.03				0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	096	0		29	10	S7126_096_0	2		Y	Generic	4	01	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								17.00		51.00					10.00		30.00													25.00						25.00				17.00				17.00			0.57	0.33				0.55	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	096	0		29	10	S7126_096_0	2		Y	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						112.50				47.00				47.00			1.57	1.50				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	096	0		29	10	S7126_096_0	2		Y	Non-Preferred Drug	4	11	1	1	4	1		010	01		010	1				30								30			30		31											85.55	47						80.83	45												47						45					47			47								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	096	0		29	10	S7126_096_0	2		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	097	0		29	10	S7126_097_0	2		Y	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								8.00		24.00					1.00		3.00													2.50						2.50				8.00				8.00			0.27	0.03				0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	097	0		29	10	S7126_097_0	2		Y	Generic	4	01	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								17.00		51.00					10.00		30.00													25.00						25.00				17.00				17.00			0.57	0.33				0.55	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	097	0		29	10	S7126_097_0	2		Y	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						112.50				47.00				47.00			1.57	1.50				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	097	0		29	10	S7126_097_0	2		Y	Non-Preferred Drug	4	11	1	1	4	1		010	01		010	1				30								30			30		31											99.62	47						91.40	45												47						45					47			47								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	097	0		29	10	S7126_097_0	2		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	098	0		29	10	S7126_098_0	2		Y	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								8.00		24.00					1.00		3.00													2.50						2.50				8.00				8.00			0.27	0.03				0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	098	0		29	10	S7126_098_0	2		Y	Generic	4	01	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								17.00		51.00					10.00		30.00													25.00						25.00				17.00				17.00			0.57	0.33				0.55	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	098	0		29	10	S7126_098_0	2		Y	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						112.50				47.00				47.00			1.57	1.50				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	098	0		29	10	S7126_098_0	2		Y	Non-Preferred Drug	4	11	1	1	4	1		010	01		010	1				30								30			30		31											99.08	47						90.60	45												47						45					47			47								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	098	0		29	10	S7126_098_0	2		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	099	0		29	10	S7126_099_0	2		Y	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								8.00		24.00					1.00		3.00													2.50						2.50				8.00				8.00			0.27	0.03				0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	099	0		29	10	S7126_099_0	2		Y	Generic	4	01	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								17.00		51.00					10.00		30.00													25.00						25.00				17.00				17.00			0.57	0.33				0.55	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	099	0		29	10	S7126_099_0	2		Y	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						112.50				47.00				47.00			1.57	1.50				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	099	0		29	10	S7126_099_0	2		Y	Non-Preferred Drug	4	11	1	1	4	1		010	01		010	1				30								30			30		31											74.25	47						72.73	45												47						45					47			47								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	099	0		29	10	S7126_099_0	2		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	100	0		29	10	S7126_100_0	2		Y	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								8.00		24.00					1.00		3.00													2.50						2.50				8.00				8.00			0.27	0.03				0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	100	0		29	10	S7126_100_0	2		Y	Generic	4	01	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								17.00		51.00					10.00		30.00													25.00						25.00				17.00				17.00			0.57	0.33				0.55	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	100	0		29	10	S7126_100_0	2		Y	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						112.50				47.00				47.00			1.57	1.50				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	100	0		29	10	S7126_100_0	2		Y	Non-Preferred Drug	4	11	1	1	4	1		010	01		010	1				30								30			30		31											79.51	47						74.73	45												47						45					47			47								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	100	0		29	10	S7126_100_0	2		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	101	0		29	10	S7126_101_0	2		Y	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								8.00		24.00					1.00		3.00													2.50						2.50				8.00				8.00			0.27	0.03				0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	101	0		29	10	S7126_101_0	2		Y	Generic	4	01	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								17.00		51.00					10.00		30.00													25.00						25.00				17.00				17.00			0.57	0.33				0.55	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	101	0		29	10	S7126_101_0	2		Y	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						112.50				47.00				47.00			1.57	1.50				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	101	0		29	10	S7126_101_0	2		Y	Non-Preferred Drug	4	11	1	1	4	1		010	01		010	1				30								30			30		31											81.94	47						76.24	45												47						45					47			47								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	101	0		29	10	S7126_101_0	2		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	102	0		29	10	S7126_102_0	2		Y	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								8.00		24.00					1.00		3.00													2.50						2.50				8.00				8.00			0.27	0.03				0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	102	0		29	10	S7126_102_0	2		Y	Generic	4	01	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								17.00		51.00					10.00		30.00													25.00						25.00				17.00				17.00			0.57	0.33				0.55	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	102	0		29	10	S7126_102_0	2		Y	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						112.50				47.00				47.00			1.57	1.50				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	102	0		29	10	S7126_102_0	2		Y	Non-Preferred Drug	4	11	1	1	4	1		010	01		010	1				30								30			30		31											86.38	47						83.89	45												47						45					47			47								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	102	0		29	10	S7126_102_0	2		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	103	0		29	10	S7126_103_0	2		Y	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								8.00		24.00					1.00		3.00													2.50						2.50				8.00				8.00			0.27	0.03				0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	103	0		29	10	S7126_103_0	2		Y	Generic	4	01	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								17.00		51.00					10.00		30.00													25.00						25.00				17.00				17.00			0.57	0.33				0.55	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	103	0		29	10	S7126_103_0	2		Y	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						112.50				47.00				47.00			1.57	1.50				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	103	0		29	10	S7126_103_0	2		Y	Non-Preferred Drug	4	11	1	1	4	1		010	01		010	1				30								30			30		31											99.51	47						97.84	45												47						45					47			47								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	103	0		29	10	S7126_103_0	2		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	104	0		29	10	S7126_104_0	2		N	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								15.00		45.00					0.00		0.00													0.00						0.00				15.00				15.00			0.50	0.00				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	104	0		29	10	S7126_104_0	2		N	Generic	4	01	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								20.00		60.00					15.00		45.00													37.50						37.50				20.00				20.00			0.67	0.50				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	104	0		29	10	S7126_104_0	2		N	Preferred Brand	4	11	1	1	3	1		110	01		100	1				30		90	1	2						90	30		31											51.62	22		22				46.94	20		20												20						20			22			22								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	104	0		29	10	S7126_104_0	2		N	Non-Preferred Drug	4	11	1	1	4	1		010	01		010	1				30								30			30		31											68.78	50						65.49	48												50						48					50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	104	0		29	10	S7126_104_0	2		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	105	0		29	10	S7126_105_0	1		N	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								15.00		45.00					0.00		0.00													0.00						0.00				15.00				15.00			0.50	0.00				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	105	0		29	10	S7126_105_0	1		N	Generic	4	01	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								20.00		60.00					15.00		45.00													37.50						37.50				20.00				20.00			0.67	0.50				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	105	0		29	10	S7126_105_0	1		N	Preferred Brand	4	11	1	1	3	1		110	01		100	1				30		90	1	2						90	30		31											51.08	22		22				46.44	20		20												20						20			22			22								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	105	0		29	10	S7126_105_0	1		N	Non-Preferred Drug	4	11	1	1	4	1		010	01		010	1				30								30			30		31											69.50	50						66.38	48												50						48					50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	105	0		29	10	S7126_105_0	1		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	106	0		29	10	S7126_106_0	1		N	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								15.00		45.00					0.00		0.00													0.00						0.00				15.00				15.00			0.50	0.00				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	106	0		29	10	S7126_106_0	1		N	Generic	4	01	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								20.00		60.00					15.00		45.00													37.50						37.50				20.00				20.00			0.67	0.50				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	106	0		29	10	S7126_106_0	1		N	Preferred Brand	4	11	1	1	3	1		110	01		100	1				30		90	1	2						90	30		31											51.16	22		22				46.45	20		20												20						20			22			22								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	106	0		29	10	S7126_106_0	1		N	Non-Preferred Drug	4	11	1	1	4	1		010	01		010	1				30								30			30		31											66.91	50						63.68	48												50						48					50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	106	0		29	10	S7126_106_0	1		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	107	0		29	10	S7126_107_0	1		N	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								15.00		45.00					0.00		0.00													0.00						0.00				15.00				15.00			0.50	0.00				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	107	0		29	10	S7126_107_0	1		N	Generic	4	01	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								20.00		60.00					15.00		45.00													37.50						37.50				20.00				20.00			0.67	0.50				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	107	0		29	10	S7126_107_0	1		N	Preferred Brand	4	11	1	1	3	1		110	01		100	1				30		90	1	2						90	30		31											50.81	22		22				46.16	20		20												20						20			22			22								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	107	0		29	10	S7126_107_0	1		N	Non-Preferred Drug	4	11	1	1	4	1		010	01		010	1				30								30			30		31											69.54	50						66.44	48												50						48					50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	107	0		29	10	S7126_107_0	1		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	108	0		29	10	S7126_108_0	1		N	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								15.00		45.00					0.00		0.00													0.00						0.00				15.00				15.00			0.50	0.00				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	108	0		29	10	S7126_108_0	1		N	Generic	4	01	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								20.00		60.00					15.00		45.00													37.50						37.50				20.00				20.00			0.67	0.50				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	108	0		29	10	S7126_108_0	1		N	Preferred Brand	4	11	1	1	3	1		110	01		100	1				30		90	1	2						90	30		31											51.01	22		22				46.36	20		20												20						20			22			22								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	108	0		29	10	S7126_108_0	1		N	Non-Preferred Drug	4	11	1	1	4	1		010	01		010	1				30								30			30		31											67.05	50						63.90	48												50						48					50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	108	0		29	10	S7126_108_0	1		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	109	0		29	10	S7126_109_0	1		N	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								15.00		45.00					0.00		0.00													0.00						0.00				15.00				15.00			0.50	0.00				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	109	0		29	10	S7126_109_0	1		N	Generic	4	01	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								20.00		60.00					15.00		45.00													37.50						37.50				20.00				20.00			0.67	0.50				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	109	0		29	10	S7126_109_0	1		N	Preferred Brand	4	11	1	1	3	1		110	01		100	1				30		90	1	2						90	30		31											50.57	22		22				45.94	20		20												20						20			22			22								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	109	0		29	10	S7126_109_0	1		N	Non-Preferred Drug	4	11	1	1	4	1		010	01		010	1				30								30			30		31											66.81	50						63.68	48												50						48					50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	109	0		29	10	S7126_109_0	1		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	110	0		29	10	S7126_110_0	1		N	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								15.00		45.00					0.00		0.00													0.00						0.00				15.00				15.00			0.50	0.00				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	110	0		29	10	S7126_110_0	1		N	Generic	4	01	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								20.00		60.00					15.00		45.00													37.50						37.50				20.00				20.00			0.67	0.50				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	110	0		29	10	S7126_110_0	1		N	Preferred Brand	4	11	1	1	3	1		110	01		100	1				30		90	1	2						90	30		31											50.38	22		22				45.74	20		20												20						20			22			22								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	110	0		29	10	S7126_110_0	1		N	Non-Preferred Drug	4	11	1	1	4	1		010	01		010	1				30								30			30		31											66.63	50						63.52	48												50						48					50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	110	0		29	10	S7126_110_0	1		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	111	0		29	10	S7126_111_0	1		N	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								15.00		45.00					0.00		0.00													0.00						0.00				15.00				15.00			0.50	0.00				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	111	0		29	10	S7126_111_0	1		N	Generic	4	01	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								20.00		60.00					15.00		45.00													37.50						37.50				20.00				20.00			0.67	0.50				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	111	0		29	10	S7126_111_0	1		N	Preferred Brand	4	11	1	1	3	1		110	01		100	1				30		90	1	2						90	30		31											50.69	22		22				46.03	20		20												20						20			22			22								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	111	0		29	10	S7126_111_0	1		N	Non-Preferred Drug	4	11	1	1	4	1		010	01		010	1				30								30			30		31											67.46	50						64.36	48												50						48					50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	111	0		29	10	S7126_111_0	1		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	112	0		29	10	S7126_112_0	1		N	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								15.00		45.00					0.00		0.00													0.00						0.00				15.00				15.00			0.50	0.00				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	112	0		29	10	S7126_112_0	1		N	Generic	4	01	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								20.00		60.00					15.00		45.00													37.50						37.50				20.00				20.00			0.67	0.50				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	112	0		29	10	S7126_112_0	1		N	Preferred Brand	4	11	1	1	3	1		110	01		100	1				30		90	1	2						90	30		31											50.43	22		22				45.78	20		20												20						20			22			22								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	112	0		29	10	S7126_112_0	1		N	Non-Preferred Drug	4	11	1	1	4	1		010	01		010	1				30								30			30		31											67.45	50						64.34	48												50						48					50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	112	0		29	10	S7126_112_0	1		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	113	0		29	10	S7126_113_0	1		N	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								15.00		45.00					0.00		0.00													0.00						0.00				15.00				15.00			0.50	0.00				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	113	0		29	10	S7126_113_0	1		N	Generic	4	01	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								20.00		60.00					15.00		45.00													37.50						37.50				20.00				20.00			0.67	0.50				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	113	0		29	10	S7126_113_0	1		N	Preferred Brand	4	11	1	1	3	1		110	01		100	1				30		90	1	2						90	30		31											50.70	22		22				46.06	20		20												20						20			22			22								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	113	0		29	10	S7126_113_0	1		N	Non-Preferred Drug	4	11	1	1	4	1		010	01		010	1				30								30			30		31											67.01	50						63.87	48												50						48					50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	113	0		29	10	S7126_113_0	1		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	114	0		29	10	S7126_114_0	1		N	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								15.00		45.00					0.00		0.00													0.00						0.00				15.00				15.00			0.50	0.00				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	114	0		29	10	S7126_114_0	1		N	Generic	4	01	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								20.00		60.00					15.00		45.00													37.50						37.50				20.00				20.00			0.67	0.50				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	114	0		29	10	S7126_114_0	1		N	Preferred Brand	4	11	1	1	3	1		110	01		100	1				30		90	1	2						90	30		31											49.50	22		22				44.94	20		20												20						20			22			22								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	114	0		29	10	S7126_114_0	1		N	Non-Preferred Drug	4	11	1	1	4	1		010	01		010	1				30								30			30		31											66.48	50						63.36	48												50						48					50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	114	0		29	10	S7126_114_0	1		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	115	0		29	10	S7126_115_0	1		N	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								15.00		45.00					0.00		0.00													0.00						0.00				15.00				15.00			0.50	0.00				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	115	0		29	10	S7126_115_0	1		N	Generic	4	01	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								20.00		60.00					15.00		45.00													37.50						37.50				20.00				20.00			0.67	0.50				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	115	0		29	10	S7126_115_0	1		N	Preferred Brand	4	11	1	1	3	1		110	01		100	1				30		90	1	2						90	30		31											51.13	22		22				46.49	20		20												20						20			22			22								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	115	0		29	10	S7126_115_0	1		N	Non-Preferred Drug	4	11	1	1	4	1		010	01		010	1				30								30			30		31											68.09	50						64.94	48												50						48					50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	115	0		29	10	S7126_115_0	1		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	116	0		29	10	S7126_116_0	1		N	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								15.00		45.00					0.00		0.00													0.00						0.00				15.00				15.00			0.50	0.00				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	116	0		29	10	S7126_116_0	1		N	Generic	4	01	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								20.00		60.00					15.00		45.00													37.50						37.50				20.00				20.00			0.67	0.50				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	116	0		29	10	S7126_116_0	1		N	Preferred Brand	4	11	1	1	3	1		110	01		100	1				30		90	1	2						90	30		31											50.49	22		22				45.90	20		20												20						20			22			22								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	116	0		29	10	S7126_116_0	1		N	Non-Preferred Drug	4	11	1	1	4	1		010	01		010	1				30								30			30		31											66.08	50						62.96	48												50						48					50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	116	0		29	10	S7126_116_0	1		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	117	0		29	10	S7126_117_0	1		N	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								15.00		45.00					0.00		0.00													0.00						0.00				15.00				15.00			0.50	0.00				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	117	0		29	10	S7126_117_0	1		N	Generic	4	01	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								20.00		60.00					15.00		45.00													37.50						37.50				20.00				20.00			0.67	0.50				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	117	0		29	10	S7126_117_0	1		N	Preferred Brand	4	11	1	1	3	1		110	01		100	1				30		90	1	2						90	30		31											49.68	22		22				45.10	20		20												20						20			22			22								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	117	0		29	10	S7126_117_0	1		N	Non-Preferred Drug	4	11	1	1	4	1		010	01		010	1				30								30			30		31											66.32	50						63.21	48												50						48					50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	117	0		29	10	S7126_117_0	1		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	118	0		29	10	S7126_118_0	1		N	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								15.00		45.00					0.00		0.00													0.00						0.00				15.00				15.00			0.50	0.00				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	118	0		29	10	S7126_118_0	1		N	Generic	4	01	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								20.00		60.00					15.00		45.00													37.50						37.50				20.00				20.00			0.67	0.50				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	118	0		29	10	S7126_118_0	1		N	Preferred Brand	4	11	1	1	3	1		110	01		100	1				30		90	1	2						90	30		31											49.63	22		22				45.06	20		20												20						20			22			22								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	118	0		29	10	S7126_118_0	1		N	Non-Preferred Drug	4	11	1	1	4	1		010	01		010	1				30								30			30		31											64.85	50						61.73	48												50						48					50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	118	0		29	10	S7126_118_0	1		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	119	0		29	10	S7126_119_0	1		N	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								15.00		45.00					0.00		0.00													0.00						0.00				15.00				15.00			0.50	0.00				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	119	0		29	10	S7126_119_0	1		N	Generic	4	01	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								20.00		60.00					15.00		45.00													37.50						37.50				20.00				20.00			0.67	0.50				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	119	0		29	10	S7126_119_0	1		N	Preferred Brand	4	11	1	1	3	1		110	01		100	1				30		90	1	2						90	30		31											50.19	22		22				45.60	20		20												20						20			22			22								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	119	0		29	10	S7126_119_0	1		N	Non-Preferred Drug	4	11	1	1	4	1		010	01		010	1				30								30			30		31											66.56	50						63.46	48												50						48					50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	119	0		29	10	S7126_119_0	1		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	120	0		29	10	S7126_120_0	1		N	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								15.00		45.00					0.00		0.00													0.00						0.00				15.00				15.00			0.50	0.00				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	120	0		29	10	S7126_120_0	1		N	Generic	4	01	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								20.00		60.00					15.00		45.00													37.50						37.50				20.00				20.00			0.67	0.50				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	120	0		29	10	S7126_120_0	1		N	Preferred Brand	4	11	1	1	3	1		110	01		100	1				30		90	1	2						90	30		31											49.56	22		22				44.99	20		20												20						20			22			22								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	120	0		29	10	S7126_120_0	1		N	Non-Preferred Drug	4	11	1	1	4	1		010	01		010	1				30								30			30		31											65.80	50						62.69	48												50						48					50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	120	0		29	10	S7126_120_0	1		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	121	0		29	10	S7126_121_0	1		N	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								15.00		45.00					0.00		0.00													0.00						0.00				15.00				15.00			0.50	0.00				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	121	0		29	10	S7126_121_0	1		N	Generic	4	01	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								20.00		60.00					15.00		45.00													37.50						37.50				20.00				20.00			0.67	0.50				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	121	0		29	10	S7126_121_0	1		N	Preferred Brand	4	11	1	1	3	1		110	01		100	1				30		90	1	2						90	30		31											49.37	22		22				44.81	20		20												20						20			22			22								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	121	0		29	10	S7126_121_0	1		N	Non-Preferred Drug	4	11	1	1	4	1		010	01		010	1				30								30			30		31											67.10	50						64.03	48												50						48					50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	121	0		29	10	S7126_121_0	1		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	122	0		29	10	S7126_122_0	1		N	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								15.00		45.00					0.00		0.00													0.00						0.00				15.00				15.00			0.50	0.00				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	122	0		29	10	S7126_122_0	1		N	Generic	4	01	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								20.00		60.00					15.00		45.00													37.50						37.50				20.00				20.00			0.67	0.50				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	122	0		29	10	S7126_122_0	1		N	Preferred Brand	4	11	1	1	3	1		110	01		100	1				30		90	1	2						90	30		31											49.34	22		22				44.80	20		20												20						20			22			22								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	122	0		29	10	S7126_122_0	1		N	Non-Preferred Drug	4	11	1	1	4	1		010	01		010	1				30								30			30		31											66.06	50						62.93	48												50						48					50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	122	0		29	10	S7126_122_0	1		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	123	0		29	10	S7126_123_0	1		N	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								15.00		45.00					0.00		0.00													0.00						0.00				15.00				15.00			0.50	0.00				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	123	0		29	10	S7126_123_0	1		N	Generic	4	01	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								20.00		60.00					15.00		45.00													37.50						37.50				20.00				20.00			0.67	0.50				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	123	0		29	10	S7126_123_0	1		N	Preferred Brand	4	11	1	1	3	1		110	01		100	1				30		90	1	2						90	30		31											49.14	22		22				44.60	20		20												20						20			22			22								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	123	0		29	10	S7126_123_0	1		N	Non-Preferred Drug	4	11	1	1	4	1		010	01		010	1				30								30			30		31											68.35	50						65.30	48												50						48					50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	123	0		29	10	S7126_123_0	1		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	124	0		29	10	S7126_124_0	1		N	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								15.00		45.00					0.00		0.00													0.00						0.00				15.00				15.00			0.50	0.00				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	124	0		29	10	S7126_124_0	1		N	Generic	4	01	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								20.00		60.00					15.00		45.00													37.50						37.50				20.00				20.00			0.67	0.50				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	124	0		29	10	S7126_124_0	1		N	Preferred Brand	4	11	1	1	3	1		110	01		100	1				30		90	1	2						90	30		31											50.39	22		22				45.75	20		20												20						20			22			22								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	124	0		29	10	S7126_124_0	1		N	Non-Preferred Drug	4	11	1	1	4	1		010	01		010	1				30								30			30		31											66.43	50						63.32	48												50						48					50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	124	0		29	10	S7126_124_0	1		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	125	0		29	10	S7126_125_0	1		N	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								15.00		45.00					0.00		0.00													0.00						0.00				15.00				15.00			0.50	0.00				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	125	0		29	10	S7126_125_0	1		N	Generic	4	01	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								20.00		60.00					15.00		45.00													37.50						37.50				20.00				20.00			0.67	0.50				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	125	0		29	10	S7126_125_0	1		N	Preferred Brand	4	11	1	1	3	1		110	01		100	1				30		90	1	2						90	30		31											49.30	22		22				44.72	20		20												20						20			22			22								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	125	0		29	10	S7126_125_0	1		N	Non-Preferred Drug	4	11	1	1	4	1		010	01		010	1				30								30			30		31											66.38	50						63.19	48												50						48					50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	125	0		29	10	S7126_125_0	1		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	126	0		29	10	S7126_126_0	1		N	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								15.00		45.00					0.00		0.00													0.00						0.00				15.00				15.00			0.50	0.00				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	126	0		29	10	S7126_126_0	1		N	Generic	4	01	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								20.00		60.00					15.00		45.00													37.50						37.50				20.00				20.00			0.67	0.50				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	126	0		29	10	S7126_126_0	1		N	Preferred Brand	4	11	1	1	3	1		110	01		100	1				30		90	1	2						90	30		31											49.44	22		22				44.88	20		20												20						20			22			22								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	126	0		29	10	S7126_126_0	1		N	Non-Preferred Drug	4	11	1	1	4	1		010	01		010	1				30								30			30		31											65.03	50						61.93	48												50						48					50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	126	0		29	10	S7126_126_0	1		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	127	0		29	10	S7126_127_0	1		N	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								15.00		45.00					0.00		0.00													0.00						0.00				15.00				15.00			0.50	0.00				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	127	0		29	10	S7126_127_0	1		N	Generic	4	01	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								20.00		60.00					15.00		45.00													37.50						37.50				20.00				20.00			0.67	0.50				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	127	0		29	10	S7126_127_0	1		N	Preferred Brand	4	11	1	1	3	1		110	01		100	1				30		90	1	2						90	30		31											50.03	22		22				45.43	20		20												20						20			22			22								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	127	0		29	10	S7126_127_0	1		N	Non-Preferred Drug	4	11	1	1	4	1		010	01		010	1				30								30			30		31											65.69	50						62.62	48												50						48					50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	127	0		29	10	S7126_127_0	1		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	128	0		29	10	S7126_128_0	1		N	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								15.00		45.00					0.00		0.00													0.00						0.00				15.00				15.00			0.50	0.00				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	128	0		29	10	S7126_128_0	1		N	Generic	4	01	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								20.00		60.00					15.00		45.00													37.50						37.50				20.00				20.00			0.67	0.50				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	128	0		29	10	S7126_128_0	1		N	Preferred Brand	4	11	1	1	3	1		110	01		100	1				30		90	1	2						90	30		31											51.64	22		22				47.01	20		20												20						20			22			22								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	128	0		29	10	S7126_128_0	1		N	Non-Preferred Drug	4	11	1	1	4	1		010	01		010	1				30								30			30		31											68.50	50						65.18	48												50						48					50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	128	0		29	10	S7126_128_0	1		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	129	0		29	10	S7126_129_0	1		N	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								15.00		45.00					0.00		0.00													0.00						0.00				15.00				15.00			0.50	0.00				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	129	0		29	10	S7126_129_0	1		N	Generic	4	01	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								20.00		60.00					15.00		45.00													37.50						37.50				20.00				20.00			0.67	0.50				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	129	0		29	10	S7126_129_0	1		N	Preferred Brand	4	11	1	1	3	1		110	01		100	1				30		90	1	2						90	30		31											52.05	22		22				47.33	20		20												20						20			22			22								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	129	0		29	10	S7126_129_0	1		N	Non-Preferred Drug	4	11	1	1	4	1		010	01		010	1				30								30			30		31											70.09	50						66.83	48												50						48					50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	129	0		29	10	S7126_129_0	1		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	130	0		29	10	S7126_130_0	1		N	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								15.00		45.00					0.00		0.00													0.00						0.00				15.00				15.00			0.50	0.00				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	130	0		29	10	S7126_130_0	1		N	Generic	4	01	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								20.00		60.00					15.00		45.00													37.50						37.50				20.00				20.00			0.67	0.50				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	130	0		29	10	S7126_130_0	1		N	Preferred Brand	4	11	1	1	3	1		110	01		100	1				30		90	1	2						90	30		31											51.75	22		22				47.08	20		20												20						20			22			22								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	130	0		29	10	S7126_130_0	1		N	Non-Preferred Drug	4	11	1	1	4	1		010	01		010	1				30								30			30		31											67.58	50						64.24	48												50						48					50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	130	0		29	10	S7126_130_0	1		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	131	0		29	10	S7126_131_0	1		N	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								15.00		45.00					0.00		0.00													0.00						0.00				15.00				15.00			0.50	0.00				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	131	0		29	10	S7126_131_0	1		N	Generic	4	01	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								20.00		60.00					15.00		45.00													37.50						37.50				20.00				20.00			0.67	0.50				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	131	0		29	10	S7126_131_0	1		N	Preferred Brand	4	11	1	1	3	1		110	01		100	1				30		90	1	2						90	30		31											51.31	22		22				46.66	20		20												20						20			22			22								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	131	0		29	10	S7126_131_0	1		N	Non-Preferred Drug	4	11	1	1	4	1		010	01		010	1				30								30			30		31											67.33	50						64.15	48												50						48					50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	131	0		29	10	S7126_131_0	1		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	132	0		29	10	S7126_132_0	1		N	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								15.00		45.00					0.00		0.00													0.00						0.00				15.00				15.00			0.50	0.00				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	132	0		29	10	S7126_132_0	1		N	Generic	4	01	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								20.00		60.00					15.00		45.00													37.50						37.50				20.00				20.00			0.67	0.50				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	132	0		29	10	S7126_132_0	1		N	Preferred Brand	4	11	1	1	3	1		110	01		100	1				30		90	1	2						90	30		31											51.88	22		22				47.24	20		20												20						20			22			22								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	132	0		29	10	S7126_132_0	1		N	Non-Preferred Drug	4	11	1	1	4	1		010	01		010	1				30								30			30		31											68.27	50						64.93	48												50						48					50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	132	0		29	10	S7126_132_0	1		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	133	0		29	10	S7126_133_0	1		N	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								15.00		45.00					0.00		0.00													0.00						0.00				15.00				15.00			0.50	0.00				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	133	0		29	10	S7126_133_0	1		N	Generic	4	01	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								20.00		60.00					15.00		45.00													37.50						37.50				20.00				20.00			0.67	0.50				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	133	0		29	10	S7126_133_0	1		N	Preferred Brand	4	11	1	1	3	1		110	01		100	1				30		90	1	2						90	30		31											50.43	22		22				45.81	20		20												20						20			22			22								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	133	0		29	10	S7126_133_0	1		N	Non-Preferred Drug	4	11	1	1	4	1		010	01		010	1				30								30			30		31											67.22	50						64.11	48												50						48					50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	133	0		29	10	S7126_133_0	1		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	134	0		29	10	S7126_134_0	1		N	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								15.00		45.00					0.00		0.00													0.00						0.00				15.00				15.00			0.50	0.00				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	134	0		29	10	S7126_134_0	1		N	Generic	4	01	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								20.00		60.00					15.00		45.00													37.50						37.50				20.00				20.00			0.67	0.50				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	134	0		29	10	S7126_134_0	1		N	Preferred Brand	4	11	1	1	3	1		110	01		100	1				30		90	1	2						90	30		31											51.67	22		22				46.98	20		20												20						20			22			22								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	134	0		29	10	S7126_134_0	1		N	Non-Preferred Drug	4	11	1	1	4	1		010	01		010	1				30								30			30		31											68.53	50						65.34	48												50						48					50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	134	0		29	10	S7126_134_0	1		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	135	0		29	10	S7126_135_0	1		N	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								15.00		45.00					0.00		0.00													0.00						0.00				15.00				15.00			0.50	0.00				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	135	0		29	10	S7126_135_0	1		N	Generic	4	01	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								20.00		60.00					15.00		45.00													37.50						37.50				20.00				20.00			0.67	0.50				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	135	0		29	10	S7126_135_0	1		N	Preferred Brand	4	11	1	1	3	1		110	01		100	1				30		90	1	2						90	30		31											52.51	22		22				47.80	20		20												20						20			22			22								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	135	0		29	10	S7126_135_0	1		N	Non-Preferred Drug	4	11	1	1	4	1		010	01		010	1				30								30			30		31											72.62	50						69.31	48												50						48					50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	135	0		29	10	S7126_135_0	1		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	136	0		29	10	S7126_136_0	1		N	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								15.00		45.00					0.00		0.00													0.00						0.00				15.00				15.00			0.50	0.00				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	136	0		29	10	S7126_136_0	1		N	Generic	4	01	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								20.00		60.00					15.00		45.00													37.50						37.50				20.00				20.00			0.67	0.50				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	136	0		29	10	S7126_136_0	1		N	Preferred Brand	4	11	1	1	3	1		110	01		100	1				30		90	1	2						90	30		31											51.74	22		22				47.02	20		20												20						20			22			22								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	136	0		29	10	S7126_136_0	1		N	Non-Preferred Drug	4	11	1	1	4	1		010	01		010	1				30								30			30		31											72.05	50						68.92	48												50						48					50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	136	0		29	10	S7126_136_0	1		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	001	0		29	10	S7694_001_0	7			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	7			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	7			Preferred Brand	2	11	1	1	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											37.26	18	18	18				34.75	15	15	15										18	18	18				15	15	15			18			18								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	001	0		29	10	S7694_001_0	7			Non-Preferred Drug	2	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											74.70	42	42	42				80.24	39	39	39										42	42	42				39	39	39			42			42								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	001	0		29	10	S7694_001_0	7			Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31											700.19	25						770.39	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	002	0		29	10	S7694_002_0	6			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	6			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	6			Preferred Brand	2	11	1	1	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											37.83	18	18	18				35.13	15	15	15										18	18	18				15	15	15			18			18								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	002	0		29	10	S7694_002_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											79.39	45	45	45				82.31	42	42	42										45	45	45				42	42	42			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	002	0		29	10	S7694_002_0	6			Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31											759.80	25						926.08	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	003	0		29	10	S7694_003_0	6			Preferred Generic	2	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								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	6			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	6			Preferred Brand	2	11	1	1	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											36.01	18	18	18				34.98	15	15	15										18	18	18				15	15	15			18			18								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	003	0		29	10	S7694_003_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											55.37	38	38	38				63.97	35	35	35										38	38	38				35	35	35			38			38								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	003	0		29	10	S7694_003_0	6			Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31											665.40	25						785.92	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	004	0		29	10	S7694_004_0	6			Preferred Generic	2	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								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	6			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	6			Preferred Brand	2	11	1	1	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											32.03	18	18	18				30.62	15	15	15										18	18	18				15	15	15			18			18								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	004	0		29	10	S7694_004_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											54.57	38	38	38				61.42	35	35	35										38	38	38				35	35	35			38			38								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	004	0		29	10	S7694_004_0	6			Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31											621.04	25						634.65	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	005	0		29	10	S7694_005_0	6			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	6			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	6			Preferred Brand	2	11	1	1	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											36.24	18	18	18				33.72	15	15	15										18	18	18				15	15	15			18			18								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	005	0		29	10	S7694_005_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											79.88	43	43	43				83.02	40	40	40										43	43	43				40	40	40			43			43								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	005	0		29	10	S7694_005_0	6			Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31											590.72	25						699.39	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	006	0		29	10	S7694_006_0	6			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	6			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	6			Preferred Brand	2	11	1	1	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											34.13	18	18	18				33.91	15	15	15										18	18	18				15	15	15			18			18								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	006	0		29	10	S7694_006_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											59.57	41	41	41				71.22	38	38	38										41	41	41				38	38	38			41			41								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	006	0		29	10	S7694_006_0	6			Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31											690.86	25						800.60	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	007	0		29	10	S7694_007_0	6			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	6			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	6			Preferred Brand	2	11	1	1	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											32.75	18	18	18				30.99	15	15	15										18	18	18				15	15	15			18			18								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	007	0		29	10	S7694_007_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											65.85	43	43	43				72.01	40	40	40										43	43	43				40	40	40			43			43								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	007	0		29	10	S7694_007_0	6			Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31											683.17	25						894.16	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	008	0		29	10	S7694_008_0	6			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	6			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	6			Preferred Brand	2	11	1	1	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											36.04	18	18	18				33.84	15	15	15										18	18	18				15	15	15			18			18								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	008	0		29	10	S7694_008_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											72.14	44	44	44				77.96	41	41	41										44	44	44				41	41	41			44			44								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	008	0		29	10	S7694_008_0	6			Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31											639.40	25						749.13	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	009	0		29	10	S7694_009_0	6			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	6			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	6			Preferred Brand	2	11	1	1	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											32.12	18	18	18				32.24	15	15	15										18	18	18				15	15	15			18			18								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	009	0		29	10	S7694_009_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											55.59	39	39	39				62.45	36	36	36										39	39	39				36	36	36			39			39								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	009	0		29	10	S7694_009_0	6			Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31											705.94	25						944.67	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	010	0		29	10	S7694_010_0	6			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	6			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	6			Preferred Brand	2	11	1	1	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											29.92	18	18	18				31.99	15	15	15										18	18	18				15	15	15			18			18								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	010	0		29	10	S7694_010_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											53.04	37	37	37				65.20	34	34	34										37	37	37				34	34	34			37			37								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	010	0		29	10	S7694_010_0	6			Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31											598.80	25						685.81	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	011	0		29	10	S7694_011_0	6			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	6			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	6			Preferred Brand	2	11	1	1	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											29.93	18	18	18				28.36	15	15	15										18	18	18				15	15	15			18			18								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	011	0		29	10	S7694_011_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											60.48	41	41	41				59.39	38	38	38										41	41	41				38	38	38			38			38								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	011	0		29	10	S7694_011_0	6			Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31											639.85	25						725.37	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	012	0		29	10	S7694_012_0	6			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	6			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	6			Preferred Brand	2	11	1	1	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											29.43	18	18	18				28.52	15	15	15										18	18	18				15	15	15			18			18								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	012	0		29	10	S7694_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											59.71	41	41	41				61.31	38	38	38										41	41	41				38	38	38			41			41								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	012	0		29	10	S7694_012_0	6			Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31											693.93	25						802.13	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	014	0		29	10	S7694_014_0	6			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	6			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	6			Preferred Brand	2	11	1	1	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											29.42	18	18	18				34.75	15	15	15										18	18	18				15	15	15			18			18								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	014	0		29	10	S7694_014_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											38.93	34	34	34				50.87	31	31	31										34	34	34				31	31	31			34			34								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	014	0		29	10	S7694_014_0	6			Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31											545.59	25						702.84	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	015	0		29	10	S7694_015_0	6			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	6			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	6			Preferred Brand	2	11	1	1	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											30.28	18	18	18				29.11	15	15	15										18	18	18				15	15	15			18			18								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	015	0		29	10	S7694_015_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											60.59	43	43	43				58.23	40	40	40										43	43	43				40	40	40			43			43								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	015	0		29	10	S7694_015_0	6			Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31											690.77	25						822.27	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	016	0		29	10	S7694_016_0	6			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	6			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	6			Preferred Brand	2	11	1	1	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											34.36	18	18	18				32.69	15	15	15										18	18	18				15	15	15			18			18								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	016	0		29	10	S7694_016_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											54.66	35	35	35				62.61	32	32	32										35	35	35				32	32	32			35			35								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	016	0		29	10	S7694_016_0	6			Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31											656.78	25						767.53	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	017	0		29	10	S7694_017_0	6			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	6			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	6			Preferred Brand	2	11	1	1	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											33.75	18	18	18				31.53	15	15	15										18	18	18				15	15	15			18			18								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	017	0		29	10	S7694_017_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											60.22	37	37	37				67.63	34	34	34										37	37	37				34	34	34			37			37								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	017	0		29	10	S7694_017_0	6			Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31											688.47	25						786.55	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	018	0		29	10	S7694_018_0	6			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	6			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	6			Preferred Brand	2	11	1	1	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											29.29	18	18	18				27.70	15	15	15										18	18	18				15	15	15			18			18								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	018	0		29	10	S7694_018_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											62.15	48	48	48				63.70	45	45	45										48	48	48				45	45	45			48			48								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	018	0		29	10	S7694_018_0	6			Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31											804.51	25						705.25	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	019	0		29	10	S7694_019_0	6			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	6			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	6			Preferred Brand	2	11	1	1	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											31.20	18	18	18				25.88	15	15	15										18	18	18				15	15	15			18			18								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	019	0		29	10	S7694_019_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											53.98	41	41	41				49.30	38	38	38										41	41	41				38	38	38			41			41								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	019	0		29	10	S7694_019_0	6			Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31											872.44	25						633.16	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	020	0		29	10	S7694_020_0	6			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	6			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	6			Preferred Brand	2	11	1	1	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											29.12	18	18	18				30.08	15	15	15										18	18	18				15	15	15			18			18								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	020	0		29	10	S7694_020_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											50.15	36	36	36				56.35	33	33	33										36	36	36				33	33	33			36			36								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	020	0		29	10	S7694_020_0	6			Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31											676.51	25						758.15	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	021	0		29	10	S7694_021_0	6			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	6			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	6			Preferred Brand	2	11	1	1	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											32.23	18	18	18				28.60	15	15	15										18	18	18				15	15	15			18			18								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	021	0		29	10	S7694_021_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											59.03	40	40	40				58.90	37	37	37										40	40	40				37	37	37			40			40								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	021	0		29	10	S7694_021_0	6			Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31											708.33	25						706.04	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	022	0		29	10	S7694_022_0	6			Preferred Generic	2	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								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	6			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	6			Preferred Brand	2	11	1	1	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											31.90	18	18	18				28.88	15	15	15										18	18	18				15	15	15			18			18								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	022	0		29	10	S7694_022_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											67.04	42	42	42				65.58	39	39	39										42	42	42				39	39	39			42			42								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	022	0		29	10	S7694_022_0	6			Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31											545.72	25						707.48	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	023	0		29	10	S7694_023_0	6			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	6			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	6			Preferred Brand	2	11	1	1	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											33.33	18	18	18				31.05	15	15	15										18	18	18				15	15	15			18			18								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	023	0		29	10	S7694_023_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											60.92	41	41	41				62.58	38	38	38										41	41	41				38	38	38			41			41								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	023	0		29	10	S7694_023_0	6			Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31											844.58	25						771.72	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	024	0		29	10	S7694_024_0	6			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	6			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	6			Preferred Brand	2	11	1	1	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											30.07	18	18	18				26.95	15	15	15										18	18	18				15	15	15			18			18								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	024	0		29	10	S7694_024_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											59.81	44	44	44				54.29	41	41	41										44	44	44				41	41	41			44			44								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	024	0		29	10	S7694_024_0	6			Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31											597.73	25						734.35	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	025	0		29	10	S7694_025_0	6			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	6			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	6			Preferred Brand	2	11	1	1	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											30.43	18	18	18				28.17	15	15	15										18	18	18				15	15	15			18			18								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	025	0		29	10	S7694_025_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											57.39	41	41	41				61.34	38	38	38										41	41	41				38	38	38			41			41								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	025	0		29	10	S7694_025_0	6			Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31											668.68	25						731.84	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	026	0		29	10	S7694_026_0	6			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	6			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	6			Preferred Brand	2	11	1	1	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											38.46	18	18	18				35.43	15	15	15										18	18	18				15	15	15			18			18								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	026	0		29	10	S7694_026_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											75.62	37	37	37				85.50	34	34	34										37	37	37				34	34	34			37			37								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	026	0		29	10	S7694_026_0	6			Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31											752.57	25						866.45	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	027	0		29	10	S7694_027_0	6			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	6			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	6			Preferred Brand	2	11	1	1	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											33.38	18	18	18				31.65	15	15	15										18	18	18				15	15	15			18			18								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	027	0		29	10	S7694_027_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											51.12	35	35	35				52.43	32	32	32										35	35	35				32	32	32			35			35								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	027	0		29	10	S7694_027_0	6			Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31											622.71	25						732.55	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	028	0		29	10	S7694_028_0	6			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	6			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	6			Preferred Brand	2	11	1	1	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											36.25	18	18	18				34.84	15	15	15										18	18	18				15	15	15			18			18								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	028	0		29	10	S7694_028_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											70.87	39	39	39				82.71	36	36	36										39	39	39				36	36	36			39			39								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	028	0		29	10	S7694_028_0	6			Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31											633.90	25						724.40	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	029	0		29	10	S7694_029_0	6			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	6			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	6			Preferred Brand	2	11	1	1	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											30.86	18	18	18				28.18	15	15	15										18	18	18				15	15	15			18			18								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	029	0		29	10	S7694_029_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											63.92	44	44	44				67.97	41	41	41										44	44	44				41	41	41			44			44								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	029	0		29	10	S7694_029_0	6			Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31											887.01	25						835.52	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	030	0		29	10	S7694_030_0	6			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	6			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	6			Preferred Brand	2	11	1	1	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											34.33	18	18	18				33.45	15	15	15										18	18	18				15	15	15			18			18								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	030	0		29	10	S7694_030_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											68.02	43	43	43				81.19	40	40	40										43	43	43				40	40	40			43			43								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	030	0		29	10	S7694_030_0	6			Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31											732.82	25						845.43	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	031	0		29	10	S7694_031_0	6			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	6			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	6			Preferred Brand	2	11	1	1	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											32.13	18	18	18				30.76	15	15	15										18	18	18				15	15	15			18			18								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	031	0		29	10	S7694_031_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											58.97	40	40	40				62.18	37	37	37										40	40	40				37	37	37			40			40								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	031	0		29	10	S7694_031_0	6			Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31											681.67	25						738.39	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	032	0		29	10	S7694_032_0	6			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	6			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	6			Preferred Brand	2	11	1	1	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											35.05	18	18	18				33.46	15	15	15										18	18	18				15	15	15			18			18								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	032	0		29	10	S7694_032_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											64.27	37	37	37				70.59	34	34	34										37	37	37				34	34	34			37			37								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	032	0		29	10	S7694_032_0	6			Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31											684.09	25						835.70	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	033	0		29	10	S7694_033_0	6			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	6			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	6			Preferred Brand	2	11	1	1	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											35.16	18	18	18				25.98	15	15	15										18	18	18				15	15	15			18			18								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	033	0		29	10	S7694_033_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											78.96	49	49	49				59.24	46	46	46										49	49	49				46	46	46			49			49								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	033	0		29	10	S7694_033_0	6			Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31											1023.11	25						703.93	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	034	0		29	10	S7694_034_0	6			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	6			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	6			Preferred Brand	2	11	1	1	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											34.49	18	18	18				32.52	15	15	15										18	18	18				15	15	15			18			18								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	034	0		29	10	S7694_034_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											57.16	38	38	38				60.25	35	35	35										38	38	38				35	35	35			38			38								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	034	0		29	10	S7694_034_0	6			Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31											659.94	25						753.79	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	070	0		29	10	S7694_070_0	6			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	6			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	6			Preferred Brand	2	11	1	1	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											31.36	18	18	18				31.49	15	15	15										18	18	18				15	15	15			18			18								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	070	0		29	10	S7694_070_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											60.27	38	38	38				71.15	35	35	35										38	38	38				35	35	35			38			38								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	070	0		29	10	S7694_070_0	6			Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31											649.93	25						741.29	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	121	0		29	10	S7694_121_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	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	5			Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								16.00	32.00	48.00					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	5			Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					43.00	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	5			Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											86.35	50	50	50				76.25	47	47	47										50	50	50				47	47	47			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	121	0		29	10	S7694_121_0	5			Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											985.38	25						981.13	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	122	0		29	10	S7694_122_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	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	5			Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								16.00	32.00	48.00					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	5			Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					43.00	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	5			Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											98.92	50	50	50				83.72	47	47	47										50	50	50				47	47	47			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	122	0		29	10	S7694_122_0	5			Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											974.38	25						916.08	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	123	0		29	10	S7694_123_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	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	5			Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								16.00	32.00	48.00					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	5			Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					43.00	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	5			Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											75.57	50	50	50				62.79	47	47	47										50	50	50				47	47	47			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	123	0		29	10	S7694_123_0	5			Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											1193.58	25						1180.46	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	124	0		29	10	S7694_124_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	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	5			Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								16.00	32.00	48.00					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	5			Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					43.00	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	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	45	45	45				81.76	42	42	42										45	45	45				42	42	42			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	124	0		29	10	S7694_124_0	5			Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											1263.91	25						1303.95	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	125	0		29	10	S7694_125_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	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	5			Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								16.00	32.00	48.00					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	5			Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					43.00	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	5			Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											85.68	50	50	50				73.33	47	47	47										50	50	50				47	47	47			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	125	0		29	10	S7694_125_0	5			Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											1147.95	25						1209.64	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	126	0		29	10	S7694_126_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	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	5			Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								16.00	32.00	48.00					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	5			Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					43.00	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	5			Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											90.91	50	50	50				78.84	47	47	47										50	50	50				47	47	47			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	126	0		29	10	S7694_126_0	5			Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											1275.72	25						1222.86	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	127	0		29	10	S7694_127_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	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	5			Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								16.00	32.00	48.00					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	5			Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					43.00	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	5			Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											71.86	50	50	50				66.25	47	47	47										50	50	50				47	47	47			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	127	0		29	10	S7694_127_0	5			Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											915.81	25						1000.58	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	128	0		29	10	S7694_128_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	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	5			Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								16.00	32.00	48.00					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	5			Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					43.00	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	5			Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											82.23	50	50	50				72.97	47	47	47										50	50	50				47	47	47			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	128	0		29	10	S7694_128_0	5			Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											1108.37	25						1039.18	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	129	0		29	10	S7694_129_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	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	5			Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								16.00	32.00	48.00					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	5			Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					43.00	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	5			Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											84.25	50	50	50				68.52	47	47	47										50	50	50				47	47	47			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	129	0		29	10	S7694_129_0	5			Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											960.20	25						988.52	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	130	0		29	10	S7694_130_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	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	5			Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								16.00	32.00	48.00					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	5			Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					43.00	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	5			Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											58.04	50	50	50				52.32	47	47	47										50	50	50				47	47	47			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	130	0		29	10	S7694_130_0	5			Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											919.99	25						958.28	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	131	0		29	10	S7694_131_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	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	5			Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								16.00	32.00	48.00					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	5			Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					43.00	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	5			Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											81.80	50	50	50				68.69	47	47	47										50	50	50				47	47	47			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	131	0		29	10	S7694_131_0	5			Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											1095.67	25						1041.26	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	132	0		29	10	S7694_132_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	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	5			Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								16.00	32.00	48.00					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	5			Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					43.00	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	5			Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											90.33	50	50	50				76.79	47	47	47										50	50	50				47	47	47			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	132	0		29	10	S7694_132_0	5			Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											1291.79	25						1264.79	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	133	0		29	10	S7694_133_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	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	5			Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								16.00	32.00	48.00					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	5			Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					43.00	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	5			Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											63.24	50	50	50				60.06	47	47	47										50	50	50				47	47	47			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	133	0		29	10	S7694_133_0	5			Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											1198.32	25						1097.86	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	134	0		29	10	S7694_134_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	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	5			Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								16.00	32.00	48.00					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	5			Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					43.00	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	5			Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											65.49	50	50	50				61.05	47	47	47										50	50	50				47	47	47			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	134	0		29	10	S7694_134_0	5			Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											1195.12	25						1107.11	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	135	0		29	10	S7694_135_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	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	5			Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								16.00	32.00	48.00					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	5			Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					43.00	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	5			Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											74.56	50	50	50				66.66	47	47	47										50	50	50				47	47	47			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	135	0		29	10	S7694_135_0	5			Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											974.58	25						870.88	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	136	0		29	10	S7694_136_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	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	5			Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								16.00	32.00	48.00					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	5			Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					43.00	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	5			Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											89.10	50	50	50				74.13	47	47	47										50	50	50				47	47	47			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	136	0		29	10	S7694_136_0	5			Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											1254.00	25						1253.01	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	137	0		29	10	S7694_137_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	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	5			Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								16.00	32.00	48.00					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	5			Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					43.00	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	5			Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											99.96	49	49	49				77.91	46	46	46										49	49	49				46	46	46			49			49								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	137	0		29	10	S7694_137_0	5			Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											920.61	25						902.43	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												
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												
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												
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	47	47	47				86.29	47	47	47				47	47	47															47			47								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
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												28							28						28																	28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S8067	003	0		29	10	S8067_003_0	1		Y	Preferred Generic	4	01	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												
S8067	003	0		29	10	S8067_003_0	1		Y	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								20.00	40.00	60.00					10.00	20.00	30.00					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												
S8067	003	0		29	10	S8067_003_0	1		Y	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								45.00	90.00	135.00					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												
S8067	003	0		29	10	S8067_003_0	1		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								95.00	190.00	285.00					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												
S8067	003	0		29	10	S8067_003_0	1		Y	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S8182	001	0		29	10	S8182_001_0	3			Preferred Generic	3	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								2.00	4.00	6.00					0.00	0.00	0.00					0.00	0.00	0.00																2.00				2.00			0.07	0.00	0.00			0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S8182	001	0		29	10	S8182_001_0	3			Generic	3	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								3.00	6.00	9.00					1.00	2.00	3.00					1.00	2.00	3.00																3.00				3.00			0.10	0.03	0.03			0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S8182	001	0		29	10	S8182_001_0	3			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					40.00	80.00	120.00					40.00	80.00	120.00																41.00				41.00			1.37	1.33	1.33			1.21	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S8182	001	0		29	10	S8182_001_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											88.46	41	41	41				86.31	40	40	40				40	40	40															41			41								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S8182	001	0		29	10	S8182_001_0	3			Specialty Tier	3	11	1	1	5	1		010	01	010		1				30					30						30		34												25							25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
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								3.00	6.00	9.00					1.00	2.00	3.00					1.00	2.00	3.00																3.00				3.00			0.10	0.03	0.03			0.09	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								5.00	10.00	15.00					3.00	6.00	9.00					3.00	6.00	9.00																5.00				5.00			0.17	0.10	0.10			0.15	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S8182	003	0		29	10	S8182_003_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					43.00	86.00	129.00					43.00	86.00	129.00																44.00				44.00			1.47	1.43	1.43			1.29	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											89.70	42	42	42				89.70	42	42	42				42	42	42															42			42								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	3		Y	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	3		Y	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					4.00	8.00	12.00					4.00	8.00	12.00																20.00				20.00			0.67	0.13	0.13			0.59	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S8182	005	0		29	10	S8182_005_0	3		Y	Preferred Brand	4	11	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	3		Y	Non-Preferred Drug	4	11	1	1	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34											75.27	50	50	50				75.27	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	3		Y	Specialty Tier	4	11	1	1	5	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		Y	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		Y	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					4.00	8.00	12.00					4.00	8.00	12.00																20.00				20.00			0.67	0.13	0.13			0.59	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S8182	006	0		29	10	S8182_006_0	4		Y	Preferred Brand	4	11	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		Y	Non-Preferred Drug	4	11	1	1	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34											77.96	50	50	50				77.96	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		Y	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
